KDE IEP
IEP Guidance Document Sample
Individual Education Program (IEP)
Kentucky County Public Schools
500 Main Street
Riverview, KY 40000
Plan Information
Meeting Date: 10-26-12 Start Date: 10-26-12
End Date: 10-25-13
Special Ed Status: Active
Special Education Setting:<40% of the
day general ed program
Primary Disability: Multiple Disabilities
Student Information
Student Name: Hunter Cole Wallace
DOB: 3-20-96
Address: 1001 Hapsfield Place Terrace,
#5
School of Attendance: Westside High
School
Student Number:
330033
District of Residence: Kentucky County
Grade: 10
Gender:
M
Race (Ethnicity
Code): W
Present Level of Academic Achievement and Functional Performance
Present Levels of Academic Achievement and Functional Performance, including how the
disability affects the student’s involvement and progress in the general curriculum:
(For preschool children include the effect on participation in appropriate activities; Beginning in
the child’s 8th grade year or when the child has reached the age of 14, a statement of transition is
included.)
Communication Status
Performance commensurate with similar age peers
Hunter communicates using multiple modalities, which include vocalizations, physical gestures,
pointing to pictures/objects and use of a voice output communication device. Recently, Hunter
has been observed to communicate a greeting to an adult by saying, “Hi” or by waving.
Receptively, Hunter follows directions accompanied by both visual and verbal prompts/cues
(20%). Hunter is familiar with following a daily routine. He uses a picture schedule to
independently follow the daily classroom routine (80%). Social stories are being utilized to
improve receptive understanding of social (pragmatic) situations (e.g., lunch with peers, hallway
behavior). Hunter often demonstrates appropriate eye contact when spoken to by an adult;
however Hunter’s eye contact is more consistent when he has initiated the communication.
Expressively, Hunter uses pictures and a voice output communication device with physical
prompts to indicate his preference when given a choice of activity or item. Hunter is working on
requesting food/drink from a field of 4 pictures (70%), and requesting an activity or item from a
field of 4 pictures (60%). Hunter often requires physical prompting to point to his selection, and
requires adult prompting to use his Augmentative Alternative Communication (ACC) device
during whole group lessons, such as morning meeting. Hunter’s voice output communication
device has a touch screen with a 4-cell, static display. Currently, 1-2 cells are “blank”
placeholders.
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IEP Guidance Document Sample
Hunter seldom independently initiates communication using his AAC device. Hunter typically
initiates communication by approaching someone and touching them on the arm or hand.
Currently, Phase 1 strategies of the Picture Exchange Communication System are being
implemented (100% assistance from facilitator is required). Hunter’s preferred reinforces
include music, books, singing, swinging, noise makers and his towel.
When asked to point to a picture to answer a wh-question (i.e., “what’s next on your schedule?”),
Hunter is able to do so from a field of 4 with 50% accuracy. When participating in a movement
activity, Hunter will use physical gestures and vocalizations to request continuation of the
activity (i.e., when pushed on a swing, then stopped, Hunter will lean forward and grunt to
indicate his request for “more swinging”).
Hunter’s parents have been trained on how to use his communication system and report that they
provide Hunter with opportunities to practice communication skills, using the same instruction
that is used at school.
Hunter’s communication disability adversely affects his ability to participate within his
educational program. It significantly affects his ability to develop age-appropriate social skills
and friendships and to independently function within society.
Academic Performance
Performance commensurate with similar age peers
As demonstrated on class instructional activities (daily class work), progress data and teacher
observation, Hunter’s academic skills are well below average as compared to non-disabled, same
age peers.
Math
According to teacher observation and progress data, Hunter continues to work on mathematic
skills pertaining to both functional and general curriculum. Recent work samples indicate he can
identify basic geometric shapes (square, circle, triangle) with 65% accuracy, but is unable to
categorize the shapes based upon their properties. With assistance, Hunter has been collecting
data from surveys given to classmates about their favorite sports and hobbies. Using this data, he
is able to construct simple bar graphs using manipulatives (70%) with partial physical prompting.
He is able to move blocks to the area of the bar graph in relation to counting, but is unable to
answer “wh” questions related to these points. He has shown growth from 65% in the addition
and subtraction of 1-digit numbers using manipulatives and can successfully perform either
operation with 85% accuracy. Hunter shows growth from 70% to 80% in his ability to match
price amounts ($1, $2, or $3) with the correct number of bills. Hunter has continued to work on
the next dollar up strategy by showing him a price card with a given price and then being asked
to touch the correct number of dollar bills he would use to make the purchase. At this time, he
can select the correct price with 75% accuracy using a field of 4 on the ACC device. Hunter’s
deficits in operational and problem solving skills inhibit his participation in general education
activities and future life skills activities related to computation of money, his ability to generalize
skills across settings, comprehend abstract concepts, and independently participate in all content
areas and community environments.
Reading
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Based on progress data, Hunter can identify 60 Dolch sight words. He enjoys listening to
adapted age appropriate books with peers. Hunter follows a visual picture schedule for his day.
Hunter participates in reading comprehension activities and reading sight words taken from the
general and functional curriculum by touching a picture card from a field of four (picture card
has icon and word(s) together). Hunter will listen to an adapted grade level passage and answer
literal comprehension questions. He is most successful in identifying main idea and main
characters with 65% accuracy. At this time, he is at 35% accuracy with identifying other story
elements such as setting and plot. He can identify twenty-five high-frequency functional
vocabulary words (e.g., teachers names, building locations, subject name) pertaining to his daily
schedule with 60% accuracy. In his content curriculum vocabulary pertaining to monthly
science and social studies units, he identifies sight words with 50% accuracy. Hunter spends a
portion of each week in the community to work on vocational and independent daily living skills.
He can correctly identify ten common community and vocational vocabulary words (stop, exit,
entrance, cart, cashier, dairy, produce, bakery, elevator, restroom) with 75% accuracy. Hunter’s
need for adapted reading passages and inability to read and comprehend grade level reading
passages impact his ability to independently participate in all content areas.
Writing
Using a simple sentence starter (I like…, I want…, I worked on…, I went) and an AAC device
with touch screen and given a field of four choices, Hunter can correctly construct three
sentences with 40% accuracy by touching the correct icon paired with familiar word from the
given choices. In Language Arts, Hunter is currently working on a research project on
percussion instruments. While he is able to identify different percussion instruments (drum,
piano, xylophone), using a field of 4 on either picture cards on an ACC device, adult or peer
assistance is needed in looking for information on the internet and in the school library. Though
he can point to the object he is researching he cannot make sense of the researched information
to communicate it in a unique way in typed format. Hunter’s inability to express independent
thoughts without prompting or assistance impacts his ability to participate in all content areas
and community environments.
Health, Vision, Hearing, Motor Ability
Performance commensurate with similar age peers
Hunter is diagnosed with autism and ataxic cerebral palsy. Hunter has a history of seizures and
requires medication at home and school.
He walks with a wide base gait and good balance. Since he enjoys walking, this activity is used
for instructional breaks, positive reinforcement, vocational routines, and social activities with
peers. He shows some caution when navigating steps by holding onto the railing and onto an
adult’s hand, but does not visually attend while walking. Therefore, standby assistance and/or
contact-guard assistance may be necessary when navigating steps, curbs, and uneven terrain.
Hunter’s gross range of motion, muscle strength, and symmetry were within normal limits. He
can transfer independently from a standing position into a classroom chair. He demonstrates
good posture while sitting in the chair. While he sits independently in a chair, he requires
prompting to stay in the chair as required by the classroom activity. He uses a ball in his
classroom and has a cushion in his classroom chair. He follows simple motor directions (e.g.,
open, hold, carry).
Hunter shows a left hand preference for feeding and for fine-motor tasks. He makes marks on
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IEP Guidance Document Sample
paper using a wide marker or bingo dauber. He demonstrates poor visual attention to a given
activity. Hunter is able to use adapted utensils and a scoop dish for feeding himself but requires
physical cues to slow down. Hunter has decreased tactile discrimination and is noted to overstuff
his mouth when eating. He requires assistance to prepare for meals (set up, cutting food,
opening containers, etc.), clean himself and his eating area when finished. He often drops food
on the table, self and floor. He prepares simple snacks with assistance.
Hunter tends to seek movement and deep pressure to regulate his sensory system. He is given
opportunities to bounce on a therapy ball in the classroom and to have movement breaks of
walking. Hunter is often observed to give himself deep pressure by pushing on his head or
grasping his hands tightly.
He continues to work on improving his assistance with toileting. Hunter has difficulty visually
tracking and demonstrating visual awareness of activities in the classroom. He does show
avoidance of certain auditory input including loud pitched noises such as alarms or screaming.
Hunter has difficulty imitating movements that are demonstrated by the teacher and avoids doing
both gross and fine-motor activities. Parent reports that Hunter enjoys inversion and swinging at
home.
Hunter’s health and motor needs negatively impact his abilities and skills in the general and
functional curriculum as well as his transition to community and postschool environments.
Social and Emotional Status
Performance commensurate with similar age peers
Hunter is a very social young man and has become very social with his classmates and other
familiar adults at school and in the community. Hunter will approach other individuals and will
initiate a greeting by waving and saying, “Hi” or will respond to a greeting of “Hi,” “Hello,” or
“Hey.” In group settings, he interacts most appropriately when he has the ability to move freely
within a designated area (reading activity, gym, work site, cafeteria). He is making progress in
turn-taking and is currently able to make three to five exchanges in a game situation with verbal
and partial-physical prompting. He continues to work on improving his assistance with toileting.
Currently, he wears undergarments and follows an hourly toileting schedule at school and at
home. He currently has on average three accidents per week at school and at this time is unable
to indicate to school staff when this has occurred. Hunter requires assistance with setting up his
food at lunch in the cafeteria. He can feed himself but requires assistance. From time to time, he
may require verbal reminders to slow down and chew his food. Hunter is able to complete a task
if his attention is focused but requires verbal prompting to regain attention, and he may require
physical prompting in order to regain attention. Hunter requires the task that he is working on to
remain in his field of vision. He loves books, music, clapping, humming, and singing. Hunter
requires much movement throughout the day and often prefers to participate in an activity while
being allowed to balance on the ball. On an average of 5 times a day, Hunter demonstrates
anxiety related behaviors such as scratching his face, slapping his thighs, and placing his hands
over his mouth. Antecedents for these behaviors include large crowds, loud noises, and being
required to remain attentive to an activity for a long period of time. Hunter utilizes a sensory
diet with scheduled movement opportunities every thirty minutes. He benefits from a variety of
calming strategies including bouncing on an exercise ball, playing a drum, and taking a walk. It
is difficult to for Hunter to regain his focus once upset to the point of demonstrating selfinjurious behavior. Hunter needs adult verbal prompting to initiate calming activities during
times of frustration 50% of the time. Hunter’s need for sensory supports across all settings
impacts his ability to access and participate in the general curriculum and all community settings.
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IEP Guidance Document Sample
Hunter needs physical assistance; hand over hand, with grooming and hygiene.
General Intelligence
Performance commensurate with similar age peers
According to the integrated assessment report, the administration of the WISC-IV yielded a fullscale IQ score of 40, which falls in the well below average range. He performs best at school
when musical and kinesthetic teaching styles are incorporated into lesson activities. Hunter
performs best when jobs and academic tasks are task-analyzed. Currently, he is able to
independently perform familiar tasks using visual supports with three steps with 80% accuracy.
Hunter uses an AAC and picture cards to participate in the functional and general curriculum,
which has been modified and adapted. Hunter continues to work on his reasoning and
problem-solving skills. He is dependent on adults to help keep him safe and participate in the
curriculum as well as the everyday school environment. Hunter’s cognitive deficits and need for
generalization of skills across settings impacts his ability to independently participate in all
school and community environments. Hunter relies on adults to keep him safe.
Transition Needs
Not an area of concern at this time (Checking this box is not an option when the student is in
the 8th Grade or 14 years or older because transition must be addressed for these students)
Instruction
Related Service
Community Experience
Employment
Daily Living Skills
Post School Adult
Living Objectives
Functional Vocational Evaluation
Hunter is 16 years old and in the 10th grade. Hunter’s Multi-Year Course of Study is outlined
through completion of high school and subsequent transition activities/programs. Based on a
student picture survey with Hunter, teacher observation, and a parent survey with his mother and
father, Hunter’s needs are in the areas of social skills, task completion, and general community
functioning.
Based on student and parent surveys, a career interest inventory, and teacher observation, Hunter
enjoys being outside, interacting with peers, and music. He prefers activities that have
predictable routines with a definite start and finish. He excels at tasks that are task-analyzed and
require movement and heavy work.
Instruction: Based on IEP progress data, Hunter can correctly identify twenty-five highfrequency classroom vocabulary words pertaining to his daily schedule with 70% accuracy. He
demonstrates learning best when he has the opportunity to generalize skills across a variety of
settings. Hunter will need continued instruction in the use of his AAC device across settings as
well as increasing sight word vocabulary related to school and community environments.
Hunter’s cognitive deficits will impact his ability to generalize skills in different settings and to
access and participate in unfamiliar environments.
Community Experiences: Hunter requires supervision and safety assistance when engaging in
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IEP Guidance Document Sample
instructional opportunities outside the school setting (e.g., shopping, banking, recreation). In
order to generalize skills into community environments, Hunter needs community-based
instruction which will enable him to practice skills in natural environments. Actual job training
in the community through the Community-Based Work Transition Program is needed in order
for Hunter to generalize work-related skills.
Employment: Based on a career interest inventory and student survey, Hunter has demonstrated
an interest in obtaining a job in the field of landscaping. IEP progress data indicates that he can
correctly identify ten common community and vocational vocabulary words with 75% accuracy
and also perform familiar tasks with three steps using visual supports with 80% accuracy.
Hunter’s cognitive deficits will impact his ability to acquire new skills involving multiple steps
in order to independently participate in vocational settings. Hunter will require supervision for
attention and safety. Hunter will need supported employment assistance as he explores locations
for jobs in landscaping as well as training of work-related skills for those particular locations.
Daily Living Skills: Hunter requires assistance with all grooming and hygiene needs. With
adapted utensils, he is able to feed himself, but needs assistance with cleaning up his area once
he is finished. Parent survey indicates they are most comfortable with Hunter living in a
supported living setting with 2-3 roommates. They also indicated that Hunter would like to
participate in weekly personal shopping activities after he graduates. Hunter’s deficits in the
area of daily living skills will impact his ability to live and perform personal care needs
independently after high school.
Functional Vision/Learning Media Assessment
Not an area of concern at this time
Consideration of Special Factors for IEP Development
(The ARC must address each question below and consider these issues in the review and revision
of the IEP)
Does the child’s behavior impede his/her learning or that of others?
Yes
No
If Yes, include appropriate strategies, such as positive behavioral interventions and supports in
the statement of device and services below.
Does the child have limited English proficiency?
Yes
No
If Yes, what is the relationship of language needs to the IEP?
Is the child blind or visually impaired?
Yes
No If Yes, the team must
consider:
 Is instruction in Braille needed?
Yes
No
 Is use of Braille needed?
Yes
No
 Will Braille be the student’s primary mode of communication?
Yes
No
 (See evaluation data for supporting evidence)
Does the child have communication needs?
Yes
No
If Yes, please specify
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IEP Guidance Document Sample
below:
See Present Levels for Communication Status
Other (Specify):
Is the child deaf or hard of hearing?
Yes
No
consider:
 The child’s language and communication needs; Describe:
See Present Levels for Communication Status
Other (Specify):
If Yes, the team must

Opportunities for direct communications with peers and professional personnel in the
child’s language and communication mode, academic level and full range of needs;
Describe:

Any necessary opportunities for direct instruction in the child’s language and
communication mode. Describe:
Are assistive technology devices and services necessary in order to implement the child’s IEP?
Yes
No
If Yes, include appropriate devices in the ‘Statement of Devices/Services’ below.
Statement of Devices/Services: If the ARC answered Yes to any of the above, include a
statement of services and or devices to be provided to address the above special factors.
See Specially Designed Instruction
See Supplemental Aids and Services
See Behavior Intervention Plan
Other (Specify):
Measurable Annual Goals and Benchmarks
Annual Measurable Goal (#1): Given a total dollar amount (dollars and cents) between $1 and
$10 on a price card, Hunter will touch the correct number of dollar bills that corresponds with the
Next Dollar with 90% accuracy across 5 consecutive sessions.
Method of Measurement: Direct Measure (teacher observation and frequency recording)
Specially Designed Instruction: Instruction using system of least prompts
Instruction using real $1 bills
Modeling
Community simulations in the classroom
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Community-based instruction
For the IEP to be in effect by the child's 16th birthday and thereafter:
This annual goal will reasonably enable the student to meet the student's postsecondary
goal in the area(s) of:
Education/training
Employment
Independent living
Benchmarks/Short Term Instructional Objectives
1. Given a total dollar amount (dollars and cents) between $1 and $5 on a price card, Hunter
will touch the correct number of dollar bills that corresponds with the Next Dollar with
90% accuracy across 5 consecutive sessions.
2. Given a total dollar amount (dollars and cents) between $1 and $8 on a price card, Hunter
will touch the correct number of dollar bills that corresponds with the Next Dollar with
90% accuracy across 5 consecutive sessions.
3. Given a total dollar amount (dollars and cents) between $1 and $10 on a price card,
Hunter will touch the correct number of dollar bills that corresponds with the Next Dollar
with 90% accuracy across 5 consecutive sessions.
Annual Measurable Goal (#2): Given one of fifteen sight words from the functional
(classroom high frequency words) or general curriculum monthly unit, Hunter will correctly
identify the word, by touching a card with the picture from a field of four with 80% accuracy
across 4 weekly consecutive sessions.
Method of Measurement: Direct Measure (teacher observation and frequency recording)
Specially Designed Instruction: Instruction using constant time delay
Pre-teach vocabulary
Selection of relevant sight words from monthly units
Collaboration with parent to identify functional sight words
from home setting
For the IEP to be in effect by the child's 16th birthday and thereafter:
This annual goal will reasonably enable the student to meet the student's postsecondary
goal in the area(s) of:
Education/training
Employment
Independent living
Benchmarks/Short Term Instructional Objectives
1. Given one of five sight words from the functional curriculum (classroom high frequency
words), Hunter will correctly identify the word, by touching a card with the word and
picture from a field of three with 80% accuracy across 4 consecutive sessions.
2. Given one of five sight words from the general curriculum monthly unit, Hunter will
correctly identify the word, by touching a card with the word and picture from a field of
three with 80% accuracy across 4 consecutive sessions.
3. Given one of five sight words from the community setting, Hunter will correctly identify
the word, by touching a card with the word and picture from a field of three with 80%
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IEP Guidance Document Sample
accuracy across 4 consecutive sessions.
Annual Measurable Goal (#3): Given a routine sentence starter (I like…, I worked on…, I
went to…, etc.) By choosing to use his ACC device or pointing, Hunter will select the word,
with accompanying picture from a field of four that accurately reflects an activity that took place
that day with 80% accuracy across 4 consecutive sessions.
Method of Measurement: Direct Measure (teacher observation and frequency recording)
Specially Designed Instruction: Instruction using AAC device
Pre-teach vocabulary
Instruction using visual supports,
Instruction in fine motor facilitation strategies
For the IEP to be in effect by the child's 16th birthday and thereafter:
This annual goal will reasonably enable the student to meet the student's postsecondary
goal in the area(s) of:
Education/training
Employment
Independent living
Benchmarks/Short Term Instructional Objectives
1. Given a routine sentence starter (I like…, I worked on…, I went to…, etc.) from his
AAC device, Hunter will select the word with accompanying picture from a field of three
that accurately reflects a functional routine activity that took place that day with 80%
accuracy across 3 consecutive sessions.
2. Given a routine sentence starter (I like…, I worked on…, I went to…, etc.) from his
AAC device, Hunter will select the word with accompanying picture from a field of three
that accurately reflects general curriculum activity (math, science, social studies,
language arts) that took place that day with 80% accuracy across 3 consecutive sessions.
3. Given a routine sentence starter (I like…, I worked on…, I went to…, etc.) from his
AAC device, Hunter will select the word with accompanying picture from a field of three
that accurately reflects an activity in the community that took place that day with 80%
accuracy across 3 consecutive sessions.
Annual Measurable Goal (#4) When experiencing mounting frustration and given a choice of 3
sensory calming activities from his AAC device (bouncing on therapy ball, wall push-ups, push
heavy cart, theraband exercises, purposeful walk), Hunter will select and access a calming
activity by touching the icon from a field of 3 with 80% accuracy across 5 consecutive
opportunities.
Method of Measurement: Direct measure (teacher observation and frequency recording)
Specially Designed Instruction: Instruction using AAC device,
Instruction in each sensory strategy
Pre-teach vocabulary
Community-based instruction
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For the IEP to be in effect by the child's 16th birthday and thereafter:
This annual goal will reasonably enable the student to meet the student's postsecondary
goal in the area(s) of:
Education/training
Employment
Independent living
Benchmarks/Short Term Instructional Objectives
1. During a moment of mounting frustration in the classroom and given a choice of 3
sensory calming activities from his AAC device (bouncing on therapy ball, wall pushups, push heavy cart, theraband exercises, purposeful walk), Hunter will select and access
a calming activity by touching the icon from a field of five with 60% accuracy across 5
consecutive opportunities.
2. During a moment of mounting frustration in an unstructured school activity (e.g. pep
rally, assembly, lunch in the cafeteria) and given a choice of 3 sensory calming activities
from his AAC device (bouncing on therapy ball, wall push-ups, push heavy cart,
theraband exercises, purposeful walk), Hunter will select and access a calming activity by
touching the icon from a field of five with 70% accuracy across 5 consecutive
opportunities.
3. During a moment of mounting frustration in a community setting and given a choice of 3
sensory calming activities from his AAC device (bouncing on therapy ball, wall pushups, push heavy cart, theraband exercises, purposeful walk), Hunter will select and access
a calming activity by touching the icon from a field of five with 80% accuracy across 5
consecutive opportunities.
Reporting Progress
Concurrent with the issuance of Report Cards
Other, specify
Supplementary Aids and Services
Statement of Supplementary Aids and Services, to be provided to the child on behalf of the child.
Use of a seat cushion, therapy ball for calming, structured movement breaks, non-slip material,
adapted plate with food guard, built-up handled utensils, visual supports, pictures, prompts and
cues, AAC devise, choice board, theraband, reinforcers for behavior and communication.
Accommodations for Administration of State Assessments and Assessments in the
Classroom
In order to justify appropriateness of accommodations for any state mandated tests, the testing
accommodations must be used consistently as part of routine instruction and classroom
assessment as well as meet all additional requirements established by the Inclusion of Special
Populations in the State-Required Assessment and Accountability Programs,703 KAR 5:070
document.
ARC determined no accommodations needed.
Readers
Scribes
Paraphrasing
Reinforcement and behavior modification strategies
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Prompting/cueing
Manipulatives
Interpreters
Other: AAC device
Use of technology
Braille
Extended time
Student has been determined eligible for participation in the Alternate Assessment
Program. Complete the Participation Guidelines for the KY Alternate Assessment form if
selecting this checkbox. If determined eligible for the Alternate Assessment, the ARC must
also determine if the student is Dimension A or Dimension B.
Dimension A
Dimension B
Program Modifications/Supports for school personnel that will be provided
Supports for school personnel: Instructional staff training on sensory modulation strategies,
strategies to enhance functional motor skills, and safety with travel on stairs, curbs, and uneven
terrain, ACC communication device, picture exchange system, seizure management. The
physical therapist will address and monitor functional gross motor skills (i.e. stairs, curbs, and
uneven terrain) within the educational environment and community.
Not needed at this time
Least Restrictive Environment (LRE) and General Education
Explain the extent, if any, to which the student will not participate in general education (content
area):
General Education: Elective classes (Art and Band)
Co-Teaching: None
Special Education: Math, Language Arts, Science, Social Studies, Social Skills, Independent
Daily Living Skills
Type of
Service
Special Education Services
Anticipated Frequency and Duration of Service
Service
Service
Service
Minutes Frequency
Period
Start
End
(Per
(Number
(Daily,
Date
Date
Service
of times
Weekly,
Frequency) provided
Monthly,
per Service Annually)
Period)
30 minutes
Special
Education
2 times
Daily
10-2612
10-2513
30 minutes
Special
Education
2 times
Daily
10-2612
10-2513
Service
Provider
(by
Position)
Special
Education
Teacher
Special
Education
Location
(e.g.,
Regular
Classroom,
Resource
Room,
Separate
Class)
Separate
Class for
Math
Separate
Class for
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45 minutes
Special
Education
1 time
Daily
10-2612
10-2513
45 minutes
Special
Education
1 time
Daily
10-2612
10-2513
Related Services
Anticipated Frequency and Duration of Service
Type of Service
Service
Service
Service
Minutes Frequenc
Period
Star End
(Per
(Daily,
y
t
Dat
Service
(Number Weekly, Date
e
Frequency of times Monthly,
)
provided Annually
per
)
Service
Period)
30
6
Yearly
1010Physical
minutes
2625Therapy
12
13
30
2
Monthly 1010Occupational
minutes
2625Therapy
12
13
20
2
weekly
1010Speech/Languag
minutes
2625e Therapy
12
13
20
1
weekly
1010Speech/Languag
minutes
2625e Therapy
12
13
20
2
Daily
1010Special
minutes
2625Transportation
12
13
Extended School Year
Are extended school year services required for this student?
Teacher
Special
Education
Teacher
Reading
Separate
Class for
(Science)
Reading
and Social
Skills
Instruction
Special
Separate
Education
Class
Teacher
(Social
Studies) for
Reading
and Social
Skills
Instruction
Service
Provider
(by
Position)
Physical
Therapist
Location
(e.g.,
Regular
Classroo
m,
Resource
Room,
Separate
Class)
Separate
Class
Occupation
al Therapist
Separate
Class
Speech
Therapist
Separate
Class
Speech
Therapist
Separate
Class
Bus Driver
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Yes
No
More data needed
If the ARC determines ESY services are to be provided, describe the service and indicate to
which annual goal or goals the service is related. If the ARC determines no ESY services are
to be provided, please document the reason(s) for this decision.
Analysis of IEP progress data and classroom performance show that Hunter requires
prolonged re-teaching in reading and math after breaks in instruction. Please see conference
summary for ESY Plan.
Transition Service Needs
(Beginning in the child’s 8 grade year or when the child has reached the age of 14 and
thereafter)
What transition assessments were used to determine the child’s preference and
interests? (Check all that apply)
th
Student Interview
Student Portfolio
Interest Inventory
Career Awareness
ILP
Student Survey
Vocational Assessments
Parent Interview
Career Aptitude
Other:
Does the student’s Individual Learning Plan (ILP) include the student’s course of
study?
No If No, do not proceed with development of IEP until ILP is initiated, including the
child’s course of study.
Yes (See student’s attached course of study to include current school year through
graduation or exiting special education)
Do transition service needs focus on child’s course of study and are they addressed in
Present Levels?
No
Yes
Postsecondary Goal(s)
(By age 16, or younger if appropriate, and thereafter)
(Postsecondary Goal(s) Related to Education/Training, Employment, and if needed,
Independent Living:
Education/Training and Employment: Upon completion of high school, Hunter’s goal is to
complete employment skills training and on-the-job training provided through the Office of
Vocational Rehabilitation in order to work in a supported employment position as a
landscape assistant.
Independent Living:
Upon completion of high school, Hunter’s goal is to live in a supported living setting with 23 roommates and to perform weekly personal shopping activities with assistance.
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KDE IEP
IEP Guidance Document Sample
Transition Service
Completion of Multi-Year Course of Study leading to an
Alternative High School Diploma
Community-Based Instruction
Individual advising on completion of ILP
Community-Based Work Transition Program (in collaboration
with Office of Vocational Rehabilitation)
Invite Agriculture teacher to transition planning sessions
Provide opportunity for participation in Regional Transition Fair
Provide information to Hunter’s parents about guardianship, SSI,
Michelle P Waiver, and Supported Living
Daily Living Skills instruction
Agency Responsible
Special Education
Teacher
Special Education
Teacher
Counselor/Job Coach
Special Education
Teacher/Job Coach
Special Education
Teacher
Special Education
Teacher
Special Education
Teacher
Special Education
Teacher
Transfer of Rights at Age of Majority
If applicable, one year before the student reaches age 18 the student and parent have
been informed of the student’s rights under Part B of the Individuals with Disabilities
Education Act, if any, that will transfer on reaching the age of majority.
Date student was first informed of the transfer of rights: 10-26-12
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