Individualized Education Program (IEP) for

Bobby Joe Smith

1. Student Information
Student
Bobby Joe Smith
DOB

12/12/2002

IEP Meeting

1/22/15

IEP Due

1/21/16

Eligibility Date

1/22/15

Next Re-Evaluation
Completed By

1/21/18

Attending School

Huckleberry Finn Elementary School

Home Language

English

Student Language

English

Classification

Specific Learning Disability

Grade

6th Grade

2. Present Levels of Academic Achievement and functional

Performance
Reading
When given the Dibels 6 Oral Reading Fluency, on
1/20/15, Bobby Joe is reading on a 4th grade level. He
is able to read 80 words per minute with 89%
accuracy. Bobby Joe is performing well below
benchmark and is likely to need intensive
support.
Writing
When Bobby Joe is given a 4-minute writing
Curriculum Based Measure prompt on 1/20/15, he
was able to write 37 total words per minute and have
25 correct word sequences. Based on this data,
Bobby Joe is currently performing on a 4th grade
level. Based on this, Bobby Joe is below grade level
and will struggle completing his work in class and at
home for his current grade level.
Math
When given the Math Computation Assessment on
1/20/15, Bobby Joe was able to achieve 32 points on
the 4th grade level. Per the AIMS Web National Norms
of 2013, this places him in the 25th percentile. Based
on this information, Bobby Joe will struggle with
meeting current grade level achievement.
Social/Behavior Bobby Joe is a great asset to any classroom.
However, he is easily distracted and often struggles
to remain on his current task. Because of this, his on

task behavior is at 60% as compared to his peers

who are on task 85% of the same time. His off task
behavior has had a negative effect on all of his
school subjects and all of his class work at home and
in the school setting.
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
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

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

Curriculum based
assessments, work
samples, and a
checklist of activities.
Progress reports.

disabilities.
4.1 Reading
Annual Goal 1

Annual Goal 2
4.2 Writing
Annual Goal 1

Annual Goal 2
4.3 Math
Annual Goal 1
Annual Goal 2
4.4 Behavior
Annual Goal 1

Bobby Joe will, when given a 5th grade reading

passage, read at least 102 words per minute, with at
least 90% accuracy on 3 out of 3 consecutive
progress monitoring assessments.
Bobby Joe will, when given a 6th grade 4 minute
writing prompt, will have written 50 total words, with
a minimum of 33 Correct Writing Sequence over 3 out
of 3 consecutive probes.
Bobby Joe will, when given a 5th grade Math
Computation probe, will be able to score a minimum
of 23 points, on 2 out of 3 consecutive probes.
Bobby Joe will, when given a daily tracking sheet, be
able to achieve 75% on task behavior per day, for 5
out of 5 consecutive school days.

5. Service plus Adaptation

Special education service student needs to achieve his annual goals
and advance in the general curriculum:
Service
Location
Minutes/Frequency
Reading Basic Skills
Special Education
30 minutes 4 times
Class
/wk
Math Comprehension
Special Education
30 minutes 4
Class
times/wk
Writing Skills
Special Education
30 minutes 4
Class
times/wk
Related Services student requires to benefit from his Special Education:
Service
Location
Minutes/Frequency
Social Worker
Social Worker Office
30 min 1 time /wk
Program Modifications, supports for schools personnel and/or
supplementary aids in his regular education programs:
Modifications
Frequency

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 duration: 01/21/16
01/22/15
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:
Bobby Joe Smith, Student

Date

Mary Joe Smith, Parent

Date

Mrs. Coplan, Special Education Teacher

Date

Mrs. Dangerfield, General Education Teacher

Date

Mrs. Beetleguise, LEA Representative

Date

[ X]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: