IEP+Draft

=IEP Draft=

This pages would be a good place to start drafting an IEP. I have samples of IEPs in my classroom that I can remove names from, scan, and share if needed.

=**School-Age**= =**Individualized Education Program (IEP)**= School District Street Address City, State, And Zip Code Telephone Number = =
 * **Student Name:** Samuel || **Date of Birth:** 06 / 22 / 2001 **Age:**  8 ||


 * **Disability Classification: Down's Syndrome** ||


 * **Street:**


 * City:** Courtland, NY


 * Zip:** || **Telephone:**


 * County of Residence:**


 * Male** ||
 * **Student ID#:**


 * Current Instructional Grade/Grade Equivalent:** Third Grade


 * Racial/Ethnic Group of Student:** || **Native Language of Student:** English


 * Interpreter for Student Needed:** **No**
 * If yes, specify language:** ||
 * **Medical Alerts:** || **Surrogate Parent Needed:** **No** ||


 * **Other Information:** ||


 * **Date of initial referral:**


 * Date initial consent for evaluation received:** / /


 * Date of IEP meeting to determine initial eligibility****:** / / ||


 * **Date of Committee on Special Education (CSE) Meeting to Develop this IEP:** / /

**Initial** **Requested Review** **Annual Review** **Reevaluation** _
 * Type of Meeting:**

__**Date IEP is to be Implemented:** / /


 * Projected Date of Next Review:**


 * Projected Date of Reevaluation Meeting:** / / __ ||  ||

â **the results of the initial or most recent evaluation, the student’s strengths, the concerns of the parents, the results of the student’s performance on any State or districtwide assessment programs;** â **the student’s needs related to communication, behavior, use of Braille, assistive technology, limited English proficiency;** â **how the student’s disability affects involvement and progress in the general education curriculum; and** â **the student’s needs as they relate to transition from school to post-school activities for students beginning with the first IEP to be in effect when the student turns age 15 (and younger if deemed appropriate).** ||
 * **Present Levels of Academic Achievement, Functional Performance and Individual Needs** ||
 * **Current functioning and individual needs in consideration of:**


 * Transcript Information – Secondary Students Only ||
 * Diploma Credits Earned: || Expected Date of High School Completion: / / Projected # years to graduate : ||
 * Commencement-level State Tests Passed: || **Expected Diploma:** ||

At Samuel's current level of competency inclusion seems challenging. Normal activities with the class can continue included with one on one sessions with the therapist when necessary. He needs to practice his cursive in class and at home. Daily writing samples will be analyzed and compared with previous offerings. The teacher will have updates ready for parents and the rest of the IEP team on a weekly basis.
 * **Academic Achievement, Functional Performance and Learning Characteristics:** ||
 * **Current levels of knowledge and development in subject and skill areas, including activities of daily living, level of intellectual functioning, adaptive behavior, expected rate of progress in acquiring skills and information and learning style.** ||
 * || ||   ||

His down syndrome does not hinder him from interacting with the rest of his class. Close friends can help Samuel as they work together on class assignments. Levels of Universal design can be included with a low tech device for all students. Personal Dry erase can be used to practice writing in cursive for the class. This addition will allow him to feel welcomed in the group.
 * **Social Development:** ||
 * **The degree and quality of the student’s relationships with peers and adults, feelings about self and social adjustment to school and community environments.** ||

Over the years Samuel has had trouble with his motor skills coordination and development. His occupational therapist will work with him during private therapy sessions at school, while his parents will help him at home. At time he will drop his writing utensils in class. A regular pen or pencil may be too thin to grip. For now he should use a thicker pen, one with a cover or adding rubberized grips to writing devices.
 * **Physical Development:** ||
 * **The degree or quality of the student’s motor and sensory development, health, vitality and physical skills or limitations that pertain to the learning process.** ||

Children should have a plastic shoebox with their required class items. Samuel should feel included with the lessons and activities by having special items in his box and keeping with the manner of universal design. Charts around the room will direct the students to their daily tasks and requirements. Samuel will learn to depend on his teacher for direction on the work as they go through the lesson. As needed Samuel can meet with his therapist to practice his writing and speaking. The teacher and therapist should meet to discuss his work and any adaptations that can be made. For example and oral report can be read with screen reading software from a computer through a typed report.
 * **Management Needs:** ||
 * **The nature of and degree to which environmental modifications and human or material resources are required to enable the student to benefit from instruction. Management needs are determined in accordance with the factors identified in the areas of academic achievement, functional performance and learning characteristics, social development and physical development.** ||

For students beginning with the first IEP to be in effect when the student turns age 15 (and younger if deemed appropriate), identify the appropriate measurable postsecondary goals based upon age appropriate transition assessments relating to training, education, employment and, when appropriate, independent living skills. ||
 * **Measurable Post-Secondary Goals (Ages 15 and Older)**
 * **Training:** ||
 * **Education:** ||
 * **Employment:** ||
 * **Independent Living Skills (when appropriate):** ||

* For students with severe disabilities who would meet the eligibility criteria to take the New York State Alternate Assessment, the IEP must also include short-term instructional objectives and benchmarks for each annual goal. ||
 * **Measurable Annual Goals**
 * **Annual Goal:** What the student will be expected to be able to do by the end of the year in which the IEP is in effect.
 * Evaluative Criteria:** How well and over what period of time the student must demonstrate performance in order to consider the annual goal to have been met.
 * Procedures to Evaluate Goal:** The method that will be used to measure progress and determine if the student has met the annual goal.
 * Evaluation Schedule:** The dates or intervals of time by which evaluation procedures will be used to measure the student’s progress. ||

- Verbally Identify Main Character and setting in a story read aloud - Observation of proper use of inflection. IE proper use of pronunciation and punctuation - Develop a volume of 500 regular and irregular site words ||  ||
 * **Annual READING Goal****:** Samuel will have the ability to read a variety of materials and text with fluency and comprehension ||
 * **Evaluative Criteria:** 80% Accuracy ||  ||
 * **Procedures to Evaluate Goal:**
 * **Evaluation Schedule:** Quarterly ||  ||

- Weekly Spelling Test - Weekly reading and comprehension of online passages through the use a computer ||  ||
 * **Annual READING Goal****:** Samuel will have the ability to communicate effectively through the use of oral and computer technology ||
 * **Evaluative Criteria:** 80% Accuracy ||  ||
 * **Procedures to Evaluate Goal:**
 * **Evaluation Schedule:** Monthly Evaluation ||  ||

Portfolio will be reviewed at the end of the semester to see if additional modifications are necessary. ||  ||
 * **Annual CURSIVE Goal:** Sam will be able to write upper/lower case letters of the alphabet in cursive. ||
 * **Evaluative Criteria:** Sam will be able to write both upper/lower case letters with 80% accuracy in cursive by the end of the first semester. ||  ||
 * **Procedures to Evaluate Goal:** Sam will practice basic hand eye coordination skills using a fat pencil, three times a week for 50 minutes with his special ed teacher. Writing samples will be taken as part of a portfolio at the beginning, middle and end of the semester use as a progress indicator. ||  ||
 * **Evaluation Schedule:**

During the second semester, based on the progress made in the first semester. Sam will begin joining letters to form words in cursive. Sam will continue working with his special ed teacher for 50 minutes to practice writing words in cursive. Sam is expected to write short words with 80% accuracy with correct spacing. ||  || A portfolio of Sam’s writing will be taken at the beginning, middle and end of the second semester to record his progress. ||  ||
 * **Annual CURSIVE Goal:** Sam will be able to write words in cursive independantly with the correct spacing and orientation to the line. ||
 * **Evaluative Criteria:**
 * **Procedures to Evaluate Goal:**
 * **Evaluation Schedule:** Portfolio will be reviewed at the end of the semester to see if any modifications are necessary. ||  ||


 * **Annual SPEAKING Goal:** Samuel will be able to speak effectively and on his current grade level by pronouncing words and phrases correctly. ||
 * **Evaluative Criteria:** Samuel will be able to pronounce provided vocabulary with 90% accuracy. ||  ||
 * **Procedures to Evaluate Goal:** Each week Samuel will be given 25 terms/phrases. The terms will be recorded on the provided digital voice recorder. Samuel will practice reciting the terms/phrases for a minimum of 1 hour per day. He will be given an oral exam bi-monthly where his is expected to pass with 90% accuracy. ||  ||
 * **Evaluation Schedule:** Samuel's progress will be reviewed at the end of each semester to determine if he is ready to advance to the next grade level's vocabulary. ||  ||


 * **Annual SPEAKING Goal:** Samuel will advance his speech skills by two grade levels through the use of computer technology software. ||
 * **Evaluative Criteria:** Samuel will recite vocabulary from Hooked on Phonics LEARN TO READ tutorials with 100% accuracy. ||  ||
 * **Procedures to Evaluate Goal:** Samuel will practice saying words on the tutorial for one hour each day. He will be given an oral exam at the end of each week. It is expected that he is able to pronounce the vocabulary covered in the tutorials with 100% accuracy. ||  ||
 * **Evaluation Schedule:** After the completion of each semester, Samuel's teacher will determine whether to advance him to the next grade level's tutorial. ||  ||

Procedures to Evaluate Goal: · Sam will practice reading into a tape recorder. · His speech therapist will work with him on slowing down his rate of speech and reading with more expression · Once a good tape as been recorded it will be submitted to his teacher for review.
 * Annual LANGUAGE goal: Sam will be able to read orally in class where fellow classmates and teacher can understand.**
 * Evaluative Criteria: Through a tape submitted to his teacher and then demonstration in class by the end of the first two semesters of the year he will be able to read orally more comfortably than he did before and will be able to demonstrate a slowed down rate of speech and reading with more expression.**


 * (Add additional annual goals as appropriate)**


 * **Recommended Special Education Programs and Services** ||


 * Special Education Program/Services ||
 * || **Frequency** || **Duration** || **Location** || **Initiation Date** ||
 * Occupational Therapy || Weekly || 1 hour || School/home || / / ||


 * Related Services ||
 * || **Frequency** || **Duration** || **Location** || **Initiation Date** ||
 * Therapist/Physician || Daily || 1 hour || School/home || / / ||
 * Therapist/Speech || Weekly || 2 hours || School/home || / / ||
 * Psychologocal Services || Monthly || 1 hour || Office || / / ||
 * Assistive Technology instructor || Monthly || 1 hour || School/home || / / ||
 * Counselor || As needed || As needed || School || / / ||


 * Program Modifications/Accommodations/Supplementary Aids and Services ||
 * || **Frequency** || **Duration** || **Location** || **Initiation Date** ||
 * Manuscript style of writing || Daily || As needed || School/home || / / ||
 * Shorter time for assignments || Daily || As needed || School/home || / / ||
 * Paraprofessional/Special Ed Instructor || Weekly || 1 1/2 hours || School || / / ||


 * Assistive Technology Devices/Services ||
 * || **Frequency** || **Duration** || **Location** || **Initiation Date** ||
 * Intellikeys || Weekly || As needed || School/home || / / ||
 * Dry Erase Board with markers || Daily || As needed || School/home || / / ||
 * Foam grips/tether || Daily || As needed || School/home || / / ||
 * Netbook || Weekly || As needed || School/home || / / ||
 * Tape recorder for oral reading || As needed || As needed || School/home || / / ||
 * Screen Reader to assist with letter comprehension || As needed || As needed || School/home || / / ||


 * Supports for School Personnel On Behalf of Student ||
 * || **Frequency** || **Duration** || **Location** || **Initiation Date** ||
 * IEP meetings || Monthly || 1 1/2 hours || School || / / ||


 * **Special Transportation Needs:**

**None**

**Student has special transportation needs as recommended below:**
 * Special seating - Specify:** **Close proximity of teacher or para.**
 * Vehicle and/or equipment needs - Specify:**
 * Adult Supervision - Specify:** **Specialized meetings with AT instructor, Counselor, etc.**
 * Type of transportation Specify:**
 * Other Accommodations – Specify:** ||


 * **Other:** ||

· **in the student’s education program,** · **in the administration of districtwide assessments of student achievement, consistent with school district policy, and** · **in the administration of State assessments of student achievement, consistent with State Education Department policy.** ||
 * =**Testing Accommodations:**=
 * The following individual appropriate accommodations are necessary to measure the academic achievement and functional performance of the student on State and districtwide assessments. Recommended testing accommodations will be used consistently:**
 * Testing Accommodation || **Conditions** || **Specifications** ||
 * Extended Time || On the reading and writing sections || As permissible by test regulations ||
 * Alternative Testing Setting ||  || Individual or small group ||
 * Oral Presentation/Reading Assistance || On the reading and writing sections || As permissible by test regulations ||
 * Alternative Scheduling or Chunking of Tests || Only for Reading and Writing Sections || As permissible by test regulations ||
 * Testing Scribe || For Writing Sections || As permissible by test regulations ||
 * Use of Highlighter || On the reading and writing sections || For sections that involve reading ||
 * Use of a computer with an adaptive keyboard || If not using a live scribe/a live scribe is not available || For writing sections ||


 * **Participation in State Assessments**

**The student will participate in the same State assessments that are administered to general education students.**

X **Graded: The student will take the State assessment with his/her grade level peers.** With the above modifications the student should be able to work at or near grade level. His current data does not support the required three year deficit to exempt him from the State assessments.

**Ungraded: The student will take the State assessment based on chronological age because his/her instructional levels in English and mathematics are three or more years below the grade-level coursework of the student’s nondisabled peers.** ||


 * **Participation in Districtwide Assessments**

X **The student will participate in the same districtwide assessments that are administered to general education students.** With the above modifications the student should be able to work at or near grade level.


 * The student will participate in alternate assessments for districtwide assessments when deemed necessary.**


 * The IEP Team will explain why the districtwide assessment(s) administered to general education students is not appropriate for the student and why the alternate assessment selected is appropriate for the student. Consent from district administration must be given before the student can take alternative assessments.** ||


 * **Removal from the general educational environment** **occurs only when the nature or severity of the disability is such that, even with the use of supplementary aids and services, education cannot be satisfactorily achieved.**

Explanation of the extent, if any, to which the student will not participate in general education programs, including extra curricular and other nonacademic activities: Sam will not be in general education reading and/or language arts classes. During these classes he should be in a class for learners with disabilities where he may receive the extra help he needs to work on his writing and oral reading skills. Sam will participate in all other general education classes, with testing modifications when applicable. Sam's teachers should also be aware of his progress with his oral reading skills and work with him when possible to practice, for example when the class is reading aloud, be sure to give Sam a shorter section to read so that he may get practice, yet not be overwhelmed.

__**Language other than English exemption**__

X **__Yes, the student’s disability adversely affects the ability to learn a language, and the student is excused from the language other than English requirement.__** ||


 * **Coordinated Set of Transition Activities (School to Post School)** ||
 * â **For students beginning with the first IEP to be in effect when the student turns age 15 (and younger if deemed appropriate) needed transition services/activities to facilitate the student’s movement from school to post-school activities.** ||
 * Coordinated Set of Transition Activities || **Activity** || **School District/Agency Responsible** || **Date** ||
 * **Instruction** ||  ||   || / / ||
 * **Related Services** ||  ||   || / / ||
 * **Development of Employment/Other Post-School Adult Living Objectives** ||  ||   || / / ||
 * **Community Experience** ||  ||   || / / ||
 * **Acquisition of Daily Living Skills** ||  ||   || / / ||
 * Functional Vocational Assessment ||  ||   || / / ||


 * **Placement Recommendation** ||
 * **10 Month Placement:** ||


 * **Extended School Year Eligible:** **Yes** **No**

If yes: Provider: || Projected dates of services: / / to / /

Site: __ ||


 * **Reporting Progress to Parents** ||
 * **Identify when periodic reports on the progress the student is making toward meeting the annual goals will be provided to the student’s parents:** ||


 * **Recommendations Upon Declassification** ||


 * Date Declassified:**


 * IEP recommendations to continue upon declassification**** : **
 * Testing Accommodations || **Conditions** || **Specifications** ||
 * **Continued Eligibility for Local Diploma (“Safety Net”): Yes** **No**
 * **Continued Eligibility for Local Diploma (“Safety Net”): Yes** **No**
 * **Continued Eligibility for Local Diploma (“Safety Net”): Yes** **No**
 * **Continued Eligibility for Local Diploma (“Safety Net”): Yes** **No**


 * Continued “Language Other Than English” Exemption: Yes** **No** ||


 * Declassification Support Services to be provided during the first year that a student moves from a special education program to a full-time general education program. ||
 * Service || **Initiation Date** || Frequency || **Duration** || **Ending Date** ||


 * =====Parent Information===== ||
 * **Student’s Name:** ||
 * **Mother’s/Guardian’s Name:**


 * Street:**


 * City:**


 * Zip:** || **Telephone:**


 * County of Residence:**


 * Native Language of Parent/Guardian:**


 * Interpreter Needed for Meeting: Yes** **No** ||
 * **Father’s/Guardian’s Name:**


 * Street:**


 * City:**


 * Zip:** || **Telephone:**


 * County of Residence:**


 * Native Language of Parent/Guardian:**


 * Interpreter Needed for Meeting: Yes** **No** ||
 * **Surrogate Parent Needed**


 * Surrogate Parent’s Name:**


 * Street:**


 * City:**


 * Zip:** || **Date Appointed:** / /


 * Telephone:**


 * Native Language of Surrogate Parent:**


 * Interpreter Needed for Meeting: Yes** **No** ||

Committee Participants
**CSE** **Subcommittee**


 * **//Name//** || **//Professional Title//** || **//Committee Member Role [1] //** ||
 * Carrie Pedregosa || Foreign Language Teacher || General Education Teacher ||
 * Sharon Phillips ||  ||   ||
 * Denville Pieters ||  ||   ||
 * Anson Pope ||  ||   ||
 * Melissa Robin || Applied Tech Teacher || General Education Teacher ||
 * Phenesha Sanders ||  ||   ||
 * Shannon Shotwell ||  ||   ||
 * Duane Taffe ||  ||   ||


 * Supplemental Page for Additional Annual Goals **


 * **Annual Goal****:** ||
 * **Evaluative Criteria:** ||  ||
 * **Procedures to Evaluate Goal:** ||  ||
 * **Evaluation Schedule:** ||  ||


 * **Annual Goal****:** ||
 * **Evaluative Criteria:** ||  ||
 * **Procedures to Evaluate Goal:** ||  ||
 * **Evaluation Schedule:** ||  ||


 * **Annual Goal****:** ||
 * **Evaluative Criteria:** ||  ||
 * **Procedures to Evaluate Goal:** ||  ||
 * **Evaluation Schedule:** ||  ||

*** Duplicate as Necessary***** SUPPLEMENTAL PAGE IF INCLUDING SHORT-TERM INSTRUCTIONAL OBJECTIVES AND BENCHMARKS FOR EACH ANNUAL GOAL***
 * **Annual Goal****:** ||
 * **Evaluative Criteria:** ||  ||
 * **Procedures to Evaluate Goal:** ||  ||
 * **Evaluation Schedule:** ||  ||

* NOTE: Federal and State law and regulations require short-term instructional objectives and benchmarks in ieps only for students with severe disabilities who would meet the eligibility criteria to take the New York State Alternate Assessment and for all preschool students with disabilities.


 * **Annual Goal****:** ||  ||
 * **Evaluative Criteria:** ||  ||   ||
 * **Procedures to Evaluate Goal:** ||  ||   ||
 * **Evaluation Schedule:** ||  ||   ||
 * **Instructional Objectives or Benchmarks:** ||  ||


 * **Annual Goal****:** ||  ||
 * **Evaluative Criteria:** ||  ||   ||
 * **Procedures to Evaluate Goal:** ||  ||   ||
 * **Evaluation Schedule:** ||  ||   ||
 * **Instructional Objectives or Benchmarks:** ||  ||

***DUPLICATE AS NECESSARY***

[1] If the parent or another CSE member participated (with parent and school district agreement) through alternative means, indicate the manner in which he or she participated (e.g., video or telephone conference calls).