 Services Plan
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Name Steve
Date of Birth

Male 
Female
Grade Level
Student Identification Number
Child/Student Address
Parent/Guardian
Parent Address
Home Phone
Effective IEP Dates from 8/30/2006
District of Residence
Step 1
to 8/30/2007
Old Timersville
Meeting Date 8/30/2006
District of Service

Work Phone
Initial IEP

Periodic Review
Arthritisville
Discuss future planning.
(Family and student preferences and interests)
Steve wishes to continue adult living so that his job, home, & community participation are maintained at their present or better levels. Joyce (wife) says she
wants the same outcomes.
Step 2
Discuss present levels of academic and functional performance.
(What do we know about this child, and how does that relate in the context of content standards, or for preschool children, in the context of appropriate activities and
how the disability affects the student’s involvement in the general education curriculum.)
Currently, Steve has partially completed an introductory textbook with 2 colleagues and with the input of an editor. The next step would be for Steve to complete
a 2nd draft of his portion of the text (equivalent to 5 chapters or about 600-700 manuscript pages). Steve’s home has flower beds in the front that
have been dug up, but now are filled with weeds. He should weed the beds and prepare the beds for planting of spring bulbs. Finally, Steve
has been elected vice president of a nonprofit advocacy organization. He should learn and complete his duties in this office for the next year.
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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Annual Goals and Short-Term Objectives
Step 3: Identify needs that require specially designed instruction
Steve needs to complete scholarly writing.
Goal #1
Step 4: Identify measurable annual goals, including academic and functional goals
Content area addressed:
Given editor’s and reviewer’s comments, Steve will complete the 2 nd draft of his portion of the book manuscript by 8/30/2006.
Benchmarks or short-term objectives
Steve will complete the 1st draft of the final chapter written no later than 9/15/2006.
Steve will complete the 2nd draft of one other chapter no later than 10/30/2006.
Steve will complete the 2nd draft of the remaining 4 chapters no later than August 30, 2007.
Student Progress
(Include a description of how the child’s progress toward meeting the annual goals will be measured and when periodic reports on the progress the child is making toward
meeting the annual goals will be provided.)
Progress will be monitored by self-checking for completion of each chapter draft by a specified date. Progress will also be monitored by colleagues and the editor
and reported as often as needed in writing to Steve.
Service:__________________
Initiation date: ______________
Step 5: Identify services
Expected duration: ______________
Frequency: (how often) ______________
(Identify all services needed for the child to attain the annual goal and progress in the general education curriculum. Services may include specially designed
instruction, related services, supplementary aids, or, on behalf of the child, a statement of program modifications, testing accommodations, or supports
for school personnel)
Step 6: Determine least restrictive environment
Determine where services will be provided
(An explanation of the extent, if any, to which the child will not participate with nondisabled children in the regular class.)
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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Annual Goals and Short-Term Objectives
Step 3: Identify needs that require specially designed instruction
Steve needs to maintain his home in its current or better condition.
Step 4: Identify measurable annual goals, including academic and functional goals
Goal #2
Content area addressed:
Given the approach of cold weather and Joyce’s commands, Steve will repair the front flower beds with assistance by 11?30/2006.
Benchmarks or short-term objectives
Steve will purchase the spring bulbs with assistance by 11/15/2006.
Steve will dig up the weeds and remove them from the beds by 11/25/2006.
Steve will plant spring bulbs, with assistance, no later than 11/30/2006.
Student Progress
(Include a description of how the child’s progress toward meeting the annual goals will be measured and when periodic reports on the progress the child is making toward
meeting the annual goals will be provided.)
Progress will be measured by observation of the flower beds on a periodic basis through self-monitoring and Joyce’s observations. Progress will be reported
verbally as needed.
Service:__________________
Initiation date: ______________
Step 5: Identify services
Expected duration: ______________
Frequency: (how often) ______________
(Identify all services needed for the child to attain the annual goal and progress in the general education curriculum. Services may include specially designed
instruction, related services, supplementary aids, or, on behalf of the child, a statement of program modifications, testing accommodations, or supports
for school personnel)
Step 6: Determine least restrictive environment
Determine where services will be provided
(An explanation of the extent, if any, to which the child will not participate with nondisabled children in the regular class.)
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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Annual Goals and Short-Term Objectives
Step 3: Identify needs that require specially designed instruction
Steve needs to perform community service.
Goal #3
Step 4: Identify measurable annual goals, including academic and functional goals
Content area addressed:
Given 4 meetings of the executive committee & 4 full board meetings per year, Steve will execute his duties as vice president of a nonprofit organization.
Benchmarks or short-term objectives
Steve will consult with the organization staff and the board president to determine his responsibilities no later than 11/30/2006.
Steve will attend all meetings during the year.
Steve will fulfill VP duties as required for the following year.
Student Progress
(Include a description of how the child’s progress toward meeting the annual goals will be measured and when periodic reports on the progress the child is making toward
meeting the annual goals will be provided.)
Progress will be recorded through self-assessment, the board’s assessment, and reported in board meeting minutes as required.
Service:__________________
Initiation date: ______________
Step 5: Identify services
Expected duration: ______________
Frequency: (how often) ______________
(Identify all services needed for the child to attain the annual goal and progress in the general education curriculum. Services may include specially designed
instruction, related services, supplementary aids, or, on behalf of the child, a statement of program modifications, testing accommodations, or supports
for school personnel)
Step 6: Determine least restrictive environment
Determine where services will be provided
(An explanation of the extent, if any, to which the child will not participate with nondisabled children in the regular class.)
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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Discuss and Document a Statement of Needed Transition Services
Name of Student Steve
Date 8/30/2006
Person(s) Responsible for Coordinating Transition Services Self
Write a statement of transition service needs that focus on the student’s courses of study during his/her secondary school experiences (beginning at age 14 or younger, if
appropriate).
Steve will need to study appropriate materials for adult living related to being a professor, homeowner, & trustee for a nonprofit organization.
FOR 16 YEARS AND OLDER
COMPLETED AFTER IEP DEVELOPMENT
EMPLOYMENT AND POSTSECONDARY LONG-TERM OUTCOME: MAIINTAI N LEVEL OF SCHOLARSHIP
Current Year
Responsible
Initiation/Duration
Activities and Services
Person/Provider
(Specify Date)
Complete introductory textbook second draft
Self, colleagues, editor
8/30/2006 – 8/30-2007
POSTSCHOOL/ADULT LIVING LONG-TERM OUTCOME: MAINTAIN HOME IN PRESENT OR BETTER CONDITION
Current Year
Responsible
Initiation/Duration
Activities and Services
Person/Provider
(Specify Date)
Repair flower beds in front of house
Self & Joyce
Functional Vocational
Evaluation
Self, Director, Board of Trustees
 Needed
Goals/Objectives that Support
Activities/Services
8/30/2006-11/30/2006
COMMUNITY PARTICIPATION LONG-TERM OUTCOME: PROVIDE SERVICE TO COMMUNITY ORGANIZATION
Current Year
Responsible
Initiation/Duration
Activities and Services
Person/Provider
(Specify Date)
Serve as vice president of APSI, Inc.
_
Goals/Objectives that Support
Activities/Services
X Not Needed
Goals/Objectives that Support
Activities/Services
8/30/2006-8/30/2007
Date Completed ______________________
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