Individualized Education Program (IEP) for

Student A
1. Student Information
Student
Student A
DOB

12/26/2004

IEP Meeting

1/27/2016

IEP Due

1/28/2016

Eligibility Date

12/5/2014

Next Re-Evaluation
Completed By

12/5/2017

Attending School

Sunset Elementary School

Home Language

English

Student Language

English

Classification

Specific Learning Disability (SLD)

Grade

6th Grade

2. Present Levels of Academic Achievement and functional

Performance
Reading
When given an oral reading fluency assessment,
Student A can read 80 words per minute with 89%
accuracy on a 4th grade reading level. This puts him
at a beginning 4th grade level with his accuracy level
being at risk. Same grade peers are expected to read
120 words per minute with 97% accuracy on a 6th
grade level by the middle of the year. Student As
reading ability affects his ability to succeed in the
general education curriculum.
Writing
When given a writing prompt, Student A can write 37
TWW with 25 CWS, which places him at a 3rd grade
level. Same grade peers are expected to obtain 46
CWS. Student As writing ability affects his ability to
succeed in the general education curriculum
Math
When given a set of math problems on a 4th grade
level, Student A can solve the problems with 32
correct digits in a 3 minute time period. Same grade
level peers are expected to solve 36 correct digits
within 3 minutes on a 6th grade level. Student As
math ability affects his ability to succeed in the
general education curriculum.
Social/Behavior Student A is on task during 60% of the intervals in a
20 minute observation period. Same age peers

average 85% on task behavior during the same

amount of time. Student As ability to stay on task in
class affects his ability to succeed in the general
education curriculum.
3. The IEP Team considered the following Special Factors
[ ]Student needs
[ X ]Student does
[ ]Student needs
Behavior

Language

Braille

Communication

Assistive
Technology

behavioral
strategies because
his behavior
impedes his
learning and/or the
learning of others.
[ ]Student has
special language
needs addressed in
his IEP because he
is an limited
English proficient
student
[ ]Student needs
Braille instruction
because he is blind
or visually
impaired.
[ ]Student has
special
communication
service needs such
as a student who is
deaf or hard of
hearing.
[ ]Student needs
assistive
technology devices
and/or services
without which
she/he would not
benefit from
special education.

not need
behavioral
strategies.

behavioral
strategies are
addressed in his
IEP.

[ X ]Student does
not have special
language needs

[ ]Students special
language needs are
addressed in his
IEP.

[ X ]Student does
not need Braille
Instruction.

[ ]Student needs
for Braille
instruction are
addressed in his
IEP.
[ ]Student needs
for special
communication
services are
addressed in his
IEP.

[ X ]Student does
not need any
special
communication
services.
[ X ]Student does
not need assistive
technology devices
and/or services to
benefit from
special education.

4. Measurable Annual goals

1. Student progress towards his annual goals
will be measured using

[ ]Student needs
for assistive
technology devices
and/or services are
addressed in his
IEP.

Curriculum based
assessment, behavior
observations, work
samples
Progress reports

2. Student progress will be reported to his

parents using
3. Student progress will be reported as often as progress is reported for
children without disabilities.
4.1 Reading

Annual Goal 1
4.2 Writing
Annual Goal 1

4.3 Math
Annual Goal 1

4.4 Behavior
Annual Goal 1

Student A will read 91 words per minute with 95%

accuracy when given a 4th grade text for one minute
on 2 out of 3 trials within 10 weeks.
Student A will write 39 CWS when given a 4th grade
writing story starter CBM progress monitoring
material in 3 minutes with 95% accuracy or greater
over the course of the IEP.
Student A will solve addition, subtraction,
multiplication and division math problems with 42
correct digits in 2 minutes with 95% accuracy or
greater on 2 out of 3 trials when given a mixed math
CBM progress monitoring probe on a 4th grade level
within 10 weeks.
Student A will be on task on 80% of the intervals
during a 20 minute observation period on 2 out of 3
trials during the course of the IEP.

5. Service plus Adaptation

Special education service student needs to achieve his annual goals
and advance in the general curriculum:
Service
Location
Minutes/Frequency
Resource Reading
Special Education
30/day
Class
Resource Language
Special Education
20/day
Arts
Class
Resource Math
Special Education
30/day
Class
Related Services student requires to benefit from his Special Education:
Service
Location
Minutes/Frequency
Program Modifications, supports for schools personnel and/or
supplementary aids in his regular education programs:
Modifications
Frequency
Reading Test Aloud
As Needed
Extended Response Time
As Needed
Minimized Distractions
As Needed
Check if transportation will be provided as a related service.

Are the post-secondary transition services, experiences, and/or

specialized instruction listed above likely to be provided or paid by
other agencies?
Not Applicable
No, Considered and not needed
Yes
Projected initiation of services:
Anticipated duriation: 1/26/2017
1/27/2016
6. Participation in State & District Assessment
See addendum
7. Regular Curriculum, Extra- Curricular & Non Academic Activities
Except for special education class times noted in the services section
of this IEP the student will participate in the regular class, regular PE,
extra-curricular and non-academic activities to the same extent as
children without disabilities, or with other exceptions (explain and
specify below).

8. Transition Plan
Not Applicable
9. Special Requirements for Graduation
Not Applicable
10. Notices & Participants
Extended School Year (ESY) services: Extended School Year (ESY)
services are provided to a child with a disability when the IEP team
determines that without ESY services, the educational program would
be of little or no benefit to the child, due to the lack of services during
the break between the normal school year and the next. Data will be
considered in determining eligibility for ESY services for your child. The
IEP team has determined that:
You child is not eligible for ESY services.
Placement Review: [ ] Initial placement [ X ]Maintain current
placement [ ]Change current placement
Parent Prior Notice for Free Appropriate Public Education: The
IEP team proposes to implement this program based on the student's
needs and represents the free, appropriate public education the
student will be provided. You have received and have protection under
the Procedural Safeguards and Annual Notifications, which were sent to

you upon the student's referral for evaluation and in conjunction with
this meeting. You may receive another copy of the Procedural
Safeguards and Annual Notifications from the special education
teacher. lf you have any questions regarding this notice or the
Procedural Safeguards and Annual Notifications, contact the special
education teacher at the student's school. Parent/guardian signature
on this form indicates that parent/guardian has received a copy of this
IEP and a copy of your Procedural Safeguards and Annual Notifications,
which includes annual notices for Child Find, Carson Smith Special
Needs Scholarship, Destruction of Records and Medicaid.
Note: Each teacher and service provider must be informed of his or her
specific responsibilities related to implementation of this IEP for the
student, and the specific accommodations, modifications, and supports
that must be provided for him in accordance with this lEP.
IEP Team Participants:
Student

Date

Parent

Date

Special Education Teacher

Date

General Education Teacher

Date

LEA

Date

[ ]The IEP team has reviewed the previous year IEP in preparation for
the development of the current lEP.
Note: lf parent signature is missing, provide them with a copy of the
IEP and the Procedural Safeguards and Annual
Notifications and indicate a reason: