Individualized Education Program (IEP) for

Student

1. Student Information
Student A
DOB 02/27/2006
IEP Meeting 1/09/2018
IEP Due 1/08/2018
Eligibility Date 1/10/2017
Next Re-Evaluation Completed By 1/10/2020
Attending School A. Elementary
Home Language English
Student Language English
Classification Specific Learning Disability
Grade 6th

2. Present Levels of Academic Achievement and functional Performance

Reading A. is a student in the 6th grade. A. is able to read 80 words per
minute with 89% accuracy on a 4th grade reading level. A’s
reading strengths is their ability to read phonetically accurate
words however they struggle with phonetically irregular words to
include some sight words. The 6th grade Middle of year bench
mark for oral reading fluency is 109 words per minute with 97%
accuracy.

A’s reading skill are impacting his access to access the general
education curriculum
Writing On the middle of year writing benchmark A was able to write 37
total words with 25 correct writing sequences. This places A in the
3rd grade middle of year 50th percentile. A’s strengths are their
ability to remain on topic. Their weakness is their spelling and
punctuation. The 6th grade middle of year writing benchmark is 55
total words written with 47 correct writing sequences

A’s writing skills will impact their access to the general education
curriculum.
Math A was able to score 36 points on a 4th grade test of math
computation with an 8 minute timing on the middle of year bench
mark. A’s strengths were in regrouping addition problems and
standard subtraction problems, and multiplication problems with
numbers in the ones place. However they struggled in regrouping
subtraction problems, multiplication with double digit numbers,
 and division. The 6th grade middle of year math computation
benchmark is 29 points.

A’s math skills will impact their access to the general education
curriculum.
Social/Behavior A was observed for 20 minutes in their general education class. It
was noted that A spent 60% of their time on task while A’s other
classmates were able to remain on task for 80% of the time. I was
noted that A was more engaged in active tasks such as completing
assignments but struggled to pay attention when directions were
being given.

A’s struggle to remain on task will impact their access to the

general education curriculum.

3. The IEP Team considered the following Special Factors

Behavior [ ]Student needs [ ]Student does not need [ X ]Student needs
behavioral strategies behavioral strategies. behavioral strategies are
because his behavior addressed in his IEP.
impedes his learning
and/or the learning of
others.
Language [ ]Student has special [ X ]Student does not [ ]Student’s special
language needs have special language language needs are
addressed in his IEP needs addressed in his IEP.
because he is an limited
English proficient
student
Braille [ ]Student needs Braille [ X ]Student does not [ ]Student needs for
instruction because he is need Braille Instruction. Braille instruction are
blind or visually addressed in his IEP.
impaired.
Communication [ ]Student has special [ X ]Student does not [ ]Student needs for
communication service need any special special communication
needs such as a student communication services. services are addressed in
who is deaf or hard of his IEP.
hearing.
Assistive [ ]Student needs [ X ]Student does not [ ]Student needs for
Technology assistive technology need assistive assistive technology
devices and/or services technology devices devices and/or services
without which she/he and/or services to are addressed in his IEP.
would not benefit from benefit from special
special education. education.

4. Measurable Annual goals

1. Student progress towards his annual goals will be test scores
measured using… curriculum based
assessment
behavior observations
work samples
2. Student progress will be reported to his parents using… Progress reports
3. Student progress will be reported as often as progress is Yes
reported for children without disabilities.
4.1 Reading
Annual Goal 1 By January 8th, 2018, A will read 100 words per minute with 95%
accuracy on a 4th grade reading level over three consecutive trails.
Annual Goal 2 By January 8th, 2018, A will read 113 words per minute with 98%
accuracy on a 5th grade reading level over three consecutive trails.
4.2 Writing
Annual Goal 1 By January 8th, 2018, A will write 56 words or more when given a
test of writing fluency and a three min timing over 3 consecutive
trails.
Annual Goal 2 By January 8th, 2018, A will have 49 or more correct writing
sequences when given a test of writing fluency and a three min
timing over 3 consecutive trails.
4.3 Math
Annual Goal 1 By January 8th, 2018, A will receive 49 points when given a 4th
grade test of math computations and an 8 minute timing over three
consecutive trails.
Annual Goal 2 By January 8th, 2018, A will receive 25 points when given a 5th
grade test of math computations and an 8 minute timing over three
consecutive trails.
4.4 Behavior
Annual Goal 1 By January 8th, 2018, A will remain on task 75% of the intervals
when observed for 20 minutes on two out of three observations
throughout the next year.

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 Special education room 30 min 5 times a week
Math General education room 45 min 4 times a week
Writing Special/Gen education room 30 min 2 times a week

Related Services student requires to benefit from hi Special Education:

Service Location Minutes/Frequency
School psychologist General education 30minutes biweekly
classroom

Program Modifications, supports for schools personnel and/or supplementary aids in his
regular education programs:
Modifications Frequency
Reduced distractions As needed
Graphic organizers As needed
Math manipulatives As needed
Extended timing As needed
Preferential seating to minimize 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?
X Not Applicable
No, Considered and not needed
Yes
Projected initiation of services: Anticipated duriation:

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:

A.
Student Date

A’s parent
Parent Date
1/09/2018
Breanna M. Tomlinson
Special Education Teacher Date

A’s teacher
General Education Teacher Date

A’s principal
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: