Individualized Education Program

Transcription

1 Individualized Education Program Date: Type: 45 Day Trial Out Amendment Student: Birthdate: Gender: Grade: Resident District: Attending District: Area Education Agency: Teacher/Service Provider: Building: Attending Building Phone: Relationship: Student lives at this address: Name: Address: Home: Cell: Work: City, ST Zip: Relationship: Student lives at this address: Name: Address: Home: Cell: Work: City, ST Zip: Duration of this IEP: From to Reevaluation is due: Procedural safeguards were reviewed by: Rights will transfer at age 18: Notification: Student: Parent: Method: Persons Present at Meeting/Position or Relationship to Student: (Listing indicates presence at the meeting, not approval or acceptance of the IEP) Outside written input: Name/Agency: Date: Parental agreement to amend without a meeting: Person who contacted parent: Method of contact: Date of agreement: Copies to: A Copies: School, AEA, Parent(s)

2 Present Levels of Academic Achievement and Functional Performance Strengths, (continued from interests previous page) and preferences of the individual. Parents' (continued concerns from previous regarding page) their child's education. The IEP team must consider the following when developing this IEP: Behavior (in the case of a student whose behavior impedes his or her learning or that of others, consider the use of positive behavioral interventions, supports, and other strategies to address that behavior) Yes, behavior is a concern and will be addressed in this IEP. Yes, behavior is a concern and will be addressed in the attached Functional Behavioral Assessment and Behavior Intervention Plan. No, behavior is not a concern. Limited English proficiency (consider the language needs related to the IEP) Yes, limited English is a concern and will be addressed in this IEP No, limited English is not a concern Communication and language, especially if the student is deaf or hard of hearing. Yes, communication and language are a concern and will be addressed in this IEP. Yes, communication and language are a concern and will be addressed in the attached Communication Plan for Deaf and Hard of Hearing. No, communication and language are not a concern. Braille instruction needs if this student has a visual impairment Yes, Braille is needed and will be addressed in this IEP No, Braille is not needed Health Needs (intervention, procedures, or services required in order to access education) Yes, health is a concern and will be addressed in this IEP. Yes, health is a concern and will be addressed in the Health Plan as a part of the student's health records. No, health is not a concern. Assistive Technology (services, software, and devices needed to access the general education curriculum) Yes, assistive technology is needed and will be addressed in this IEP. No, assistive technology is not needed This student requires accessible instructional materials (AIM): Transition assessments and other information essential for the development of this IEP (address living, learning & working): Living: (continued Information from previous Sources: page) Living: Results: B (Students ages 13-21) Copies: School, AEA, Parent(s)

3 Learning: (continued from Information previous page) Sources: Learning: Results: Working: (continued Information from previous page) Sources: Working: Results: Other (continued information from previous essential page) for the development of this IEP Describe the effect of this individual's disability on involvement and progress in the general education curriculum (continued from and previous the functional page) implications of the student's skills. Based on the transition assessments, describe the post-secondary expectations for living, learning, and working. Post-secondary (continued from previous expectation page) for living: Is living an area of need that will be addressed with goals, services or activities in this IEP? Post-secondary (continued from previous expectation page) for learning: Is learning an area of need that will be addressed with goals, services or activities in this IEP? Post-secondary (continued from previous expectation page) for working: Is working an area of need that will be addressed with goals, services or activities in this IEP? Course of study What (continued requirements from previous does page) this student need to meet to graduate? B (Students ages 13-21) Copies: School, AEA, Parent(s)

4 What (continued is this from student's previous page) current status with regard to these requirements? Target graduation date (mo/yr): Courses and activities needed to pursue the post secondary expectations and graduate by the target graduation date? B (Students ages 13-21) Copies: School, AEA, Parent(s)

5 Goal No: Goal Area: Domain: Current Academic Achievement and Functional Performance (Results of the initial or most recent evaluation and results on district-wide assessments relevant to this goal; performance in comparison to general education peers (continued and from standards.) previous page) Baseline (Describe individual's current performance in measurable terms using the same measurement as measurable (continued from annual previous goal page) and progress monitoring procedures.) Measurable Annual Goal: conditions (when and how the individual will perform); behavior (what the individual will (continued do); and from criterion previous page) (acceptable level of performance). Progress Monitoring procedures (State how progress toward meeting this goal will be measured, how often progress (continued will from previous be measured, page) and the decision making rule that will be used in considering instructional changes.) Position(s) responsible for services: See attached graph (table continued Major Milestones from previous or Short page) Term Objectives/Dates Expected (Required Major for Milestones students assessed or Short against Term Objectives/Dates alternate achievement Expected standards) (Required for students assessed against alternate achievement standards) Comments/Progress Notes/Dates Achieved Comments/Progress Notes/Dates Achieved Goal #: Progress Report 1 = This goal has been met. 2 = Progress has been made towards the goal. It appears that the goal will be met by the time the IEP is reviewed. 3 = Progress has been made towards the goal but the goal may not be met by the time the IEP is reviewed. 4 = Progress is not sufficient to meet this goal by the time the IEP is reviewed. Instructional strategies will be changed. 5 = Your child did not work on this goal during this reporting period (provide an explanation to the parents). (table continued from previous page) D Copies: School, AEA, Parent(s)

6 Special Education Services Special education services, activities and supports are provided in order for an individual: 1) to make progress towards reaching IEP goals; 2) to be involved in and progress in the general curriculum; 3) to be educated and participate with peers; 4) to participate in extracurricular and nonacademic activities; and 5) by age 14, to pursue post-high school living, learning & working outcomes. Minutes in School Day: Total minutes removed from general education per month: LRE: Removal from General Education: % plus Time in General Education: % = 100% EC Code: Regular EC program min./month: Special Ed. program min./month: Describe each service Begin Date: End Date: Provider: Minutes Per: In General Education Setting: In Special Education Setting: Describe each service Service Code: Begin Date: End Date: Provider: Minutes Per: In General Education Setting: In Special Education Setting: Describe each service Service Code: Begin Date: End Date: Provider: Minutes Per: In General Education Setting: In Special Education Setting: Describe each service Service Code: Describe each activity or support Begin Date: Provider: Time and frequency provided: Describe each activity or support Category: Begin Date: Provider: Time and frequency provided: Describe each activity or support Category: Begin Date: Provider: Time and frequency provided: Describe each activity or support Category:

7 Service: Service: Service: Future Services Future Services Future Services Future Services F Copies: School, AEA, Parent(s)

8 Special Education Services, continued Are extended school year (ESY) services required? If yes, specify the goals that require ESY services and describe the services. If no because ESY needs cannot (continued be from determined previous page) at this time, specify when ESY consideration will occur. Are specialized transportation services required that are related to the disability? If yes, describe. Special route (outside normal attendance area or transportation not typically provided based on distance from school) Attendant services Specially equipped vehicle Other: Physical (continued Education: from previous page) General Modified describe below Specially designed requires goal(s) Will this student participate in district-wide assessments (DWA)?, not yet school-age No, student is incarcerated in an adult correctional facility If yes, indicate how this individual will participate in district-wide assessments for Annual Yearly Progress (AYP) in: Reading: Standard assessment (Iowa Assessments) Iowa Alternate Assessment Math: Standard assessment (Iowa Assessments) Iowa Alternate Assessment Science: Standard assessment (Iowa Assessments) Iowa Alternate Assessment The standard assessment will be given: with accommodations without accommodations If with accommodations, describe accommodations necessary to measure academic achievement and functional (continued from performance: previous page) If this student will participate in the Iowa Alternate Assessment: Why can't the individual participate in the general (continued assessment? from previous page) Why (continued is this from alternate previous page) assessment appropriate for this student? Non-AYP district-wide assessments will be given: With Accommodations Without Accommodations Through an Alternate Assessment G Copies: School and AEA

9 If with accommodations, describe accommodations necessary to measure academic achievement and functional (continued from performance: previous page) Additional Considerations Will this individual receive all special education services in general education environments? If no, explain: Will this individual participate in nonacademic activities with nondisabled peers and have the same opportunity to participate in extracurricular activities as nondisabled peers? If no, explain: Will this individual attend the school he or she would attend if nondisabled? If no, explain: Will this individual attend a special school? If yes, attach responses to the special school questions. Progress reports Parents: You will be informed of your child's IEP progress An IEP report with report cards and progress reports Other: times per year. You will receive: Updated copies of the IEP goal pages G Copies: School and AEA