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: School: Student ID#: Bob Thorton Bishop Elementary 985732 Principal: Grade 4 Dec. 5, 2010 Mr. Strict School Year: 2010 - 2011 Gender: Male Date of Birth: March 19, 2001

Current Grade/Special Class: Most Recent IPRC Date: Exceptionality: Behaviour

Date Annual Review Waived by Parent:

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 Wide Range Achievement Test Fourth Edition Bender-Gestalt Date Nov. 15, 2012 Nov. 15, 2012 Nov. 15, 2012 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 Strength - kinesthetic learner - reading - articulate - one-on-one-learning

Areas of Need - visual memory processes - oral arithmetic - self-regulation - coping techniques - following directions - dealing with consequences appropriately Yes (List Below) X No

Specialized Health Support Services/Personal Support Required

Students 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. 2. 3. 4. 5. Math Language Arts Behavour MOD MOD MOD MOD MOD X AC X AC AC AC AC ALT ALT X ALT ALT ALT 6. 7. 8. 9 10. MOD MOD MOD MOD MOD AC AC AC AC AC ALT ALT ALT ALT 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 Assessment Accommodations - extra time - use of manipulatives - use of computer to complete tests and assignments

Accommodation and Exemptions for Provincial Assessments: Accommodations: Yes (List Below) No

Exemptions:

Yes (State educational rationale)

No

Special Education Program To be completed for each subject/course with modified expectations and/or alternative expectations. 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.

Student ID#: 985732

Learning Expectations (Knowledge and/or skills to be assessed by reporting period, including Grade level)

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)

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 peoples personal space

- breathing techniques and calming strategies - role play truth-telling scenarios - have Bob make hands-off posters

- reward chart for appropriate behaviour - reward chart for appropriate behaviour - observation that his posters show appropriate behaviour - checklist with success criteria - observation - conference with Bob after campaign to see if his stance on his bullying others has changed

- be able to recognize the value of other - have Bob write a letter explaining how peoples 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

IEP Developed by:

Staff Member Mr. Strict Mr. Oats Mr. Garrison Position Principal Special Education Teacher Classroom Teacher

Sources Consulted in the Development of the IEP: (check)

X X X IPRC Statement of Decision (if applicable) Provincial Report Card Previous IEP 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 students 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 Dec. 20, 2010

Completion Date of IEP Development Phase:

(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 X Provincial Report Card (Required if student has modified expectations and/or accommodations only) June 28, 2011 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 Ministrys standards, addresses the students strengths and needs, and the learning expectations will be reviewed and student progress monitored at least once every reporting period. Principals 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: Student Signature:

(If 16 or older)

Date: Date: