INDIVIDUALIZED EDUCATION PROGRAM
STUDENT’S NAME:
DOB
June 6, 2006
Jake Jones
SCHOOL YEAR
IEP INITIATION/DURATION DATES
FROM
2013
-
AUGUST 2013
2014
GRADE
TO
1
-
2
AUGUST 2014
THIS IEP WILL BE IMPLEMENTED DURING THE REGULAR SCHOOL TERM UNLESS NOTED IN EXTENDED SCHOOL YEAR SERVICES.
STUDENT PROFILE
Jake is a first grade student. Jake really enjoys drawing and participating in physical activities such as running.
He has a good relationship with the staff but struggles when interacting with his peers. Jake’s mother recently
passed away and he is currently living with his aunt, uncle, and two cousins. He is having a hard time adjusting
to his new environment due to his lack of social and communication skills.
Jake needs small group instruction in Math and Reading because he works at a slower pace than his peers. For
Reading, He has made a significant improvement in fluency, but still needs direct instruction in comprehension.
Jake also struggles when retelling stories and knowing the difference between the author and illustrator.
Individualized instruction will be used to encourage improvement in this area. In Math, he excels at completing
patterns and naming shapes. Jake also has difficulty with continuing sequences and counting on. He also still
struggles when adding and subtracting simple two digit numbers.
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SDE Approved 09/15/08
INDIVIDUALIZED EDUCATION PROGRAM
STUDENT’S NAME:
JAKE JONES
SPECIAL INSTRUCTIONAL FACTORS
Items checked “YES” will be addressed in this IEP:
YES
NO







[X]
[ ]
[X]
[ ]
[X]
[X]
[ ]
[X]
[ ]
[X]
[ ]
[ ]
[X]
[ ]
[ ]
[X]
Does the student have behavior which impedes his/her learning or the learning of others?
Does the student have limited English proficiency?
Does the student need instruction in Braille and the use of Braille?
Does the student have communication needs (deaf or hearing impaired only)?
Does the student need assistive technology devices and/or services?
Does the student require specially designed P.E.?
Is the student working toward alternate achievement standards and participating in the
Alabama Alternate Assessment?
 Are transition services addressed in this IEP?
TRANSPORTATION AS A RELATED SERVICE
Does the student require transportation as a related service?
[ ]
Does the student need accommodations or modifications for transportation?
[ ]
If yes, check any transportation accommodations/modifications that are needed.
[ ]
[ ]
[ ]
Bus driver is aware of student’s behavioral and/or medical concerns
Wheelchair lift
Restraint system.
Specify:
[ ]
Other.
Specify:
YES [ X ]
YES [ X ]
NO
NO
NONACADEMIC and EXTRACURRICULAR ACTIVITIES
Will the student have the opportunity to participate in nonacademic/extracurricular activities with his/her nondisabled
peers?
[ ] YES.
[ X ] YES, with supports. Describe: Paraprofessional should attend Jake during these activities.
[ ]
NO. Explanation must be provided:
METHOD/FREQUENCY FOR REPORTING PROGRESS OF ATTAINING GOALS TO PARENTS
Annual Goal Progress reports will be sent to parents each time report cards are issued (every
9
weeks).
.
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SDE Approved 09/15/08
INDIVIDUALIZED EDUCATION PROGRAM
STUDENT’S NAME:
JAKE JONES
[ ] This student is in a middle school course of study that will help prepare him/her for transition.
EXIT OPTIONS (Complete for students in grades 9-12)
[ ] Alabama High School Diploma
[ ] Graduation Certificate
[ ] Alabama Occupational Diploma
[ ] Other
Anticipated Date of Exit:
Month
Year
PROGRAM CREDIT TO BE EARNED (Complete for students in grades 9-12)
For each course taken, indicate
program credit to be earned.
ENGLISH
MATH
SCIENCE
SOCIAL
STUDIES
Alabama High School Diploma
Alabama Occupational Diploma
Graduation Certificate
TRANSITION
(Beginning not later than the first IEP to be in effect when the student is 16,
or earlier if appropriate, and updated annually thereafter)
Transition Assessments (Check the assessment(s) used to determine the student’s measurable transition goals):
[ ]
Transition Planning Assessments
[ ] Interest Inventory
[ ]
Other
Transition Goals:
Postsecondary Education/Employment Goal
If Other is selected, specify
Community/Independent Living Goal
If Other is selected, specify
Transition Services: (Based on this student's strengths, preferences, and interests, the following coordinated
transition services will reasonably enable the student to meet the postsecondary goals.)
[
[
[
[
]
]
]
]
Vocational Evaluation (VE)
Employment Development (ED)
Postsecondary Education (PE)
Financial Management (FM)
[
[
[
[
]
]
]
]
Personal Management (PM)
Transportation (T)
Living Arrangements (LA)
Advocacy/Guardianship (AG)
[
[
[
[
]
]
]
]
Community Experiences (CE)
Medical (M)
Linkages to Agencies (L)
Other
TRANSFER OF RIGHTS
(Beginning not later than the IEP that will be in effect when the student reaches 18 years of age.)
Date student was informed that the rights under the IDEA will transfer to him/her at the age of 19
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SDE Approved 09/15/08
INDIVIDUALIZED EDUCATION PROGRAM
STUDENT’S NAME:
AREA:
JAKE JONES
Reading
PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE:
ASSESSMENTS SHOW THAT JAKE HAS IMPROVED IMMENSILY ON HIS READING SINCE LAST YEAR. HE
IS STILL READING ON A KINDERGARTEN LEVEL. JAKE IS STILL STRUGGLING WITH HIS POPCORN
WORDS, AND CANNOT FULLY RETELLTHE ROLES OF CHARACTERS IN A STORY. THUS, HIS
COMPREHENSION IS BEING EFFECTED.
MEASURABLE ANNUAL GOAL related to meeting the student’s needs:
By May 2014, Jake will be able to read all of his popcorn words with 1 or fewer errors. Jake will also be able to
retell a story and discuss the author, illustrator, and the roles of each character with two or fewer errors.
TYPE(S) OF EVALUATION FOR ANNUAL GOAL:
[
[
[
[
]
]
]
]
Curriculum Based Assessment
Data Collection
Other:
Other:
[ x ] Teacher/Text Test [ x ] Teacher Observation
[ ] State Assessment(s) [ x ] Work Samples
[ x]
Grades
Other:
DATE OF MASTERY: August 2013
BENCHMARKS:
1. BY THE END OF FIRST GRADE, HE SHOULD MASTER THE FIVE POPCORN
Date of Mastery:
WORDS. THE WORDS ARE AND, WHAT, IS, ARE, AND WHY.
2. BY THE END OF FIRST GRADE, HE SHOULD BE ABLE TO RETELL A STORY Date of Mastery:
AND ANSWER 8 OUT OF 10 COMPREHENSION QUESTIONS CORRECTLY.
3. BY THE END OF FIRST GRADE, HE SHOULD BE ABLE TO IDENTIFY
Date of Mastery:
CHARACTERS, MAIN EVENTS IN A STORY, AND SETTING WITH SUPPORT.
4. BY THE MIDDLE OF THE SCHOOL YEAR, JAKE SHOULD BE ABLE TO NAME Date of Mastery:
THE AUTHOR, ILLUSTRATOR, AND THE ROLE OF EACH.
SPECIAL EDUCATION AND RELATED SERVICE(S): (Special Education, Supplementary Aids and Services,
Program Modifications, Accommodations Needed for Assessments, Related Services, Assistive Technology, and Support
for Personnel.)
Anticipated
Type of Service(s)
Frequency
Amount
Beginning/
Location of
of Service(s)
of time
Ending Date
Service(s)
Special Education
Supplementary reading instruction
3 times a
30 min.
___8/13_____ to
intervention program.
week
__8/14____
Supplementary Aids and Services
________ to ________
Program Modifications
________ to ________
Accommodations Needed for Assessments
Needs extended time to complete his
test. Teacher may read the test questions
to student if necessary.
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Once or twice
a week
30 min.
_8/13_______t o
___5/14__
SDE Approved 09/15/08
SPECIAL EDUCATION AND RELATED SERVICE(S): (Special Education, Supplementary Aids and Services,
Program Modifications, Accommodations Needed for Assessments, Related Services, Assistive Technology, and Support
for Personnel.)
Anticipated
Type of Service(s)
Frequency
Amount
Beginning/
Location of
of Service(s)
of time
Ending Date
Service(s)
Related Services
________ to ________
________ to ________
Assistive Technology
________ to ________
Support for Personnel
________ to ________
INDIVIDUALIZED EDUCATION PROGRAM
STUDENT’S NAME:
AREA:
JAKE JONES
Math
PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE:
JAKE IS ON A KINDERGARTEN MATH LEVEL. CURRICULUM BASED ASSESSMENTS REVEAL THAT JAKE
IS VERY CAPABLE OF COUNTING BY 10’S, BUT STRUGGLES WITH COUNTING BY 5’S. JAKE ALSO HAS
DIFFICULTY WITH SEQUENCING WHEN GIVEN A RANDOM NUMBER. HIS ADDING OF TWO DIGIT
NUMBERS NEEDS IMPROVEMENT AS WELL.
MEASURABLE ANNUAL GOAL related to meeting the student’s needs:
By May 2014 Jake will be able to count by 5’s to 100 with 3 or fewer errors. Jake will also be able count forward or
backward from any given number.
TYPE(S) OF EVALUATION FOR ANNUAL GOAL:
[
[
[
[
]
]
]
]
Curriculum Based Assessment
Data Collection
Other:
Other:
[ x ] Teacher/Text Test [ x ] Teacher Observation
[ ] State Assessment(s) [ x ] Work Samples
[ x]
Grades
Other:
DATE OF MASTERY: August 2013
BENCHMARKS:
1. BY THE END OF FIRST GRADE, HE WILL BE ABLE TO DISTINGUISH THE
DIFFERENCE BETWEEN 2D AND 3D SHAPES.
2. BY THE END OF FIRST GRADE, HE WILL MASTER COUNTING BY 10’S.
3. BY THE END OF FIRST GRADE, JAKE WILL KNOW HOW TO ADD AND
SUBTRACT SINGLE DIGITS WITH 2 OR LESS ERRORS.
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Date of Mastery:
Date of Mastery:
Date of Mastery:
SDE Approved 09/15/08
4. BY THE END OF FIRST GRADE, HE SHOULD BE ABLE TO COUNT FORWARD
BEGINNING FROM A GIVEN NUMBER WITHIN THE KNOWN SEQUENCE.
Date of Mastery:
SPECIAL EDUCATION AND RELATED SERVICE(S): (Special Education, Supplementary Aids and Services,
Program Modifications, Accommodations Needed for Assessments, Related Services, Assistive Technology, and Support
for Personnel.)
Anticipated
Type of Service(s)
Frequency
Amount
Beginning/
Location of
of Service(s)
of time
Ending Date
Service(s)
Special Education
Supplementary math instruction
3 times a
30 min.
___8/13_____ to
intervention program.
week.
__8/14____
Supplementary Aids and Services
________ to ________
Program Modifications
________ to ________
Accommodations Needed for Assessments
Needs extended time to complete his
test.
Once or twice
a week
30 min.
_8/13_______t o
___5/14__
Related Services
________ to ________
________ to ________
Assistive Technology
________ to ________
Support for Personnel
________ to ________
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SDE Approved 09/15/08
INDIVIDUALIZED EDUCATION PROGRAM
STUDENT’S NAME:
JAKE JONES
GENERAL FACTORS
HAS THE IEP TEAM CONSIDERED:
 The strengths of the child?
 The concerns of the parents for enhancing the education of the child?
 The results of the initial or most recent evaluations of the child?
 As appropriate, the results of performance on any State or districtwide assessments?
 The academic, developmental, and functional needs of the child?
 The need for extended school year services?
YES
[x]
[x]
[x]
[x]
[x]
[x]
NO
[ ]
[ ]
[ ]
[ ]
[ ]
[ ]
LEAST RESTRICTIVE ENVIRONMENT
Does this student attend the school (or for a preschool-age student, participate in the environment) he/she would attend if
nondisabled?
[x ] Yes
[ ] No
If no, explain:
Does this student receive all special education services with nondisabled peers? [x ] Yes [ ] No
If no, explain (explanation may not be solely because of needed modifications in the general curriculum):
[ X ] 6-21 YEARS OF AGE
(Select one from the drop-down box.)
[ ] 3-5 YEARS OF AGE
Secondary LRE (only if LRE above is Private School-Parent Placed)
COPY OF IEP
COPY OF SPECIAL EDUCATION RIGHTS
Was a copy of the IEP given to parent at the IEP meeting?
[ x] Yes
[ ] No
If no, date sent to parent:
Was a copy of the Special Education Rights given to parent
at the IEP meeting?
[ x] Yes
[ ] No
If no, date sent to parent:
Date copy of amended IEP provided/sent to parent
June 26, 2013
THE FOLLOWING PEOPLE ATTENDED AND PARTICIPATED IN THE MEETING TO DEVELOP THIS IEP.
Position
Parent
Parent
LEA Representative
Special Education Teacher
General Education Teacher
Student
Career/Technical Education Rep
Other Agency Representative
Signature
Date
INFORMATION FROM PEOPLE NOT IN ATTENDANCE
Position
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Name
Date
SDE Approved 09/15/08