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School District Identifying Information

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


STUDENT NAME: Justin Manzanet
DATE OF BIRTH:
11/13/2000LOCAL ID #:
PROJECTED DATE IEP IS TO BE IMPLEMENTED: 04/25/2012

DISABILITY CLASSIFICATION: Learning Disability


PROJECTED DATE OF ANNUAL REVIEW: 04/25/2013

PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS


DOCUMENTATION OF STUDENT'S CURRENT PERFORMANCE AND ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS
EVALUATION RESULTS (INCLUDING FOR SCHOOL-AGE STUDENTS, PERFORMANCE ON STATE AND DISTRICT-WIDE ASSESSMENTS)
Justin is a fifth grade student who was evaluated by the WIAT-III to determine his overall achievement which included his basic reading and
mathematic abilities. Justin's performance indicates that his basic reading falls below average; putting him in the 8th percentile rank. Justin
functioned on an average to high average in his reading comprehension skills, however he foiund difficulty revolving arouns the listening
comprehension tasks. For the receptive voabulary portion of the test, Justin performed on an average level of achievement, meeting s 5.7 grade
equivilency. In the oral discourse section, in which the student is read aloud a sentence or short passage and then answer related questions
following; Justin received a below average mark, putting him at a 1.9 grade equivilant. This implies that the student had difficulties remaining
focused during the longer passages. Justin's overall mathematics score fell within an average level; putting him in the 23rd percentile. His strength
was in numerical operations, where his weakness was in math problem solving. Math problem solving is formatted as word problems. With these
results, it indicates that his reading abilities may have impeded his scores in math problem solving. This suggests that Justin is able to answer
correctly to grade appropriate math problems.
ACADEMIC ACHIEVEMENT, FUNCTIONAL PERFORMANCE AND LEARNING CHARACTERISTICS
LEVELS OF KNOWLEDGE AND DEVELOPMENT IN SUBJECT AND SKILL AREAS INCLUDING ACTIVITIES OF DAILY LIVING, LEVEL OF INTELLECTUAL
FUNCTIONING, ADAPTIVE BEHAVIOR, EXPECTED RATE OF PROGRESS IN ACQUIRING SKILLS AND INFORMATION, AND LEARNING STYLE:
Justin does not appear to be having any difficulties performing household and daily activities. He is able to take care of his personal needs without
assistance. There seems to be no concern with Justin's general intellegence, including his memory, problem solving ability, and language
functioning.There are no general concerns with Justin's ability to make decisions and appropriate judgements. Justin is independent in all selfcare
activities in his school environment. He uses the stairs, and transitions around school/ classroom, and participates in all movement activities (ex.
gym or recess) without any restrictions. He requires additional time and refocusing in order to complete any task given. His ability to process the
concept that is being taught and ability to complete classwork is affected by his inability to focus his attention. Justin has a hard time acquiring new
skills and needs many trials for mastery. Justin benefits from constant repetition and reinforcement. Justin learns best through visual, auditory,
handson and repetition. Justin transitions between subjects but often needs guidance and redirection to the next sequence of the activity.
Justin is able to do the differentiated work on his just right level in class however, he struggles with attention. The directions for the task at
hand need to be repeated many times. Justin needs to be refocused and prompted many times during the independent work. Justin's difficulty
remaining focused impacts his expected rate of progression in aquiring skills and information.
STUDENT STRENGTHS, PREFERENCES, INTERESTS:
New York State Education Department IEP Form

Justin seems to prefer working individually. Justin would benefit from multi-sensory presentation of material to motivate him to stay focused. Justin is
a very friendly student who is very cooperative.Justin enjoys playing video games and attends choir after school. Justin works best hands on. He
loves to use the IPAD and is always talking about app's to use on his tablet at home. Justin works best when
he is working one to one with the teacher. Justin demonstrates a motivation to learn. He wants to be able to read at grade level. He loves
reading non fiction books over fiction. Justin enjoys watching television, playing games on his tablet, and playing with friends.
ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF
CONCERN TO THE PARENT:
The lack of focus and struggle with reading skills are impeding his ability to progress.
*Justin requires additional time to process and answer questions.
*Justin needs concepts to be broken into steps and examples.
*Justin would benefit from reading material at his level to increase independence.
*Justin needs to work on his reading comprehension skills, particularly in retelling stories and drawing conclusions.
*Justin would benefit from comprehension strategies modeled for him (i.e. reread, use of pictorial clues, context clues) for better
comprehension and retelling with details and to make predictions and inferences.
*Justin needs close monitoring and refocusing to complete tasks.
*Justin needs to be seated close to the teacher to improve ability to focus and maintain attention and so that the teacher may provide
additional cue(s) as needed.
SOCIAL DEVELOPMENT
THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT'S RELATIONSHIPS WITH PEERS AND ADULTS; FEELINGS ABOUT SELF; AND SOCIAL
ADJUSTMENT TO SCHOOL AND COMMUNITY ENVIRONMENTS:
Overall, Justin is able to get along with peers and adults. Justin was very cooperative and respectful throught the testing period. Justin has a positive
image of himself. Justin is adjusted to his school setting and was able to adapt easily to a new environment.Justin is an energetic young boy who
enjoys working with his peers and helping them out when they need it. Justin may at times display
negative behaviors to escape from work. Justin tries to do work in the classroom, but his impulsivity and lack of attention may prevent him from
doing work correctly and until completion.
STUDENT STRENGTHS:
Justin was very motivated to continue his work despite his distractions. Justin is a very friendly student.Justin wants to be accepted by his friends
and tries to do the work required in class.
SOCIAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT:
Justin is determined to complete the tasks but his lack of attention often results in him not following rules or directions for tasks.
PHYSICAL DEVELOPMENT
THE DEGREE (EXTENT) AND QUALITY OF THE STUDENTS MOTOR AND SENSORY DEVELOPMENT, HEALTH, VITALITY AND PHYSICAL SKILLS OR
LIMITATIONS WHICH PERTAIN TO THE LEARNING PROCESS:
Parent reports that Justin is in good health and his physical development is age appropriate. Vision and hearing is said to be within normal
limits. Justinn sleeps well and eats well. Justin loves going to recess and gym. He loves to participate in all movement activities. There are no
physical development issues reported by parent.
STUDENT STRENGTHS:
Justin loves to play with his friends and willfully helps others in need.
New York State Education Department IEP Form

PHYSICAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT :
Parent reports that she is very concerned regarding Justin's inattention, hyperactivity and academic difficulties. Parent states that she
understands that in addition to other supports, Justin's inattention needs to be addressed.
Although Justin is motivated to improve his behavior, his inability to regulate his impulses limits his progress at times.
MANAGEMENT NEEDS
THE NATURE (TYPE) AND DEGREE (EXTENT) TO WHICH ENVIRONMENTAL AND HUMAN OR MATERIAL RESOURCES ARE NEEDED TO ADDRESS
NEEDS IDENTIFIED ABOVE: Justin would benefit from instructional strategies that increase attention such as private cueing, preferential seating task
analysis with positive reinforcement for successive approximation of the academic skills and short term goals that guide instruction.
EFFECT OF STUDENT NEEDS ON INVOLVEMENT AND PROGRESS IN THE GENERAL EDUCATION CURRICULUM OR, FOR A PRESCHOOL
STUDENT, EFFECT OF STUDENT NEEDS ON PARTICIPATION IN APPROPRIATE ACTIVITIES
Justin's academic and social deficits may interfere with his ability to complete assignments independently.
STUDENT NEEDS RELATING TO SPECIAL FACTORS
BASED ON THE IDENTIFICATION OF THE STUDENT'S NEEDS, THE COMMITTEE MUST CONSIDER WHETHER THE STUDENT NEEDS A PARTICULAR
DEVICE OR SERVICE TO ADDRESS THE SPECIAL FACTORS AS INDICATED BELOW, AND IF SO, THE APPROPRIATE SECTION OF THE IEP MUST
IDENTIFY THE PARTICULAR DEVICE OR SERVICE(S) NEEDED.
Does the student need strategies, including positive behavioral interventions, supports and other strategies to address
behaviors that impede the student's learning or that of others?
Yes
No
Does the student need a behavioral intervention plan?
No
Yes:
For a student with limited English proficiency, does he/she need a special education service to address his/her language needs
as they relate to the IEP?
Yes
No
Not Applicable
For a student who is blind or visually impaired, does he/she need instruction in Braille and the use of Braille?
Yes
No
Not Applicable
Does the student need a particular device or service to address his/her communication needs?
Yes
No
In the case of a student who is deaf or hard of hearing, does the student need a particular device or service in consideration
of the student's language and communication needs, opportunities for direct communications with peers and professional
personnel in the student's language and communication mode, academic level, and full range of needs, including
opportunities for direct instruction in the student's language and communication mode?
Yes
No
Not Applicable
Does the student need an assistive technology device and/or service?
Yes
No
If yes, does the Committee recommend that the device(s) be used in the student's home?
Yes
No
BEGINNING

NOT LATER THAN THE FIRST

IEP

TO BE IN EFFECT WHEN THE STUDENT IS AGE

15 (AND

AT A YOUNGER AGE IF DETERMINED APPROPRIATE)

MEASURABLE POSTSECONDARY GOALS


LONG-TERM GOALS FOR LIVING, WORKING AND LEARNING AS AN ADULT

EDUCATION/TRAINING:
New York State Education Department IEP Form

EMPLOYMENT:
INDEPENDENT LIVING SKILLS (WHEN APPROPRIATE):
TRANSITION NEEDS
In consideration of present levels of performance, transition service needs of the student that focus on the student's courses of
study, taking into account the students strengths, preferences and interests as they relate to transition from school to postschool activities:

MEASURABLE ANNUAL GOALS


THE FOLLOWING GOALS ARE RECOMMENDED TO ENABLE THE STUDENT TO BE INVOLVED IN AND PROGRESS IN THE GENERAL EDUCATION
CURRICULUM, ADDRESS OTHER EDUCATIONAL NEEDS THAT RESULT FROM THE STUDENT'S DISABILITY, AND PREPARE THE STUDENT TO MEET
HIS/HER POSTSECONDARY GOALS.
ANNUAL GOALS
WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE
BY THE END OF THE YEAR IN WHICH THE IEP IS IN
EFFECT

CRITERIA
MEASURE TO DETERMINE
IF GOAL HAS BEEN
ACHIEVED

Reading
In one year, using a multi sensory approach, Justin will
use information gained from text to demonstrate
understanding of the text (e.g., inferences, main idea,
fact, opinion).

3 out of 5 trials

Reading
In one year, using a multi sensory approach, Justin will
use information gained from text to demonstrate
understanding of grade level words by using context
clues (e.g., sentences, clues, key words, definitions).

60% Accuracy

Writing
In one year, using a multi sensory approach, Justin will
be able to develop an essay on an informational topic
focused on facts, details, and opinions by using a
graphic organizer and assistance from the teacher.

50% Accuracy

Math
In one year, using a multi sensory approach, Justin will

3 out of 5 trials

New York State Education Department IEP Form

METHOD
HOW PROGRESS WILL BE
MEASURED

Teacher Made Materials


Class Activities
Portfolio(s)
Teacher/Provider
Observations
Check Lists
Verbal Explanation
Teacher Made Materials
Class Activities
Portfolio(s)
Teacher/Provider
Observations
Verbal Explanation
Check Lists
Teacher Made Materials
Class Activities
Portfolio(s)
Teacher/Provider
Observations
Check Lists
Teacher Made Materials
Class Activities

SCHEDULE
WHEN PROGRESS WILL
BE MEASURED

3 times per
year

3 times per
year

3 times per
year

3 times per
year

be able to fluently multiply and divide two digit by two


digit whole numbers with teacher assistance.

Math
In one year, using a multi sensory approach, Justin will
be able to solve multi step word problems using the four
operations by using a graphic organizer

3 out of 5 trials

Portfolio(s)
Check Lists
Verbal Explanation
Teacher/Provider
Observations
Teacher Made Materials
Class Activities
Portfolio(s)
Teacher/Provider
Observations
Check Lists
Verbal Explanation

3 times per
year

REPORTING PROGRESS TO PARENTS


Identify when periodic reports on the student's progress toward meeting the annual goals will be provided to the student's
parents:

New York State Education Department IEP Form

ALTERNATE SECTION FOR STUDENTS WHOSE IEPS WILL INCLUDE SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS
(REQUIRED

FOR PRESCHOOL STUDENTS AND FOR SCHOOL-AGE STUDENTS WHO MEET ELIGIBILITY CRITERIA TO TAKE THE
ALTERNATE ASSESSMENT)

NEW YORK STATE

MEASURABLE ANNUAL GOALS


THE FOLLOWING GOALS ARE RECOMMENDED TO ENABLE THE STUDENT TO BE INVOLVED IN AND PROGRESS IN THE GENERAL EDUCATION
CURRICULUM OR, FOR A PRESCHOOL CHILD, IN APPROPRIATE ACTIVITIES, ADDRESS OTHER EDUCATIONAL NEEDS THAT RESULT FROM THE
STUDENT'S DISABILITY, AND, FOR A SCHOOL-AGE STUDENT, PREPARE THE STUDENT TO MEET HIS/HER POSTSECONDARY GOALS.
ANNUAL GOAL
WHAT THE STUDENT WILL BE EXPECTED TO ACHIEVE
BY THE END OF THE YEAR IN WHICH THE IEP IS IN
EFFECT

CRITERIA
MEASURE TO DETERMINE
IF GOAL HAS BEEN
ACHIEVED

METHOD
HOW PROGRESS WILL BE

SCHEDULE
WHEN PROGRESS WILL

MEASURED

BE MEASURED

SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS (INTERMEDIATE STEPS BETWEEN THE STUDENTS PRESENT LEVEL OF
PERFORMANCE AND THE MEASURABLE ANNUAL GOAL):

ANNUAL GOAL
CRITERIA
METHOD
SCHEDULE

SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS (INTERMEDIATE STEPS BETWEEN THE STUDENTS PRESENT LEVEL OF
PERFORMANCE AND THE MEASURABLE ANNUAL GOAL):

ANNUAL GOAL
CRITERIA
METHOD
SCHEDULE

SHORT-TERM INSTRUCTIONAL OBJECTIVES AND/OR BENCHMARKS (INTERMEDIATE STEPS BETWEEN THE STUDENTS PRESENT LEVEL OF
PERFORMANCE AND THE MEASURABLE ANNUAL GOAL):

(DUPLICATE TABLE/ROWS AS NEEDED)

New York State Education Department IEP Form

REPORTING PROGRESS TO PARENTS


Identify when periodic reports on the student's progress toward meeting the annual goals will be provided to the student's
parents:
RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES

SPECIAL EDUCATION PROGRAM/SERVICES


SPECIAL EDUCATION PROGRAM:

RELATED SERVICES:

SERVICE DELIVERY
RECOMMENDATION
S*

FREQUENC
Y

DURATIO
LOCATION

HOW

LENGTH

OFTEN
PROVIDED

OF
SESSION

WHERE

PROJECTED
BEGINNING/
SERVICE
DATE(S)

SERVICE WILL BE
PROVIDED

SUPPLEMENTARY AIDS AND


SERVICES/PROGRAM
MODIFICATIONS/ACCOMMODATIONS:

ASSISTIVE TECHNOLOGY DEVICES AND/OR


SERVICES:

SUPPORTS FOR SCHOOL PERSONNEL ON


BEHALF OF THE STUDENT:

* Identify, if applicable, class size (maximum student-to-staff ratio), language if other than English, group or individual services,
New York State Education Department IEP Form

direct and/or indirect consultant teacher services or other service delivery recommendations.

12-MONTH SERVICE AND/OR PROGRAM Student is eligible to receive special education services and/or program during
July/August:
No
Yes
If yes:
Student will receive the same special education program/services as recommended above.
OR
Student will receive the following special education program/services:

SPECIAL EDUCATION
PROGRAM/SERVICES

SERVICE DELIVERY
RECOMMENDATION

DURATIO
FREQUENCY
N

Name of school/agency provider of services during July and August:


For a preschool student, reason(s) the child requires services during July and August:

TESTING ACCOMMODATIONS (TO BE COMPLETED

LOCATION

PROJECTED
BEGINNING/
SERVICE
DATE(S)

FOR PRESCHOOL CHILDREN ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED

PRESCHOOL CHILDREN):

INDIVIDUAL TESTING ACCOMMODATIONS, SPECIFIC TO THE STUDENTS DISABILITY AND NEEDS, TO BE USED CONSISTENTLY BY THE STUDENT
IN THE RECOMMENDED EDUCATIONAL PROGRAM AND IN THE ADMINISTRATION OF DISTRICT-WIDE ASSESSMENTS OF STUDENT ACHIEVEMENT
AND, IN ACCORDANCE WITH DEPARTMENT POLICY, STATE ASSESSMENTS OF STUDENT ACHIEVEMENT
TESTING ACCOMMODATION
CONDITIONS*
IMPLEMENTATION RECOMMENDATIONS**
NONE
Extended time
Classwork and standardized assessments
Student will have Double Time for all tasks and
State exams.
Location with minimal distractions
standardized assessments
State testing only.
Preferential seating
Classroom activities
Seating with minimal distrations and in close
New York State Education Department IEP Form

perimeter to the teacher.


On-task focusing prompts
Classroom activities and state exams
Student will have directions read and reread,
including state exams.

*Conditions Test Characteristics: Describe the type, length, purpose of the test upon which the use of testing accommodations
is conditioned, if applicable.
**Implementation Recommendations: Identify the amount of extended time, type of setting, etc., specific to the testing
accommodations, if applicable.

BEGINNING

NOT LATER THAN THE FIRST

IEP

TO BE IN EFFECT WHEN THE STUDENT IS AGE

15 (AND

AT A YOUNGER AGE, IF DETERMINED APPROPRIATE).

COORDINATED SET OF TRANSITION ACTIVITIES


NEEDED ACTIVITIES TO FACILITATE
THE STUDENTS MOVEMENT FROM
SCHOOL TO
POST-SCHOOL ACTIVITIES

Instruction
Related Services
Community Experiences
Development of Employment and
Other Post-school Adult Living
Objectives
Acquisition of Daily Living Skills (if
applicable)
Functional Vocational Assessment (if
applicable)

SCHOOL DISTRICT/
AGENCY RESPONSIBLE

SERVICE/ACTIVITY

PARTICIPATION IN STATE AND DISTRICT-WIDE ASSESSMENTS


(TO

BE COMPLETED FOR PRESCHOOL STUDENTS ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL STUDENTS)

The student will participate in the same State and district-wide assessments of student achievement that are administered
to general education students.
The student will participate in an alternate assessment on a particular State or district-wide assessment of student
New York State Education Department IEP Form

achievement.
Identify the alternate assessment:
Statement of why the student cannot participate in the regular assessment and why the particular alternate assessment
selected is appropriate for the student:
PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES
REMOVAL FROM THE GENERAL EDUCATION ENVIRONMENT OCCURS ONLY WHEN THE NATURE OR SEVERITY OF THE DISABILITY IS SUCH THAT,
EVEN WITH THE USE OF SUPPLEMENTARY AIDS AND SERVICES, EDUCATION CANNOT BE SATISFACTORILY ACHIEVED.
FOR THE PRESCHOOL STUDENT:
Explain the extent, if any, to which the student will not participate in appropriate activities with age-appropriate nondisabled
peers (e.g., percent of the school day and/or specify particular activities):
FOR THE SCHOOL-AGE STUDENT:
Explain the extent, if any, to which the student will not participate in regular class, extracurricular and other nonacademic
activities (e.g., percent of the school day and/or specify particular activities):
If the student is not participating in a regular physical education program, identify the extent to which the student will
participate in specially-designed instruction in physical education, including adapted physical education:
EXEMPTION FROM LANGUAGE OTHER THAN ENGLISH DIPLOMA REQUIREMENT:
No
Yes - The Committee has determined that the
student's disability adversely affects his/her ability to learn a language and recommends the student be exempt from the
language other than English requirement.
SPECIAL TRANSPORTATION
TRANSPORTATION RECOMMENDATION TO ADDRESS NEEDS OF THE STUDENT RELATING TO HIS/HER DISABILITY
None.
Student needs special transportation accommodations/services as follows:

Student needs transportation to and from special classes or programs at another site:
PLACEMENT RECOMMENDATION
General education classroom

New York State Education Department IEP Form

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