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INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Students Name: Bic Mitchum


INDIVIDUALIZED EDUCATION PROGRAM (IEP)

School Age

Students Name:

Bic Mitchum

IEP Team Meeting Date (mm/dd/yy):

10-13-2015

IEP Implementation Date (Projected Date when Services and Programs Will Begin):
Anticipated Duration of Services and Programs:
Date of Birth:
Age:
Grade:

10-14-2015
10-13-2016

5-25-2000

15 Yrs. 4 Mos.
9th

Anticipated Year of Graduation:


Local Education Agency (LEA):
County of Residence:

2019
Mastery Charter School-Gratz Campus
Philadelphia County

Name and Address of Parent/Guardian/Surrogate:


Gillette Mitchum

Phone (Home):

215-800-0000

Phone (Work):

610-555-5555

6789 Barbasol Ave, Philadelphia, PA 19111

Other Information:

Most Recent re-evaluation: 10/12/2013


Primary Disability: Specific Learning Disability in Reading
Secondary Disability: Speech or Language Impairment
Related Services: Speech Therapy- 960 minutes (group) per IEP term.

The LEA and parent have agreed to make the following changes to the IEP without convening an IEP meeting, as documented by:
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April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum

Date of Revision(s)

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Participants/Roles

IEP Section(s) Amended

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
IEP TEAM/SIGNATURES
The Individualized Education Program team makes the decisions about the students program and placement. The students parent(s), the students special
education teacher, and a representative from the Local Education Agency are required members of this team. Signature on this IEP documents attendance, not
agreement.
Role

Printed Name

Signature

Parent/Guardian/Surrogate

Gillette Mitchum

Gillette Mitchum

Student*

Bic Mitchum

Bic Mitchum

Regular Education Teacher**

Christine Rock

Christine Rock

Special Education Teacher

Jennifer Cooper

Jennifer Cooper

Local Ed Agency Rep

Phillip Smith

Philip Smith

Maggie Gleason

Maggie Gleason

Parent/Guardian/Surrogate

Career/Tech Ed Rep***
Community Agency Rep
Teacher of the Gifted****
Speech & Language Therapist

*
The IEP team must invite the student if transition services are being planned or if the parents choose to have the student participate.
**
If the student is, or may be, participating in the regular education environment
***
As determined by the LEA as needed for transition services and other community services
****
A teacher of the gifted is required when writing an IEP for a student with a disability who also is gifted.
One individual listed above must be able to interpret the instructional implications of any evaluation results.
Written input received from the following members:
Colin Bussisere-Nichols: Algebra 1
Christopher Irving: Leveled Literacy

Transfer of Rights at Age of Majority


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INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
For purposes of education, the age of majority is reached in Pennsylvania when the individual reaches 21 years of age. Likewise, for purposes of the Individuals
with Disabilities Education Act, the age of majority is reached for students with disabilities when they reach 21 years of age.

PROCEDURAL SAFEGUARDS NOTICE

I have received a copy of the Procedural Safeguards Notice during this school year. The Procedural Safeguards Notice provides information about my rights,
including the process for disagreeing with the IEP. The school has informed me whom I may contact if I need more information.
Signature of Parent/Guardian/Surrogate:

Gillette Mitchum

MEDICAL ASSISTANCE PROGRAM BILLING NOTICE


(Applicable only to parents who have consented to the release of billing information to Medical Assistance programs)
I understand that the school may charge the School-Based Access Program (SBAP)or any program that replaces or supplements the SBAPthe cost of
certain special education and related services described in my childs IEP. To make these charges to the SBAP, the school will release to the administrator of
that program the name, age, and address of my child, verification of Medicaid eligibility for my child, a copy of my child s IEP, a description of the services
provided and the times and dates during which such services were provided to my child, and the identity of the provider of such services. I understand that
such information will not be disclosed, and such charges will not be made, unless I consent to the disclosure. I acknowledge that I have provided written
consent to disclose such information.
I understand that my consent is ongoing from year-to-year unless and until I withdraw it. I can withdraw my consent in writing, or orally if I am unable to
write, at any time. My refusal to consent or my withdrawal of consent will not relieve the school of the obligation to provide, at no cost to me or my family,
any service or program to which my child is entitled under the Individuals with Disabilities Education Act ( IDEA) or that is necessary to enable my child to
receive a free appropriate public education as described in my childs IEP.
I understand that the school cannot
Require me or my family to sign up for or enroll in any public benefits or insurance program, such as Medicaid, as a condition of receiving a free appropriate
public education for my child;
Require me or my family to incur any expense for the provision of a free appropriate public education to my child, including co-payments and deductibles,
unless it agrees to pay such expenses on my or my familys behalf;
Cause a decrease in available lifetime coverage or any other insured benefit;
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Students Name: Bic Mitchum
Cause me or my family to pay for services that would otherwise be covered by a public benefits or insurance program and that are required for my child
outside the time that he or she is in school;
Risk the loss of eligibility for home and community-based waivers, based on aggregate health-related expenditures.

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Students Name: Bic Mitchum
I. SPECIAL CONSIDERATIONS THE IEP TEAM MUST CONSIDER BEFORE DEVELOPING THE IEP. ANY FACTORS CHECKED AS YES MUST BE ADDRESSED IN THE IEP.
Is the student blind or visually impaired?
Yes

The IEP must include a description of the instruction in Braille and the use of Braille unless the IEP team determines, after an
evaluation of the students reading and writing skills, needs, and appropriate reading and writing media (including an
evaluation of the students future needs for instruction in Braille or the use of Braille), that instruction in Braille or the use of
Braille is not appropriate for the student.

No

Is the student deaf or hard of hearing?


Yes

The IEP must include a communication plan to address the following: language and communication needs; opportunities for
direct communications with peers and professional personnel in the students language and communication mode; academic
level; full range of needs, including opportunities for direct instruction in the students language and communication mode;
and assistive technology devices and services. Indicate in which section of the IEP these considerations are addressed. The
Communication Plan must be completed and is available at www.pattan.net

No

Does the student have communication needs?


X

Yes

Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual goals, etc.)

No

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


Yes

Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction, annual goals, etc.)

No

Does the student have limited English proficiency?


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Students Name: Bic Mitchum
Yes

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The IEP team must address the students language needs and how those needs relate to the IEP.

No

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
Does the student exhibit behaviors that impede his/her learning or that of others?
Yes

The IEP team must develop a Positive Behavior Support Plan that is based on a functional assessment of behavior and that
utilizes positive behavior techniques. Results of the functional assessment of behavior may be listed in the Present Levels
section of the IEP with a clear measurable plan to address the behavior in the Goals and Specially Designed Instruction sections
of the IEP or in the Positive Behavior Support Plan if this is a separate document that is attached to the IEP. A Positive Behavior
Support Plan and a Functional Behavioral Assessment form are available at www.pattan.net

No

Other (specify):

II. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE


Include the following information related to the student:
Present levels of academic achievement (e.g., most recent evaluation of the student, results of formative assessments, curriculum-based
assessments, transition assessments, progress toward current goals)
Present levels of functional performance (e.g., results from a functional behavioral assessment, results of ecological assessments, progress
toward current goals)
Present levels related to current postsecondary transition goals if the students age is 14 or younger if determined appropriate by the IEP team
(e.g., results of formative assessments, curriculum-based assessments, progress toward current goals)
Parental concerns for enhancing the education of the student
How the students disability affects involvement and progress in the general education curriculum
Strengths
Academic, developmental, and functional needs related to students disability
Present Levels of Academic Achievement:

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
INTRODUCTION
Bic is a 15 year old student currently attending Simon Gratz Mastery Charter School (SGMC).
This is Bic's first year attending Mastery-Gratz Campus. Prior to attending SGMC Bic attending
Mastery Charter School-Pastorius Campus. Bic was first referred for an evaluation in 2006 to
determine eligibility for speech and language services. He was found to have a severe
articulation disorder and has been receiving speech language therapy since the first grade.
Bic was re-evaluated on October 17, 2013. Results from the re-evaluation indicated that Bic
was still eligible to receive special education services as a student with a specific learning
disability in reading. Bic also continued to qualify for speech therapy as a student with a
secondary disability of speech or language impairment. Bic lives at home with his parents and
four siblings. Bic is a very polite, well-mannered and friendly young man. In his spare time,
Bic enjoys riding bikes, playing video games and hanging out with his friends. Bic is well liked
by his teachers and peers. Bic's favorite subjects in school are Math and Gym, and his least
favorite subjects are Reading and Writing. Currently, Bic is participating in both math and
reading intervention programs daily. In addition, Bic receives speech therapy for 30 minutes,
1 time a week.
EDUCATIONAL RE-EVALUATION SUMMARY
Bic was reevaluated as a 7th grade student at Mastery Charter School- Pastorius Campus
during his triennial re-evaluation process. According to the reevaluation conducted
(10/17/2013) by Opeyemi Akanbi, Bic is eligible for special education services under the
primary disability category, Specific Learning Disability in reading, and a secondary disability
category of Speech or Language Impairment.
COGNITIVE ASSESSMENTS
Bic was administered the Differential Ability Scales, Second Edition (DAS-II) on September 23,
2013.
The DAS-II provides an estimate of a student's overall cognitive abilities. According to the
DAS-II, Bic's overall cognitive functioning (GCA) was found to be in the Low range, less
developed than his same aged peers. Results of cognitive assessments indicate that Bic does
better on tasks that allow him to use visual cues as well as timed tasks that involve automatic
processing. He does less well on tasks that require him to utilize short-term memory with no
visual cues, as well as overall verbal and nonverbal reasoning. Academically, Bic continues to
struggle in all areas of reading and also needs help with encoding.
ACHIEVEMENT ASSESSMENTS
On September 24, 2013 Bic was administered the Wechsler Individual Achievement Test-Third
Edition (WIAT-III). The WIAT-III is an individually administered test that measures an
individual's academic achievement. It consists of sixteen subtests that create the Total
Achievement Score, which is used to evaluate listening, speaking, reading, writing, and
mathematics skills. Overall, Bic scored within the Low Range on the Total Reading, Basic
Reading, and Reading Comprehension and Fluency Composites. His performance on the Oral
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Students Name: Bic Mitchum
Language and Written Expression composites were variable. However, he performed better or
receptive language measures than he did on expressive language (also as measured by the
DAS-II cognitive assessment). When it comes to writing, he struggled with spelling words but
performed better when composing sentences and an essay. Bic performed within the Below
Average Range on the Mathematics composite and within the Average Range on the Math
Fluency composite, suggesting that his automaticity with basic math facts is more developed
than his problem-solving and calculations.
ASSESSMENT SUMMARY

Fountas & Pinnell Reading Assessment


In September of 2015, Bic was administered the Fountas & Pinnell Reading Assessment.
According to Bic's results he is currently reading independently at letter K (2.0). Letter K
indicates that Bic is reading independently on a second grade level. Bic's instructional reading
level is letter L (2.5). Letter K represents a second grader, 5 months into school.
Calculation Digits Correct Assessment
On October 8, 2015 Bic was administered the Digits Correct Math Assessment. Bic correctly
answered 32 digits out of a total of 62 total digits on a grade 4 math probe. Bic's results place
him in the 75th percentile for the fall.
STAR Math assessment
On August 26, 2015 Bic was administered the STAR Math Assessment. Bic's results indicate
that he is working at a 4.6 (Grade Equivalent). Bic's test performance is comparable to that of
an average fourth grader after the sixth month of the school year.
BENCHMARK ASSESSMENTS
At the beginning of the 2014-2015 school year, Bic participated in
examinations to gauge progress towards grade level standards.
Date
Assessment
6/11/15
Science
6/11/15
Composition
6/11/15
Literature
6/11/15
Math

a series of benchmark
Performance Level
Below Basic
Below Basic
Below Basic
Below Basic

*Benchmark testing for RP1 2015, has not yet been administered to Bic. Benchmark
testing begins October 21,2015
CURRENT GRADES
*African-American History
Algebra 99 %
Leveled Literacy Intervention 95%
Corrective Reading 98%
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Students Name: Bic Mitchum

Freshman Seminar 90%


*Foundational Writing Course
Art 79%
Math Foundations 94%
UPDATE ON PREVIOUS IEP GOALS
READING: Bic will read at a level P (4.00) with 98% accuracy, a comprehension score of 77%
or higher and a reading fluency speed of 100 words per minute as measured by a researchbased literacy assessment. Baseline: Currently Bic reads at level M (3.00) with 99% accuracy,
a comprehension score of 100% and a reading fluency speed of 122 words per minute.
UPDATE:
In September of 2015, Bic was administered the Fountas & Pinnell Reading Assessment.
According to Bic's results he is currently reading independently at letter K (2.0). Letter K
indicates that Bic is reading independently on a second grade level. Bic's instructional reading
level is letter L (2.5). Letter K represents a second grader, 5 months into school.

MATH: Bic will answer 33 or more digits correctly in 2 out of 3 trials to equate to a beginning
of 5th grade level equivalency in his math computation skills, as measured by Computation
Digits Correct given three times per report period. These computation areas include: Division,
Multiplication, Addition and Subtraction of Fractions. Baseline: On the fourth grade Basic Math
Computation Digits Correct Test, Bic got 24 digits correct which correlates into a grade
equivalency of the beginning of fourth grade (50th percentile).
UPDATE:
On August 26, 2015 Bic was administered the STAR Math Assessment. Bic's results indicate
that he is working at a 4.6 (Grade Equivalent). Bic's test performance is comparable to that of
an average fourth grader after the sixth month of the school year.
TEACHER INPUT
Colin Bussiere-Nichols (Algebra 1):
Mr. Bussiere-Nichols completed a Teacher Input Form for Bic on 10/7/15. According to Mr.
Bussiere-Nichols, Bic is currently passing Algebra 1 with a 98%. Mr.Bussiere-Nichols shared
that Bic is well behaved in class and is "always happy". Mr. Bussiere-Nichols added that "Bic is
one of the hardest working students I have ever seen". Mr. Bussiere-Nichols also shared that
Bic completes his homework, classwork and independent work in on time daily.

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Students Name: Bic Mitchum
Present Level of Functional Performance:
DISCIPLINE HISTORY
Since the beginning of the school year, Bic has not earned any Level II offenses, however Bic has
had minor infractions. On 9/18/15 Bic filled 1 demerit card.
ATTENDANCE (As of 8/15 )
Unexcused Absences: 0
Excused Absences: 0
Unexcused Tardies: 0
SPEECH/LANGUAGE ASSESSMENTS
Bic was administered three test to assess his speech/language. The following formal assessments
were administered with the following results:
*Expressive One-Word Picture Vocabulary Test-tests the verbal-auditory-visual ability to
name vocabulary. Results showed a standard score of 75 and age equivalent of 8 yrs.-0 months.
This score is below average for his age.
*Oral and Written Language Scales-test listening comprehension subtest resulted in a
standard score of 81, age equivalent of 9 yrs. -0 months. This score is below average for Bic's
age. The Oral Expression subtest resulted in a standard score of 81, language age of 8 yrs.-11
months. This is also below average of his age. There is no statistical difference between the two
scores.
*The Goldman-Fristoe 2 Test of Articulation-a test of speech sound production in spoken
sentences. The following sounds are in error: sh, ch, r, j, and inconsistent L and R blend sounds.
During conversational speech (longer utterances) speech sound errors increase, are very
noticeable and interfere with intelligibility.
SPEECH/PRESENT LEVELS
Bic attends small group speech therapy sessions, where he works on improving the articulation of
his target sounds, which are /r/, /r-blends/ and /l-blends/. In regards to his articulation skills, Bic
has made significant improvements towards his goal during this past IEP term. Per his progress
reporting results from Report Period 4 of last school year, Bic has mastered the articulation of
the /r/ phoneme in all positions at the word level. During a structured task, at the sentence level,
Bic is articulating the /r/ phoneme in the initial position with 100% accuracy. However, his
accuracy decreases to 45% when the /r/ is in the medial and final position of words at the
sentence level. He requires cues to utilize correct tongue positioning consistently when
attempting to co-articulate the /r/ sound with other sounds within a sentence. He has also made
significant improvement with his articulation of /r-blends/ and /l-blends/ at the structured
sentence level as well, especially during a reading task. He is able to articulate /r-blends/ and /lblends/ at the sentence level with 84%, but can be inconsistent with this at times. It is
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recommended that Bic continue to work on his articulation of /r/, /r-blends/ and /1-blends/, at the
single sentence to conversational level with emphasis placed on self-monitoring and selfcorrection of his articulation in order to increase his awareness of his speech and improve overall
intelligibility.

SPEECH: Bic will improve articulation skills and increase his speech intelligibility by appropriately
producing /r/, /r/-blends, and /l/-blends in all positions (i.e. initial, medial, and final) of single
words, phrases, sentences, in reading, and conversation with 80% accuracy across 3 targeted
therapy sessions. Baseline: Bic is able to produce the /r/ sound in single words with 50% accuracy.
UPDATE:
Bic attends small group speech therapy sessions, where he works on improving the articulation of
his target sounds, which are /r/, /r-blends/ and /l-blends/.
In regards to his articulation skills, Bic has made significant improvements towards his goal during
this past IEP term. Per his progress reporting results from Report Period 4 of last school year, Bic
has mastered the articulation of the /r/ phoneme in all positions at the word level. During a
structured
task, at the sentence level, Bic is articulating the /r/ phoneme in the initial position with 100%
accuracy. However, his accuracy decreases to 45% when the /r/ is in the medial and final position
of words at the sentence level. He requires cues to utilize correct tongue positioning consistently
when attempting to co-articulate the /r/ sound with other sounds within a sentence. He has also
made significant improvement with his articulation of /r-blends/ and /l-blends/ at the structured
sentence level as well, especially during a reading task. He is able to articulate /r-blends/ and /lblends/ at the sentence level with 84%, but can be inconsistent with this at times. It is
recommended that Bic continue to work on his articulation of /r/, /r-blends/ and /1-blends/, at the
single sentence to conversational level with emphasis placed on self-monitoring and selfcorrection of his articulation in order to increase his awareness of his speech and improve overall
intelligibility.

Present Levels Related to Current Postsecondary Transition Goals:

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Students Name: Bic Mitchum
On October 7, 2015, Bic completed the Transition Planning Inventory-Second Edition (TPI) and a
career interest survey. The results of the two assessments indicate the Bic is interested in
pursuing careers in either Health Sciences or Technology. When presented with the results of the
assessments, Bic shared with his Case Manager, Ms. Harris that he would rather work and study
careers in technology. Bic added that he would rather work in this area because; he likes to fix
things and play video games.

Post-Secondary Education
Bic shared that after high school he would like to attend a 4 year college or university. Bic
acknowledged that he needs to improve his overall reading, math and speech/language to gain
entry into college.
Employment
Bic shared that he would like to work in the field of technology. According to Bic he would like to
research jobs in the area of technology and work on learning how to write a resume to better
assist him in obtaining gainful employment.
Independent Living
In regards to independent living, Bic shared he would like to live independently after graduating
college. An independent living goal is not appropriate at this time.
Areas of need in regards to obtaining employment and continuing education after the completion
of high
school are:
*Increase his basic academic skills and speech
*Increase knowledge about various job fields as related to Bic's interests and increase skills
related to these jobs as appropriate.
*Bic research various jobs in technology outlining salaries, degree/certificates needed, and other
job qualifications.
At this time, no outside agencies are being utilized to assist Bic in his transition goals.
TEACHER INPUT
Christopher Irving (Leveled Literacy):
Mr. Irving completed a Teacher Input Form for Bic on 10/7/15. According to Mr. Irving "Bic always
follows directions and is very cooperative. He seems eager to participate in small group
discussions and helps others regularly. Academically Mr. Irving added that Bic excels at talking
about his reading, and it appears that Bic is thinking about what he has read. In addition, Bic
seems to struggle with reading accuracy and fluency. Mr. Irving also added that Bic works well
independently, in small groups and has good organizational skills. However, Bic does not turn in
his homework assignments on time.

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Students Name: Bic Mitchum
Parental Concerns for Enhancing the Education of the Student:
Parental questionnaire was sent home with Bic on 10/7/2015, however to date it has not been
returned. During the IEP team meeting, mom shared that she does not have any concerns at this
time.

How the students disability affects involvement and progress in the general education curriculum:
Bics diagnosis of Specific Learning Disability affects his involvement in the general education
curriculum. Bic requires small group speech and language intervention to remediate his deficits.
Bic receives a 30 minute session once a week in a small group setting with a Speech Therapist as
well as reading support through a school wide reading intervention program. Bic also participates
in a Math Intervention program daily. Bic participates with the support of specially designed
instruction, accommodations, and curricular modifications in all other subjects with his nondisabled peers.

Strengths
-Respectful
-Potential to participate in class discussions
-Cooperative and willing to work hard/participate
-Positive
-Timed tasks
-Memory tasks with visual cues
-Basic Math calculation and word problem skills

Academic, developmental, and functional needs related to students disability:


According to the October 2013 evaluation date and teacher feedback, Bic demonstrates the
following
areas of need:
-reading fluency
-reading comprehension
-decoding skills
-spelling
-retention of vocabulary words and expressive language including written expression
-math calculation and problem solving
-speech language support
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III. TRANSITION SERVICES This is required for students age 14 or younger if determined appropriate by the IEP team. If the student does not attend the
IEP meeting, the school must take other steps to ensure that the students preferences and interests are considered. Transition services are a coordinated
set of activities for a student with a disability that is designed to be within a results oriented process, that is focused on improving the academic and
functional achievement of the student with a disability to facilitate the students movement from school to post school activities, including postsecondary
education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent
living, or community participation that is based on the individual students needs taking into account the students strengths, preferences, and interests.
POST SCHOOL GOALS Based on age appropriate assessment, define and project the appropriate measurable postsecondary goals that address education
and training, employment, and as needed, independent living. Under each area, list the services/activities and courses of study that support that goal.
Include for each service/activity the location, frequency, projected beginning date, anticipated duration, and person/agency responsible.
For students in Career and Technology Centers, CIP Code:
No CIP code is needed

Postsecondary Education and Training Goal:


Bic has a postsecondary goal of attending a four year college or university to major in Engineering or Technology.
Courses of Study:

Measurable Annual Goal


Yes/No
(Document in Section V)
Yes

10/12/2015 - 10/11/2016

Algebra 1, Math Foundations, AA History, Corrective Reading, Leveled Literacy, Art, Freshman Seminar

Service/Activity

Location

Frequency

Projected Beginning
Date

Anticipated
Duration

Person(s)/Agency
Responsible

*** Bic will improve his overall


reading and reading
comprehension skills.

Regular Education
Classroom

daily

10/12/2015

10/11/2016

Special Education
/ Regular Education
Teacher

***Bic will improve his overall


Math computation and Math
fluency skills

Regular Education
Classroom

per IEP term

10/12/2015

10/11/2016

Special Education
/ Regular Education
Teacher

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Students Name: Bic Mitchum
***Bic will continue to receive
speech and language therapy to
further develop his
communication skills.

Special Education
Classroom

Bic will receive intense reading


and math remedial support to
further progress towards skill
development.

Special
Education/Regular
Education Classroom

Bic will attend Mastery's annual


college Fair.

Gymnasium

weekly

10/12/2015

10/11/2016

Speech Therapist

daily

10/12/2015

10/11/2016

Regular
Education/Special
Education Teacher

per IEP term

10/12/2015

10/11/2016

Case Manager

Employment Goal:

Measurable Annual Goal


Yes/No
(Document in Section V)
Yes

Bic has an employment goal of pursuing a career in the field of Technology.


Courses of Study:

10/12/2015 - 10/11/2016

Algebra 1, Math Foundations, AA History, Corrective Reading, Leveled Literacy, Art, Freshman Seminar

Service/Activity

Location

Frequency

Projected Beginning
Date

Anticipated
Duration

Person(s)/Agency
Responsible

*** Bic will be given the daily


opportunity to improve his
mathematics skills, including
application and problem-solving,
through daily instruction and
practice in the classroom.

Regular
Education/Special
Education Classroom

daily

10/12/2015

10/11/2016

Classroom teacher

*** Bic will be given daily


opportunities to improve his
reading fluency, and reading
comprehension skills through
daily instruction and practice in
the classroom.

Regular
Education/Special
Education Classroom

daily

10/12/2015

10/11/2016

Regular
Education/Special
Education Teacher

Bic research various jobs in


technology outlining salaries,
degree/certificates needed, and
other job qualifications.

Special Education
Classroom

10/12/2015

10/11/2016

Case Manager

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per IEP term

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Students Name: Bic Mitchum
Bic will attend a career fair, in
order to assist him in determining
what type of job he can obtain
with his skill interest and grades

Special Education
Classroom

per IEP term

10/12/2015

10/11/2016

Case Manager

Bic will practice writing a current


resume and be able to explain all
experiences included on the
resume.

Special Education
Classroom

per IEP term

10/12/2015

10/11/2016

Case Manager

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Students Name: Bic Mitchum
Independent Living Goal, if appropriate:

Bic has a goal of living independently after he graduates high school. Bic will about obtain this goal with little
assistance.

Measurable Annual Goal


Yes/No
(Document in Section V)
No

Courses of Study: 10/12/2015 - 10/11/2016


lgebra 1, Math Foundations, AA History, Corrective Reading, Leveled Literacy, Art, Freshman Seminar

Service/Activity

Location

Frequency

Projected Beginning
Date

Anticipated
Duration

Person(s)/Agency
Responsible

Bic will be given daily


opportunities to improve his
reading fluency, and reading
comprehension skills through
daily instruction and practice in
the classroom.

Regular
Education/Special
Education Classroom

daily

10/12/2015

10/11/2016

Regular
Education/Special
Education Teacher

Bic research various jobs in


technology outlining salaries,
degree/certificates needed, and
other job qualifications.

Special Education
Classroom

per IEP term

10/12/2015

10/11/2016

Case Manager

Page 19 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
IV. PARTICIPATION IN STATE AND LOCAL ASSESSMENTS
Instructions for IEP Teams:
Please select the appropriate assessment option. Information on available testing accommodations may be found in the Accommodations Guidelines
available on www.education.state.pa.us.
State Assessments
Not Assessed
No statewide assessment is administered at this students grade level.
No English proficiency assessment administered because the student is not an English Language Learner.
PSSA (Math administered in grades 3-8; Science administered in grades 4 and 8; Reading administered in grades 3-8; Writing administered in grades 5
and 8; and ELA*)
Tested Subject Without Accommodations
With Accommodations
Accommodations to be Provided

Math
Science
Reading
Writing
ELA*
*ELA will replace the Reading and Writing PSSAs in 2014-15 for grades 3-8.

Keystone Exam (Replaces the 11th grade PSSA in high school; Student must participate by 11 th grade)
Tested Subject Without Accommodations
With Accommodations
Accommodations to be Provided
Extended time

Algebra 1
X
Small-group setting
Read aloud test directions and requested test items
Refocusing prompts
Simplified directions
Literature
X
Extended time
Small-group setting
Simplified directions
Read aloud test directions and requested test items
Refocusing prompts
Page 20 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
Biology
X
Extended time
Simplified directions
Small-group setting
Read aloud test directions and requested test items
Refocusing prompts
Keystone Project Based Assessment (Available when student is unable to demonstrate proficiency on a Keystone Exam or Keystone Exam module.)
Tested Subject Without Accommodations
With Accommodations
Accommodations to be Provided
Algebra 1
Literature
Biology
Validated Local Assessment (Available when selected as option by LEA)
Tested Subject Without Accommodations
With Accommodations
Accommodations to be Provided
Algebra 1
Literature
Biology
PASA (Administered in grades 3-8, 11 for Reading and Math; Grades 4, 8, 11 for Science)
Student will participate in the PASA.
Explain why the student cannot participate in the PSSA or the Keystone Exam for Reading/Literature, Math/Algebra 1, Science/Biology, and Composition
(The Composition exam will be available for the 2016-17 school year):

Explain why the PASA is appropriate:

Choose how the students performance on the PASA will be documented.


Videotape (preferred method)

Written narrative notes (requires prior approval in accordance with PDE guidance)

Page 21 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
ACCESS for ELLs (Administered in grades K-12)
Without Accommodations

Domains
With Accommodations Unable to Participate Accommodations to be Provided or Rationale for Inability to
Participate in Selected Domains

Listening
Reading
Writing
Speaking
Alternate ACCESS for ELLs (Administered in grades 1-12)
Student will participate in the Alternate ACCESS for ELLs.
Explain why the student cannot participate in the ACCESS for ELLs:

Explain why the Alternate ACCESS for ELLs is appropriate:

Without Accommodations
Listening
Reading
Writing
Speaking

Domains
With Accommodations Unable to Participate Accommodations to be Provided or Rationale for Inability to
Participate in Selected Domains

Local Assessments
Local assessment is not administered at this students grade level; OR
Student will participate in local assessments without accommodations; OR
X

Student will participate in local assessments with the following accommodations; OR

-- Extended time
-- Small-group setting
Page 22 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
-- Read aloud test directions
-- Refocusing prompts
Read aloud test directions and requested test items for math and science only

Page 23 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
V. GOALS AND OBJECTIVES Include, as appropriate, academic and functional goals. Use as many copies of this page as needed to plan appropriately.
Specially designed instruction may be listed with each goal/objective or listed in Section VI.
Short term learning outcomes are required for students who are gifted. The short term learning outcomes related to the students gifted program may be
listed under Goals or Short Term Objectives.
MEASURABLE ANNUAL GOAL
Include: Condition, Name, Behavior, and Criteria
(Refer to Annotated IEP for description of these
components)

Describe HOW the


students progress toward
meeting this goal will be
measured

Describe WHEN periodic


reports on progress will be
provided to parents

General F&P growth goal


Standardized or Norm
Bic will read independently at a
Reference Tests
level N (3.0 GLE) with 96% accuracy and
at with satisfactory comprehension at as
measured by a research-based literacy
assessment in 3 out of 4 trials.
(Baseline: Bic currently reads at
level K (2.0 GLE) with 97% word accuracy and
unsatisfactory on comprehension on the
Fountas & Pinnell Benchmark Assessment
System)

Quarterly IEP Progress


Report

General math growth goal: Bic will


increase overall math level to a 5th grade
level equivalent as measured by a researchbased math assessment in 3 out of 4 trials.
(Baseline: Bic is currently
performing at 4th grade level equivalent
with a scaled score of 645 on the STAR math
assessment)

Standardized or Norm
Reference Tests

Quarterly IEP Progress


Report

Computation/Fluency: Given 25 questions at


the 4th grade level, Bic will increase his math
problem solving skills from 32 digits correct
to 47 (in spring) digits correct, (75th
percentile) in 4 minutes in 3 out of 4 trials.
(Baseline: 32
digits correct on a grade 4 Digits Correct
Assessment)

Criterion-Referenced
Tests

Quarterly IEP Progress


Report

Page 24 of 37

Report of Progress

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
At the sentence to conversational level,
Oral Presentation; Oral
Bic will produce target sounds (/r/,
Testing
/r-blends/ and /l-blends/) in all positions
of words (initial, medial, final) with 80%
accuracy over 3 consecutive speech sessions.
Baseline: Bic is producing the /r/
sound at the structured sentence level with
60% accuracy. He is producing /r-blends/ and
/l-blends/ at the structured sentence level
with 83% accuracy, but can be inconsistent.

Quarterly IEP Progress


Report

SHORT TERM OBJECTIVES Required for students with disabilities who take alternate assessments aligned to alternate achievement standards (PASA).
Short term objectives / Benchmarks

Page 25 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
VI. SPECIAL EDUCATION / RELATED SERVICES / SUPPLEMENTARY AIDS AND SERVICES / PROGRAM MODIFICATIONS Include, as appropriate, for nonacademic
and extracurricular services and activities.
A. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION (SDI)
SDI may be listed with each goal or as part of the table below.
Include supplementary aids and services as appropriate.
For a student who has a disability and is gifted, SDI also should include adaptations, accommodations, or modifications to the general
education curriculum, as appropriate for a student with a disability.
Modifications and SDI

Location

Frequency

Projected Beginning Date

Anticipated Duration

daily

10/14/15

10/13/16

weekly

10/14/15

10/13/16

Due to Bics current level


of cognitive functioning,
he will be provided visual
cues in all learning
environments

All Major and Minor


Subject
Areas

Due to Bics
communication needs he
will be given visual,
auditory, kinesthetic cues,
modeling, sound drills and
speech games along with
self-monitoring.

Speech Support
Classroom

Due to Bics current


reading level Bic will be
taught skills to help him
relate new vocabulary
words and their meanings
to his own experiences to
aid in retention.

All Major and Minor


Subject
Areas

daily

10/14/15

Due to Bics current level


of cognitive functioning all
teachers will model and
encourage self-monitoring
strategies such as
directing Bic to stop and
ask himself, "What did I
just read" in order to build
upon his comprehension
skills.

All Major and Minor


Subject
Areas

daily

10/14/15

Page 26 of 37

10/13/16

10/13/16

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
Due to Bics current math
level Break multi-step
math problems into
smaller pieces. If there are
certain steps that need to
be followed, each step
could be
put on an index card to
remind the student of how
to proceed in order to help
facilitate organization and
understanding of multiplestep math problems.

10/14/15
Math Class

10/13/16

daily

B. RELATED SERVICES List the services that the student needs in order to benefit from his/her special education program.
Service

Location

Frequency

Projected Beginning Date

Anticipated Duration

C. SUPPORTS FOR SCHOOL PERSONNEL List the staff to receive the supports and the supports needed to implement the students IEP.
School Personnel to
Receive Support

School Staff

Page 27 of 37

Support

Location

On-going
communication
between parent and Across All Settings
Mastery Charter
School.

Frequency

Projected Beginning
Date

Anticipated Duration

weekly

10/14/15

10/13/16

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum

Case Manager

Regular Education
Teacher

Page 28 of 37

On-going
communication
between parent and
All Major and Minor
Mastery Charter
Subject Areas
School's special
education
department.

daily

10/14/15

10/13/16

Ongoing support
and communication
between general
education teachers
and special
education
department.

daily

10/14/15

10/13/16

All Major and Minor


Subject Areas

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
D. GIFTED SUPPORT SERVICES FOR A STUDENT IDENTIFIED AS GIFTED WHO ALSO IS IDENTIFIED AS A STUDENT WITH A DISABILITY Support services are
required to assist a gifted student to benefit from gifted education (e.g., psychological services, parent counseling and education, counseling services,
transportation to and from gifted programs to classrooms in buildings operated by the school district).

Support Service

Not Applicable

Support Service

Not Applicable

Support Service

Not Applicable

E. EXTENDED SCHOOL YEAR (ESY) The IEP team has considered and discussed ESY services, and determined that:

Student IS eligible for ESY based on the following information or data reviewed by the IEP team:

OR

X As of the date of this IEP, student is NOT eligible for ESY based on the following information or data reviewed by the IEP team:

Extended School Year (ESY) services have been discussed and it has been determined that Bic is not eligible for ESY
services because he is able to make progress in the general education curriculum with the support of specially
designed instruction and accommodations and modifications made to the curriculum. Bic's ability to recoup previously
learned information after a period of time away from school is self-sufficient.

The Annual Goals and, when appropriate, Short Term Objectives from this IEP that are to be addressed in the students ESY Program are:
Page 29 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum

If the IEP team has determined ESY is appropriate, complete the following:
ESY Service to be Provided

Page 30 of 37

Location

Frequency

Projected Beginning Date

Anticipated Duration

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name: Bic Mitchum
VII. EDUCATIONAL PLACEMENT
A. QUESTIONS FOR IEP TEAM The following questions must be reviewed and discussed by the IEP team prior to providing the explanations regarding
participation with students without disabilities.

It is the responsibility of each public agency to ensure that, to the maximum extent appropriate, students with disabilities, including those in public
or private institutions or other care facilities are educated with students who are not disabled. Special classes, separate schooling or other removal of
students with disabilities from the general educational environment occurs only when the nature or severity of the disability is such that education in
general education classes, EVEN WITH the use of supplementary aids and services cannot be achieved satisfactorily.

What supplementary aids and services were considered? What supplementary aids and services were rejected? Explain why the supplementary
aids and services will or will not enable the student to make progress on the goals and objectives (if applicable) in this IEP in the general
education class.

What benefits are provided in the general education class with supplementary aids and services versus the benefits provided in the special
education class?

What potentially beneficial effects and/or harmful effects might be expected on the student with disabilities or the other students in the
class, even with supplementary aids and services?

To what extent, if any, will the student participate with nondisabled peers in extracurricular activities or other nonacademic activities?
Explanation of the extent, if any, to which the student will not participate with students without disabilities in the regular education class:
Bic will not participate with students without disabilities in the general education classroom
when he is receiving speech and language services.

Explanation of the extent, if any, to which the student will not participate with students without disabilities in the general education curriculum:
Bic will not participate when he receives small group speech and language intervention for 30
minutes, once per week and when he has check-ins with his case manager. He participates in
all other general education curriculum classes including research based reading intervention
and math intervention.

Page 31 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name:
B. Type of Support
1. Amount of special education supports
Itinerant: Special education supports and services provided by special education personnel for 20% or less of the school day

Supplemental: Special education supports and services provided by special education personnel for more than 20% of the day but less than
80% of the school day
Full-Time: Special education supports and services provided by special education personnel for 80% or more of the school day

2. Type of special education supports


Autistic Support

Blind-Visually Impaired Support

Deaf and Hard of Hearing Support

Emotional Support

Learning Support

Life Skills Support

Page 32 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name:
Multiple Disabilities Support

Physical Support

Speech and Language Support

Page 33 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name:
C. Location of students program

Name of School District where the IEP will be implemented:

Francis D. Pastorius - Mastery Charter School

Name of School Building where the IEP will be implemented:

Mastery Charter School - Gratz Campus

Is this school the students neighborhood school (i.e., the school the student would attend if he/she did not have an IEP)?
Yes

X No. If the answer is no, select the reason why not.


Special education supports and services required in the students IEP cannot be provided in the neighborhood school

Other. Please explain:

Page 34 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name:
VIII. PENNDATA REPORTING: Educational Environment (Complete either Section A or B; Select only one Educational Environment)
To calculate the percentage of time inside the regular classroom, divide the number of hours the student spends inside the regular classroom by the total number of hours in the school day (including
lunch, recess, study periods). The result is then multiplied by 100.

SECTION A: For Students Educated in Regular School Buildings with Non Disabled Peers Indicate the Percentage of time INSIDE the regular classroom for this student:
Time spent outside the regular classroom receiving services unrelated to the students disability (e.g., time receiving ESL services) should be considered time inside the regular classroom.
Educational time spent in age-appropriate community-based settings that include individuals with and without disabilities, such as college campuses or vocational sites, should be counted as time
spent inside the regular classroom.
Calculation for this Student:

Column 1

Column 2

Calculation

Indicate Percentage

Total hours the student


spends in the regular
classroom per day

Total hours in a typical


school day

(Hours inside regular


classroom hours in
school day) x 100 = %

Section A: The percentage of


time student spends inside the
regular classroom:

(including lunch, recess &


study periods)

(Column 1 Column 2) x
100 = %
(5/7) x 100

___71__% of the day

Percentage Category

Using the calculation result select the appropriate percentage category

INSIDE the Regular Classroom 80% or More of the Day


X INSIDE the Regular Classroom 79-40% of the Day
INSIDE the Regular Classroom Less Than 40% of the Day

SECTION B: This section required only for Students Educated OUTSIDE Regular School Buildings for more than 50% of the day select and indicate the Name of School or
Facility on the line corresponding with the appropriate selection: (If a student spends less than 50% of the day in one of these locations, the IEP team must do the calculation
in Section A)

Page 35 of 37

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name:

Approved Private School (Non Residential) _________________________


Approved Private School (Residential)
_________________________
Other Private Facility (Non Residential)
_________________________
Other Private Facility (Residential)
________________________
Other Public Facility (Residential)
________________________

Page 36 of 37

Other Public Facility (Non Residential) _________________________


Hospital/Homebound
_________________________
Correctional Facility
_________________________
Out of State Facility
_________________________
Instruction Conducted in the Home
_________________________

April 2014

INDIVIDUALIZED EDUCATION PROGRAM (IEP)


Students Name:

EXAMPLES for Section A: How to Calculate PennDataEducational Environment Percentages


Column 1

Column 2

Calculation

Total hours the student spends in the


regular classroom per day

Total hours in a typical school day


(including lunch, recess & study
periods)

(Hours inside regular classroom hours in school day)


x 100 = %

Indicate Percentage
Section A: The percentage of time student
spends inside the regular classroom:

(Column 1 Column 2) x 100 = %

Example 1

5.5

6.5

(5.5 6.5) x 100 = 85%

85% of the day


(Inside 80% or More of Day)

Example 2

(3 5) x 100 = 60%

60% of the day


(Inside 79-40% of Day)

Example 3

(1 5) x 100 = 20%

20% of the day


(Inside less than 40% of Day)

For help in understanding this form, an annotated IEP is available on the PaTTAN website at www.pattan.net Type Annotated Forms in the Search feature on the website. If you do not have access
to the Internet, you can request the annotated form by calling PaTTAN at 800-441-3215.

Page 37 of 37

April 2014