I N D I V I D U A L I Z E D E D U C AT I O N P R O G R A M

STUDENTS NAME:
DOB

SCHOOL YEAR

6/20/1999

IEP INITIATION/DURATION DATES

FROM

2014

10/31/14

2015

GRADE

TO 10/30/15

THIS IEP WILL BE IMPLEMENTED DURING THE REGULAR SCHOOL TERM UNLESS NOTED IN EXTENDED SCHOOL YEAR SERVICES.

STUDENT PROFILE WILL INCLUDE GENERAL STATEMENTS REGARDING:

Strengths of the student:

!!
!
!
!

!!

!
!!
!!
!
!!
!!
!!
Johnny is very capable of completing tasks with some teacher prompting. In math, he does very
well with counting and can recognize numbers up to 100. He also has mastered rote counting.
These tasks and other math tasks become easier for Johnny when he is provided with
manipulatives. Johnny also loves books. He typically prefers books with engaging pictures and
anything to do with construction, outdoors, or science. He enjoys leveled books when they are
filled with pictures. His letter recognition has increased from the previous year. He is typically
able to listen and focus on a book, especially non-fiction text. This aligns with his listening
comprehension score being an 81. His receptive language is a strength because Johnny is able
to comprehend passages and texts that are read to him and also is able to follow multi-step
directions with prompts. As far as behavior is concerned, Johnny typically shows interest in
playing with others. He also is easily excited when shown a reward or incentive for his good
behavior. He is a very active boy who loves to play games.

!!
!!
!

Parental concerns:

Page

of

ALSDE Approved Feb. 2012

His mother states her greatest concerns for her child, academically, is that he is not where he needs to be and she is not
able to supervise his homework or assist him with take-home work. Her reasoning is because he is taken home by his
grandmother everyday and stays with her until she gets home from work. Long term, the mother would like to see
Johnny stay focused in class, make friends, and continue to improve in his education.
Student Preferences and/or Interests:
Johnny is very interested in anything construction. This includes Tonka, legos, building blocks and iPad game Kids
Construction Vehicles. His favorite books is Goodnight, Goodnight, Construction Site. In general, he loves any use of
the iPad. He also has started playing Minecraft. His favorite subject is science because he is able to get out of his seat
and learnin a hands-on approach. He also loves art and any opportunity he gets to draw. Johnny seems to want to
participate in activities with his friends, but does not know how to interact with them. In essence, he typically prefers
working by himself.
Results of the most recent evaluations:

Page

of

ALSDE Approved Feb. 2012

KTEA II: Total=65 (Letter/Word recognition-79, Reading Comprehension- 65, Reading total- 70; Math concepts and
applications- 67, math computation- 66, math total- 63; Written expression- 67, Spelling- 66, Written Language total66, Listening comprehension- 76, Oral Expression- 60, Oral language total- 64)

!Adaptive Behavior Assessment System Second Edition (ABAS-II) Home Version

Adaptive Skills Q- 40 (Conceptual domain- 49, social domain- 55, practical domain- 40)
Adaptive Behavior Assessment System Second Edition (ABAS-II)- School version
Adaptive Skills Q- 40 (conceptual domain- 50, social domain- 55, practical domain- 43)

!Behavior Evaluation Scale Third Edition- School (BES-3)

Quotient- 86
!Documentation of Severe Communication Needs/Impairment

Student demonstrates language deficits as indicated: Does not ask/answer questions appropriately, express himself
effectively.

!Environmental, Cultural, Language

ECEC checklist- Three areas checked: 1 in Environmental; 1 in Cultural; 1 in Economic
!Stanford-Binet Intelligence Scales (SB5)
Full Scale- 65; (Verbal Intelligence Quotient- 64, Non-verbal intelligence quotient- 69)
!Expressive One Word Picture Vocabulary Test- 2000
Standard Score- 67
!OWLS- Listening Comprehension and Oral Expression
Oral Composite- 72 (Listening comprehension- 81, oral expression- 66)
!Berry Buktencia Developmental Test of Visual Motor Integration- 4
VMI 64 (Visual- 69, Motor coordination- 65)
!Observation

He is having a difficult time staying on task, teacher redirects him 3 times to get started on his math, the math problem
was: Add 18 and 7. He used counters to add them, he counted tokens one at a time, after counting to 25, he stared away,
teacher redirects him to write his answer, he wrote the answer slowly, looks around the room, he told the teacher 12 plus
6 was easy, he wrote the answer 6, teacher circled addition sign, teacher reminded him that it was addition, he said oh,
okay and erased his answer, he used counters again and realized the answer was 18, he completed 6/9 simple addition
and subtraction problems in 30 minutes time, he had to correct 3 out of those 6.

!Record Review

Accommodations (Inclusive setting, small group directed instruction)

Documentation to rule out lack of appropriate instruction
The student has participated in the locally adapted research based reading curriculum, and the instruction was provided
w/fidelity. The student has participated in a research based math program according to the local math pacing guide. The
student has received reading and/or math instruction by a highly qualified teacher (Student transferred from Florida in
late March 2009).

!Grades
4 nine weeks progress= (reading- 71, language-77, math-64, science -60, social studies -62)
!Vision
th

Passed with glasses

The academic, developmental, and functional needs of the student:

Page

of

ALSDE Approved Feb. 2012

Johnny has some difficulty with his attention span in class. His attention span increases when the teacher intervenes.
The goal for Johnny is to be able to complete a task over the time span of 10 minutes without teacher intervention.
There will be steps to help him achieve his goal.
He is not on grade level for reading (on two grade levels below). The IEP team will work together so that Johnny will be
able to read first grade level text. He may initially use picture supports, but the end goal is for him to be able to read
without visual support with a 75% accuracy trials (RF.1.4a)
In math, we are going to focus on subtraction and addition. Once these skills are mastered, he will have a solid
foundation to build off in the future. He wll be introduced to mental math strategies and notecards to help him fluently
add an subtract with at least 75% accuracy in 3/3 trials (2-OA2).
Johnny has some difficulties with expressive communication. He is a very bright student who comprehends information
very well. He will work on answering WH questions: who, what, when, where, and why. This will help his
comprehension by answering with the appropriate response trials with 75% accuracy (RL.2.1)
Other:

For the child transitioning from EI to Preschool, justify if IEP will not be implemented on the childs 3
birthday:

Page

of

ALSDE Approved Feb. 2012

!
!

I N D I V I D U A L I Z E D E D U C AT I O N P R O G R A M
STUDENTS NAME:

!!
!!
YES

!!
!!
NO

Does the student have limited English proficiency?

[ ]

[x]

Does the student need instruction in Braille and the use of Braille?

[ ]

[x]

Does the student have communication needs (deaf or hearing impaired only)?

[x]

[ ]

Does the student need assistive technology devices and/or services?

[ ]

[x ]

Does the student require specially designed P.E.?

[ ]

[x]

Is the student working toward alternate achievement standards and participating in the
Alabama Alternate Assessment?

[ ]

[x ]

Are transition services addressed in this IEP with an annual goal(s)?

[ ]

[ x]

!
SPECIAL INSTRUCTIONAL FACTORS
!Items checked YES will be addressed
in this IEP:
! Does the student have behavior which impedes
his/her learning or the learning of others?

[x]

[ ]

TRANSPORTATION AS A RELATED SERVICE

!
Students mode of transportation:
[ ] Regular bus

[ ] Bus for special needs

[ ] Parent contract

Does the student require transportation as a related service?

[ ] YES

[ x ] Other:

Parent transportation

[x ] NO

If yes, check any transportation needs:

[ ]

Bus assistance:

[ ] Adult support

[ ]

Preferential seating

[ ]

Behavioral Intervention Plan

[ ]

Wheelchair lift and securement system

[ ]

Restraint system

[ ] Medical support

Specify type:

!
Page

[ ]

Other. Specify:

[ ]

Bus driver and support personnel are aware of the students behavioral and/or medical concerns.

of

ALSDE Approved Feb. 2012

NONACADEMIC and EXTRACURRICULAR ACTIVITIES

Will the student have the opportunity to participate in nonacademic/extracurricular activities with his/her nondisabled
peers?
[ x ] YES.
[ ]

YES, with supports. Describe:

[ ]

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

Page

of

weeks).

ALSDE Approved Feb. 2012

I N D I V I D U A L I Z E D E D U C AT I O N P R O G R A M
STUDENTS NAME:

!!
[ ]
[ ]

[ ]

This student is in a middle school course of study that will help prepare him/her for transition.
This student was invited to the IEP Team meeting.
After prior consent of the parent or student (Age 19) was obtained, other agency representatives were invited to the
IEP Team meeting.

EXIT OPTIONS (Complete for students in Grades 9-12)

[ ]

Alabama High School Diploma

[ ]

Alabama Occupational Diploma

[ ]

Graduation Certificate

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 Assessments (Check the assessment(s) used to determine the students measurable transition goals):
!
[ ] Transition Planning Assessments
[ ] Interest Inventory
[ ] Other
!Goals
for Postsecondary Transition:
!Postsecondary
Education/Training Goal

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)

!If Other is selected, specify

!Employment/Occupation/Career Goal
!If Other is selected, specify
!Community/Independent Living Goal
!If Other is selected, specify
!Transition Services:

Based on the student's strengths, preferences, and interests, the following coordinated transition
services will reasonably enable the student to meet the postsecondary goals. Consider these service areas: Vocational
Evaluations (VE), Community Experiences (CE), Personal Management (PM), Transportation (T), Employment Development (ED),
Medical (M), Postsecondary Education (PE), Living Arrangements (LA), Linkages to Agencies (LTA), Advocacy/Guardianship (AG),
Financial Management (FM), and if appropriate Functional Vocational Evaluation (FVE).

Page

of

ALSDE Approved Feb. 2012

!
!

Transition Strands
Academics/Post Secondary
Education/Training

!Service(s)

Employment/
Occupations/
Careers

Personal/ Social

Daily Living

Page

of

ALSDE Approved Feb. 2012

INDIVIDUALIZED

!!
!
E D U C AT I O N

PROGRAM

STUDENTS NAME:

[ ] This goal is related to the students transition services needs.

AREA:

READING

!PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE:

!
In reading, Johnny is able to identify 21/26 alphabelt letters and can identify 18 coresponding letter sounds. He can also
identify some CVC words but struggles to decode first grade level words without the support of an illustration or
picture. He can recognize first grade Dolch sight words with 85% accuracy.
MEASURABLE ANNUAL GOAL related to meeting the students needs: DATE OF MASTERY:
By April 2015, Johnny will be able to read first grade level text without picture supports with 75% accuracy on trials.
(RF.1.4a).

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:

[ x ] Curriculum Based Assessment [ ] Teacher/Text Test
[ x ] Teacher Observation
[ x ] Data Collection
[ ] State Assessment(s) [ ] Work Samples
[ ] Other:

[ ]

[ ]

Grades

Other:

BENCHMARKS:
1.

By November 2014, Johnny will be able to recognize all letters and corresponding
sounds of the alphabet with 85% accuracy 4/4 trials (RF.K.3a).

2.

By January 2015, Johnny will be able to read CVC words within a text using picture Date of Mastery:
supports with 85% accuracy on 4/4 trials (RF.K.2d).

3.

By March 2015, Johnny will be able to read a first grade text using minimal picture
supports with 85% accuracy on 4/4 trials (RF.1.4a).

Date of Mastery:

Date of Mastery:

[ ] This goal is related to the students transition services needs.

AREA:

MATH

!PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE:

In math, Johnny is able to complete single digit addition problems independently (K-OA2). Recognize addition and
subtraction symbols with prompting (1-OA1), identify numbers up to 100, and use simple manipulative objects
(counters, chips, etc) to count and work out problems. Johnny can also write out numbers correctly, but his lack of
concentration impedes his ability to do so with comprehension. His reliance on manipulatives impedes his ability to
compute problems mentally (2-OA2) and therefore is unable to complete basic mathematical problems in adequate
amount of time.
Page

of

ALSDE Approved Feb. 2012

MEASURABLE ANNUAL GOAL related to meeting the students needs: DATE OF MASTERY:
By April, Johnny will be able to fluently add and subtract within 20 using mental strategies with at least 75% accuracy
on 3/3 trials (2-OA2).

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:

[ X ] Curriculum Based Assessment [ ] Teacher/Text Test
[ X ] Teacher Observation
[ ] Data Collection
[ ] State Assessment(s) [X] Work Samples
[ ]

Other:

[ ]

[ ]

Grades

Other:

BENCHMARKS:
1.

By November 2014, Johnny will be able to fluently add within 20 using at least one
mental strategy with 80% accuracy on 3/3 trials (2-OA2).

Date of Mastery:

2.

By January 2015, Johnny will be able to fluently subtract within 20 using at least
one mental strategy with 80% accuracy on 3/3 trials (2-OA2).

Date of Mastery:

3.

By March 2015, Johnny will be able to fluently add and subtract within 20 using at
least one mental strategy with 70% accuracy on 3/3 trials. (2-OA2).

Date of Mastery:

!!
!

I N D I V I D U A L I Z E D E D U C AT I O N P R O G R A M

STUDENTS NAME:

[ ] This goal is related to the students transition services needs.

AREA:

Behavior

!PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE:

Johnny is able to stay focused on one assignment for 5 minutes at a time or longer with additional prompting from the
teacher. He can also sit in his chair for five minutes without prompting from his teacher. When working in a group,
Johnny works well with the other students as long as they are patient and understanding of him.
MEASURABLE ANNUAL GOAL related to meeting the students needs: DATE OF MASTERY:
By April 2015, Johnny will be able to sit in his chair and focus on his assignment for 10 minutes without teacher
propting 4/5 times.

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:

[ ] Curriculum Based Assessment [ ] Teacher/Text Test
[ x ] Teacher Observation
[ x ] Data Collection
[ ] State Assessment(s) [ ] Work Samples
[ x ] Other:

[ ]

[ ]

Grades

Other:

Chart/reward system

BENCHMARKS:

Page

of

ALSDE Approved Feb. 2012

1.

By November 2014, Johnny will be able to focus on his work for 7 minutes given
one stretching break in between his work time on 4/5 times

2.

By January 2015, Johnny will be able to focus on his work for 10 minutes given one Date of Mastery:
stretching break in between his work time on 4/5 times

3.

By March 2015, Johnny will be able to focus on his work for 10 minutes given one
stretching break after the 10 minutes 4/5 times.

4.

Date of Mastery:

Date of Mastery:
Date of Mastery:

!
!!

[ ] This goal is related to the students transition services needs.

AREA:

Language

!PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE:

Johnny is able to respond verbally with yes or no by indicating with his head when asked a question by
a peer or teacher. He has a very low volume level when communicating with peers and teachers.
MEASURABLE ANNUAL GOAL related to meeting the students needs: DATE OF MASTERY:

By April 2015, He will be able to respond to questions such as who, what, when, where, why, and how
with appropriate volume on trials with 75% accuracy. (RL.2.1).

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:

[ ] Curriculum Based Assessment [ ] Teacher/Text Test
[ X ] Teacher Observation
[ x ] Data Collection
[ ] State Assessment(s) []
Work Samples
[ ]

Other:

[ ]

[ ]

Grades

Other:

BENCHMARKS:
1.

By November 2014, Johnny will be able to respond yes or no with

appropriate volume in trials with 80% accuracy.

Date of Mastery:

2.

By January 2015, Johnny will be able to respond to wh questions in

traisl with 75% accuracy.

Date of Mastery:

3.

By March 2015, Johnny will be able to respond to wh questions with

appropriate volume in trials with 80% accuracy.

Date of Mastery:

!
!!Students Name:
Page

of

INDIVIDUALIZED

!!
!
E D U C AT I O N

PROGRAM

ALSDE Approved Feb. 2012

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.)

Special Education

Amount
of time

Johnny will receive small group

instruction in reading everday

Everyday

30 min

11/1/to10/29

General Ed classroom
preferably

Johnny will receive small group

instruction in math every day.

everyday

30 min

11/1to10/29

General Ed classroom
preferably

Johnny will recive small group instruction

for behavioral needs

Everyday

10 min

11/1 to 10/29

Special Ed classroom

Related Services

[x ] Needed

[ ] Not Needed

Service(s)

Speech/Language

!
Supplementary Aids and Services
!
Service(s)

Anticipated
Frequency of
Service(s)

Amount
of time

Weekly

30 min

Beginning/Ending
Duration Dates

Anticipated
Frequency of
Service(s)

Service(s)

Beginning/Ending
Duration Dates

11/1 to 10/29

Location of Service(s)

Location of Service(s)

Speech room

to

[ x ] Needed

[ ] Not Needed

Anticipated
Frequency of
Service(s)

Amount
of time

Beginning/Ending
Duration Dates

Location of Service(s)

Johnny will have a picture schedule to stay Everyday

on task everyday

All day

11/1 to 10/29

All school
environments

Johnny will have a lego reward system

(similar to token reward system)

All day

11/1 to 10/29

All school
environments

!
Program Modifications
!
Service(s)

Everyday

[ ] Needed

[ x] Not Needed

Anticipated
Frequency of
Service(s)

Amount of
time

Beginning/Ending
Duration Dates

Location of Service(s)

to
to

Accommodations Needed for

Assessments

Page

Service(s)
of

[ x ] Needed
Anticipated
Frequency of
Service(s)

[ ] Not Needed
Amount of
time

Beginning/Ending
Duration Dates

Location of Service(s)
ALSDE Approved Feb. 2012

Johnny will be assessed on his averaged When needed

accuracy of 3 separate trials.

Dependent
on subject

11/1 to 10/29

All school
environments

to

!
Assistive Technology

Service(s)

[ ] Needed

[ x ] Not Needed

Anticipated
Frequency of
Service(s)

Amount
of time

Beginning/Ending
Duration Dates

Location of Service(s)

to
to

!
Support for Personnel

[ ] Needed

Service(s)

Anticipated
Frequency of
Service(s)

[ x ] Not Needed
Amount
of time

Beginning/Ending
Duration Dates

Location of Service(s)

to

!
INDIVIDUALIZED
!
!STUDENTS NAME: JOHNNY APPLESEED

to
E D U C AT I O N P R O G R A M

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

!The IEP Team has considered the need for extended school year services.

[ x ] Yes

[ ] 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? [ ] Yes [ x] No
If no, explain (explanation may not be solely because of needed modifications in the general curriculum):
He gets pulled to go into the resource room

[ X ] 6-21 YEARS OF AGE

[ ] 3-5 YEARS OF AGE

Least Restricted Environment:

General education classroom

COPY OF IEP
Page

of

COPY OF SPECIAL EDUCATION RIGHTS

ALSDE Approved Feb. 2012

Was a copy of the IEP given to parent/student (age 19) at

the IEP Team meeting?
[ x ] Yes
[ ] No

Was a copy of the Special Education Rights given to parent/

student (age 19) at the IEP Team meeting?
[x ] Yes
[ ] No

!If no, date sent: `

!If no, date sent:
!
Date copy of amended IEP provided/sent to parent/student (age 19)
!

THE FOLLOWING PEOPLE ATTENDED AND PARTICIPATED IN THE MEETING TO DEVELOP THIS IEP.

Position

Signature

Date

Parent
Parent
General Education Teacher
Special Education Teacher
LEA Representative
Someone Who Can Interpret The Instructional
Implications Of The Evaluation Results
Student
Career/Technical Education Representative
Other Agency Representative

INFORMATION FROM PEOPLE NOT IN ATTENDANCE

Position

Page

of

Name

Date

ALSDE Approved Feb. 2012