SAMPLE INDIVIDUAL EDUCATION PLAN
Reason for Development of IEP
X
Student identified as exceptional by IPRC
Student not formally identified but requires special education program/services including modified/alternative
learning expectations and/or accommodations
Name:
Bob Thorton
School:
Bishop Elementary
Student ID#:
985732
Current Grade/Special Class:
Most Recent IPRC Date:
Exceptionality:
Gender:
Male
Principal:
Mr. Strict
Grade 4
Dec. 5, 2010
Date of Birth:
School Year:
March 19, 2001
2010 - 2011
Date Annual Review Waived by Parent:
Behaviour
IPRC Placement Decision: (check one)
Regular Class With Indirect Support
Regular Class With Resource Assistance
Regular Class With Withdrawal Assistance
X Special Education Class With Partial Integration
Special Education Class Full Time
Assessment Data:
List relevant educational, detailed medical/health (hearing, vision, physical, neurological) psychological,
speech/language, occupational, physiotherapy, and behavioural assessments.
Information Source
WISC-IV
Date
Nov. 15, 2012
Wide Range Achievement
Test Fourth Edition
Bender-Gestalt
Nov. 15, 2012
Nov. 15, 2012
Areas of Strength
- kinesthetic learner
- reading
- articulate
- one-on-one-learning
Summary of Results
Below average for oral arithmetic, and high score on
comprehension
below average for arithmetic and spelling, but above average
reading level
problems with fine motor precision, age norm is 8.5 years
Areas of Need
- visual memory processes
- oral arithmetic
- self-regulation
- coping techniques
- following directions
- dealing with consequences appropriately
Specialized Health Support Services/Personal Support Required
Yes (List Below) X No
Student’s Strengths and Needs: Subjects, courses, or alternative programs to which the IEP applies: Identify each
as Modified (MOD), Accommodated only (AC), or Alternative (ALT)
1.
Math
MOD
X AC
ALT
6.
MOD
AC
ALT
2.
Language Arts
MOD
3.
Behavour
MOD
X AC
ALT
7.
MOD
AC
ALT
AC
X ALT
8.
MOD
AC
ALT
4.
MOD
AC
ALT
9
MOD
AC
ALT
5.
MOD
AC
ALT
10.
MOD
AC
ALT
Elementary Program Exemptions or Secondary School Compulsory Course Substitutions
Yes (Education rationale required)
X
No
Student is currently working toward the attainment of a:
Ontario Secondary School Diploma
Ontario Secondary School Certificate
Certificate of Accomplishment
Accommodations:
(Assume common to all subjects unless indicated)
Instructional Accommodations
- frequent breaks
- reinforcement incentives
- use of manipulatives
- high structure
- non-verbal signals
- extra time
Environmental Accommodations
- computer
- cool down area
Accommodation and Exemptions for Provincial Assessments:
Accommodations:
Exemptions:
Yes (List Below)
No
Yes (State educational rationale)
No
Assessment Accommodations
- extra time
- use of manipulatives
- use of computer to complete tests
and assignments
Special Education Program
To be completed for each subject/course with modified expectations
and/or alternative expectations.
Student ID#: 985732
SUBJECT/COURSE/ALTERNATIVE PROGRAM: Behaviour
Current Level of Achievement:
Current Level of Achievement for Alternative Program:
(Describes starting point for plan development) Bob is able to accept consequences for inappropriate behaviour
Letter Grade/Mark
when frustrated or angered appropriately 1 out of 10 times. He is
Curriculum Grade Level
compliant in 2 out of 10 situations.
Annual Program Goal(s): A goal statement describes what a student can reasonably be expected to accomplish by the
end of the school year in a particular subject, course or alternative program.
By the end of June, Bob will be able to accept consequences for inappropriate behaviour when frustrated or angered 5 out of 10
times. He will be compliant in 6 out of 10 situations.
Learning Expectations
(Knowledge and/or skills to be assessed by
reporting period, including Grade level)
Term 1
- be able to identify and self-regulate
frustration and anger when it occurs
- be able to identify the importance of
honesty, and to be honest in interactions
with others
- be able to recognize and remember other
people’s personal space
Teaching Strategies
(List only those that are different for this
student and specific to the learning
expectations for the subject/course/alternative
program)
Assessment Methods
(For expectations for each reporting period)
- breathing techniques and calming
strategies
- reward chart for appropriate behaviour
- role play truth-telling scenarios
- reward chart for appropriate behaviour
- have Bob make hands-off posters
- observation that his posters show
appropriate behaviour
- be able to recognize the value of other
- have Bob write a letter explaining how
people’s property, and to only handle what he would feel if someone stole from him
belongs to others with their permission
- be able to following directions when given - one-to-one instruction
- be able to recognize when behaviour
- have Bob participate in an anti-bullying
towards other students is inappropriate,
campaign
and to change that behaviour
- checklist with success criteria
- observation
- conference with Bob after campaign to
see if his stance on his bullying others
has changed
IEP Developed by:
Staff Member
Mr. Strict
Mr. Oats
Mr. Garrison
Sources Consulted in the Development of the IEP:
(check)
Position
Principal
Special Education Teacher
Classroom Teacher
X
X
IPRC Statement of Decision (if applicable)
Provincial Report Card
Previous IEP
X
Parents/Guardian
Student
Other (List Below)
Other Sources:
Date of Placement in Special Education Program: (select and appropriate option and provide date)
X
1) First day of attendance in new special education program
2) First day of the new school year or semester in which the student is continuing in a placement
3) First day of student’s enrollment in a special program that he/she begins mid-year or mid-semester as
a result of a change in placement
Date of Placement:
Dec. 6, 2010
Completion Date of IEP Development Phase:
Dec. 20, 2010
(Within 30 school days following the Date of Placement)
Transition Plan:
For Student who are 14 years of age or older, unless solely identified as gifted.
Transition Goal
Specific Goal(s) for Transition to Postsecondary Activities
Actions Required
Name of Person(s) Responsible for
Actions
Timelines
Implementation and Monitoring:
Human Resources: (Teaching/non-teaching)
Include service, initiation date, frequency or intensity, and location.
- Mr. Oats, the Special Education teacher, will be giving Bob direct instruction 60-80% of the school day in a class with
no more than 10 students. Starting December 6, 2010.
Evaluation
Reporting Dates:
Reporting Format: (please check)
February 15, 2011
June 28, 2011
X Provincial Report Card
(Required if student has
modified expectations and/or
accommodations only)
X Alternative Report
Log of Parent/Student Consultation and Staff Review/Updating
Date
Activity
Outcome
(Indicate Parent/Student Consultation or Staff Review)
December 5, 2010
IPRC Decision
- Bob identified as behaviour
exceptionality
December 7, 2010
IEP Team Meeting
- Mr. Strict has applied for a High
Needs Amount so that a Teachers
Assistant may be assigned to Bob.
The Principal has the legal requirement to implement and monitor the IEP.
The plan has been developed according to the Ministry’s standards, addresses the student’s strengths and needs, and
the learning expectations will be reviewed and student progress monitored at least once every reporting period.
Principal’s Signature:
Date:
Parent/Guardian/Student Involvement:
I was consulted in the development of this IEP
I declined the opportunity to be consulted in the development of this IEP
I have received a copy of this IEP
Parent/Guardian/Student Comments:
Parent/Guardian Signature:
Date:
Student Signature:
Date:
(If 16 or older)