Running head: Mia STANDARDS BASED IEP
Standards based IEP for Mia
YOUR NAME
CLASS
……… University
Introduction
On this page you will write an introduction – 1 page – of what the reader will see in this IEP –
Describe what a standards based IEP is, talk about the parts and how you developed your goals etc.
INDIVIDUALIZED EDUCATION PROGRAM
COVER PAGE
Student Name: Mia Alex Page 1 of 14
Student ID Number: 5214322 Grade: 5
DOB: 04/14/2011 Age: 11 years, 5 months Disability(ies): Specific Learning Disability (dyscalculia)
Parent Name: Alex (father) and Lilith (mother)
Home Address 9275 Hermosa Drive Phone # (H) (202) 657- 6789
Fairfax, VA 22031 Phone # (W) (202) 535-4559
Date of IEP meeting………………………………………….…………………………..……..…… 9/15/2021
Date parent notified of IEP meeting………………………………..………………………………………..… 8/21/2021
This IEP will be reviewed no later than ………..…………………….……………..……….…………… 9/14/2022
Most recent eligibility date…………………………….…………………………………….…………… 3/2/2021
Next re-evaluation, including eligibility, must occur before ………..……..…………..…..……………. 2/10/2024
Copy of IEP given to parent / Alex (father) and Lilith (mother) On (Date) 9/15/2021
IEP Teacher/Manager: Karen Matthews Phone Number (301) 423-4593
The Individualized Education Plan (IEP) that accompanies this document is meant to support the positive process and team approach. The IEP is a working document that outlines the student’s vision for the future, strengths and needs. The IEP is not written in isolation. The intent of an IEP is to bring together a team of people who understand and support the student in order to come to consensus on a plan and an appropriate and effective education for the student. No two teams are alike and each team will arrive at different answers, ideas and supports and services to address the student’s unique needs. The student and his/her family members are vital participants, as well as teachers, assistants, specialists, outside service providers, and the principal. When all team members are present, the valuable information shared supports the development of a rich student profile and education plan.
PARTICIPANTS INVOLVED:
The list below indicates that the individual participated in the development of this IEP and the placement decision; it does not authorize consent. Parent consent is indicated on the “Prior Notice” page.
NAME OF PARTICIPANT POSITION
Mia Student
Mr. Alex Student’s Father
Mrs. Lilith Student’s Mother
Ms. Victoria Smith 5th Grade General Education Teacher
Ms. Karen Matthews Special Education Teacher ____________
Ms. Caroline Sampson Assistant Principal __________________
Mrs. Annie Lawson School Counselor
INDIVIDUALIZED EDUCATION PROGRAM
FACTORS FOR IEP TEAM CONSIDERATION
Student Name: Mia Alex Date: 9/15/2021 Page: 2 of 14
Student ID Number: 5214322
During the IEP meeting, the following factors must be considered by the IEP team. Best practice suggests that the IEP team document that the factors were considered and any decision made relative to each. The factors are addressed in other sections of the IEP if not documented on this page (for example: see Present Level of Academic Achievement and Functional Performance).
1. Results of the initial or most recent evaluation of the student;
_________Refer to the Present Level of Academic Achievement and Functional Performance_____
2. The strengths of the student;
________ Refer to the Present Level of Academic Achievement and Functional Performance_____
3. The academic, developmental, and functional needs of the student;
________ Refer to the Present Level of Academic Achievement and Functional Performance______
4. The concerns of the parent(s) for enhancing the education of their child;
________ Refer to the Present Level of Academic Achievement and Functional Performance______
5. The communication needs of the student;
________Refer to the Present Level of Academic Achievement and Functional Performance
6. The student’s needs for benchmarks or short-term objectives;
_________ Short-term objectives /benchmarks are not included ____________________
7. Whether the student requires assistive technology devices and services. When considering whether assistive technology is required, the IEP team may refer to the Virginia Assistive Technology Resource Guide to facilitate the discussions about goals and objectives, areas of difficulty, and whether AT devices or services are needed, and whether accessible instructional materials in alternate formats are needed.
____________________________Assistive Technology is not required at this time__________________________________
8. In the case of a student whose behavior impedes his or her learning or that of others, consider the use of positive behavioral interventions, strategies, and supports to address that behavior;
Refer to the Present Level of Academic Achievement and Functional Performance
9. In the case of a student with limited English proficiency, consider the language needs of the student as those needs relate to the student’s IEP;
Mia is not a student with limited English proficiency.
10. In the case of a student who is blind or is visually impaired, provide for instruction in Braille and the use of Braille unless the IEP team determines after an evaluation of the student’s reading and writing skills, needs, and appropriate reading and writing media, including an evaluation of the student’s 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. When considering that Braille is not appropriate for the child the IEP team may use the Functional Vision and Learning Media Assessment for Students who are Pre-Academic or Academic and Visually Impaired in Grades K-12 (FVLMA) or similar instrument; and
Mia is not a student who is blind or visually impaired.
11. In the case of a student who is deaf or hard of hearing, consider 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. The IEP team may use the Virginia Communication Plan when considering the student’s language and communication needs and supports that may be needed.
Mia is not a student who is deaf or hard of hearing.
INDIVIDUALIZED EDUCATION PROGRAM
PRESENT LEVEL OF ACADEMIC ACHEIVEMENT AND FUNCTIONAL PERFORMANCE
Student Name: Mia Alex Date: 9/15/2021 Page: 3 of 14
Student ID Number: 5214322
The Present Level of Academic Achievement and Functional Performance summarize the results of assessments that identify the student’s interests, preferences, strengths and areas of need, including assistive technology and/or accessible materials. It also describes the effect of the student’s disability on his or her involvement and progress in the general education curriculum, and for preschool children, as appropriate, how the disability affects the student’s participation in appropriate activities. This includes the student’s performance and achievement in academic areas such as writing, reading, mathematics, science, and history/social sciences. It also includes the student’s performance in functional areas, such as self-determination, social competence, communication, behavior and personal management. Test scores, if included, should be self-explanatory or an explanation should be included, and the Present Level of Academic Achievement and Functional Performance should be written in objective measurable terms, to the extent possible. There should be a direct relationship among the desired goals, the Present Level of Academic Achievement and Functional Performance, and all other components of the IEP.
_______________________________________________________________________________________________
Mia is an eleven-year-old 5th grade student attending Ellis Elementary School. At her most recent eligibility meeting Mia was found eligible for special education as a student with Specific Learning Disabilities in math and reading. In addition, Mia was recently diagnosed with a specific learning disability (dyscalculia). Mia receives instruction in the fifth grade general education classroom. Most of her classes are taught by the general education teacher, Ms. Smith. At this time, Mia is not receiving any support services.
Mia’s math teacher, Ms. Smith, reports that Mia can use addition and subtraction to solve problems involving whole numbers and decimals. On the last benchmark assessment with addition and subtraction of decimals, she scored an 87%. Mia can multiply whole numbers without the use of a calculator; one digit by one digit with 60% accuracy, one digit by two digits with 45% accuracy, and three digits by two digits with 20% accuracy. Mia knows her multiplication facts with 0’s – 12’s on sight with no errors but struggles with word problems, applications and problem solving.
Mia’s reading teacher, Mrs. Martin, reports that she has a good knowledge of how print is organized. She can read a whole passage. On a recent Informal Reading Assessment, Mia’ scores showed that she is approximately one grade level behind in reading. Mia’ reading teacher believes comprehension is her major area of need. On the KTEA, Mia scored in the 6th percentile for reading comprehension. Tasks such as identifying the main idea are particularly difficult for Mia. When asked to give the main idea of a selection, Mia typically responds with one specific detail that she can recall.
(Continued on page 4)
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
PRESENT LEVEL OF ACADEMIC ACHEIVEMENT AND FUNCTIONAL PERFORMANCE, continued
Student Name: Mia Alex Date: 9/15/2021 Page: 4 of 14
Student ID Number: 5214322
PRESENT LEVEL OF ACADEMIC ACHEIVEMENT AND FUNCTIONAL PERFORMANCE, continued.
All of Mia’ teachers expressed a concern about Mia’ level in writing. Her teacher reports that Mia is confused when it comes to use different forms of writing such as narrative, descriptive, expository, and persuasive. In addition, all of Mia’ teachers feel that Mia is a visual learner and that she struggles to retain and follow oral directions. Further in all classes, Mia benefits greatly when the teacher models the task before attempting it independently.
Ms. Smith and Mrs. Martin both report that Mia is outgoing, has many friends, and enjoys participating in group activities, but often Mia gets bored if she does not understand a concept and as a result has trouble cooperating with other students. When this occurs it usually requires four to five teacher prompts for Mia to return to her seat. Furthermore, Mia completes her work but often forgets to turn it in on time; she needs three to four verbal reminders to turn in her work, which affects her grades.
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
MEASURABLE ANNUAL GOALS, PROGRESS REPORT
Student Name: Mia Alex Date: 9/15/2021 Page: 5 of 14
Student ID Number: 5214322 Area of Need: Mathematics
# 1 MEASURABLE ANNUAL GOAL:
Given a word math problem, Mia will be able to analyze the problem and solve it, with 80 % accuracy, on 4 out of 5 occasions, each grading period.
The IEP team considered the need for short-term objectives/benchmarks.
Short-term objectives/benchmarks are included for this goal. (Required for students participating in the VAAP)
Short-term objectives/benchmarks are not included for this goal.
How will progress toward this annual goal be measured? (check all that apply)
____ Classroom Participation
____ Checklist
__X__ Class work
____ Homework
____ Observation
____ Special Projects
_X___ Tests and Quizzes
____ Written Reports
____ Criterion-referenced test:_________________________
____ Norm-referenced test: ___________________________
____ Other: ________________________________________
Progress on this goal will be reported to the parent or adult student using the following codes. Attach comments using progress report comment form located in section two.
Anticipated Date of Progress Report*
11/30/21
2/30/22
4/30/22
6/15/22
Actual Date of Progress Report
Progress Code
SP -The student is making Sufficient Progress to achieve this annual goal within the duration of this IEP.
IP -The student has demonstrated Insufficient Progress to meet this annual goal and may not achieve this goal within the duration of this IEP.
ES – The student demonstrates Emerging Skill but may not achieve this goal within the duration of this IEP.
NI -The student has Not been provided Instruction on this goal.
M -The student has Mastered this annual goal.
* Progress reports will be provided at least as often as parents are informed of the progress of children without disabilities.
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
MEASURABLE ANNUAL GOALS, PROGRESS REPORT
Student Name: Mia Alex Date: 9/15/2021 Page: 6 of 14
Student ID Number: 5214322 Area of Need: Reading
# 2 MEASURABLE ANNUAL GOAL:
Given grade level material, Mia will demonstrate comprehension of fictional and nonfictional texts and use word analysis strategies, with 80% accuracy, on 4 out of 5 occasions, each grading period.
The IEP team considered the need for short-term objectives/benchmarks.
Short-term objectives/benchmarks are included for this goal. (Required for students participating in the VAAP)
Short-term objectives/benchmarks are not included for this goal.
How will progress toward this annual goal be measured? (check all that apply)
___Classroom Participation
_ __ Checklist
__X__ Class work
____ Homework
____ Observation
____ Special Projects
__X__ Tests and Quizzes
____ Written Reports
____ Criterion-referenced test:_________________________
____ Norm-referenced test: ___________________________
____ Other: ________________________________________
Progress on this goal will be reported to the parent or adult student using the following codes. Attach comments using progress report comment form located in section two.
Anticipated Date of Progress Report*
11/30/21
2/30/22
4/30/22
6/15/22
Actual Date of Progress Report
Progress Code
SP -The student is making Sufficient Progress to achieve this annual goal within the duration of this IEP.
IP -The student has demonstrated Insufficient Progress to meet this annual goal and may not achieve this goal within the duration of this IEP.
ES – The student demonstrates Emerging Skill but may not achieve this goal within the duration of this IEP.
NI -The student has Not been provided Instruction on this goal.
M -The student has Mastered this annual goal.
* Progress reports will be provided at least as often as parents are informed of the progress of children without disabilities.
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
MEASURABLE ANNUAL GOALS, PROGRESS REPORT
Student Name: Mia Alex Date: 9/15/2021 Page: 7 of 14
Student ID Number: 5214322 Area of Need: Writing
# 3 MEASURABLE ANNUAL GOAL:
Mia will write in a variety of forms to include narrative, descriptive, expository, and persuasive, with 80% accuracy, on 4 out of 5 writing assignments each grading period.
The IEP team considered the need for short-term objectives/benchmarks.
Short-term objectives/benchmarks are included for this goal. (Required for students participating in the VAAP)
Short-term objectives/benchmarks are not included for this goal.
How will progress toward this annual goal be measured? (check all that apply)
___Classroom Participation
____ Checklist
__X__ Class work
____ Homework
____ Observation
____ Special Projects
__X__ Tests and Quizzes
____ Written Reports
____ Criterion-referenced test:_________________________
____ Norm-referenced test: ___________________________
____ Other: ________________________________________
Progress on this goal will be reported to the parent or adult student using the following codes. Attach comments using progress report comment form located in section two.
Anticipated Date of Progress Report*
11/30/21
2/30/22
4/30/22
6/15/22
Actual Date of Progress Report
Progress Code
SP -The student is making Sufficient Progress to achieve this annual goal within the duration of this IEP.
IP -The student has demonstrated Insufficient Progress to meet this annual goal and may not achieve this goal within the duration of this IEP.
ES – The student demonstrates Emerging Skill but may not achieve this goal within the duration of this IEP.
NI -The student has Not been provided Instruction on this goal.
M -The student has Mastered this annual goal.
* Progress reports will be provided at least as often as parents are informed of the progress of children without
disabilities.
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
MEASURABLE ANNUAL GOALS, PROGRESS REPORT
Student Name: Mia. Date: 9/15/2021 Page: 8 of 14
Student ID Number: 5214322 Area of Need: Behavior
# 4 MEASURABLE ANNUAL GOAL:
During structured classroom activities, Mia will demonstrate control and engage in self-regulation by remaining in her seat and staying on task, with no more than 3 fading teacher prompts per day, as monitored by a weekly positive behavior chart.
Also, Mia will turn in 3 out of 5 her completed work with the use of reminding calendar put on her table, as monitored by a weekly positive behavior chart.
The IEP team considered the need for short-term objectives/benchmarks.
Short-term objectives/benchmarks are included for this goal. (Required for students participating in the VAAP)
Short-term objectives/benchmarks are not included for this goal.
How will progress toward this annual goal be measured? (check all that apply)
____ Classroom Participation
____ Checklist
____ Class work
____ Homework
__X__ Observation
____ Special Projects
____ Tests and Quizzes
____ Written Reports
____ Criterion-referenced test:_________________________
____ Norm-referenced test: ___________________________
__X__ Other: positive reinforcement chart
Progress on this goal will be reported to the parent or adult student using the following codes. Attach comments using progress report comment form located in section two.
Anticipated Date of Progress Report*
11/30/21
2/30/22
4/30/22
6/15/22
Actual Date of Progress Report
Progress Code
SP -The student is making Sufficient Progress to achieve this annual goal within the duration of this IEP.
IP -The student has demonstrated Insufficient Progress to meet this annual goal and may not achieve this goal within the duration of this IEP.
ES – The student demonstrates Emerging Skill but may not achieve this goal within the duration of this IEP.
NI -The student has Not been provided Instruction on this goal.
M -The student has Mastered this annual goal.
* Progress reports will be provided at least as often as parents are informed of the progress of children without disabilities.
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT
ACCOMMODATIONS/MODIFICATIONS
Student Name: Mia Alex Date: 9/15/2021 Page: 9 of 14
Student ID Number: 5214322
This student will be provided access to general education classes, special education classes, other school services and activities including nonacademic activities and extracurricular activities, and education related settings:
___ with no accommodations/modifications
_X__ with the following accommodations/modifications
Accommodations/modifications provided as part of the instructional and testing/assessment process will allow the student equal opportunity to access the curriculum and demonstrate achievement. Accommodations/modifications also provide access to nonacademic and extracurricular activities and educationally related settings. Accommodations/modifications based solely on the potential to enhance performance beyond providing equal access are inappropriate.
Accommodations may be in, but not limited to, the areas of time, scheduling, setting, presentation and response including assistive technology and/or accessible materials. The impact of any modifications listed should be discussed.
ACCOMMODATIONS/MODIFICATIONS (list, as appropriate)
Accommodation(s)/Modification(s)
Frequency
Location
(Name of school *)
Instructional Setting
Duration
m/d/y to m/d/y
Extended Time
Daily
Ellis E.S.
All classes
9/15/21 to 6/20/22
Frequent Breaks
Daily
Ellis E.S.
All classes
9/15/21 to 6/20/22
Preferential Seating
Daily
Ellis E.S.
All classes
9/15/21 to 6/20/22
Minimal distractions
Daily
Ellis E.S.
All classes
9/15/21 to 6/20/22
Place Keeper/Tracking tool
Daily
Ellis E.S.
All classes
9/15/21 to 6/20/22
Graphic organizer for reading/writing
Daily
Ellis E.S.
Reading/Writing tasks
9/15/21 to 6/20/22
Large diameter pencil
Daily
Ellis E.S.
All classes
9/15/21 to 6/20/22
Use of manipulatives for math
Daily
Ellis E.S.
Math
9/15/21 to 6/20/22
Calculator
Daily
Ellis E.S.
Math
9/15/21 to 6/20/22
Positive reinforcement chart
Daily
Ellis E.S.
All classes
9/15/21 to 6/20/22
Reminding Calendar
Daily
Ellis E.S.
All classes
9/15/21 to 6/20/22
* IEP teams are required to identify the specific school site (public or private) when the parent expresses concerns about the location of the services or refuses the proposed site. A listing of more than one anticipated location is permissible, if the parents do not indicate that they will object to any particular school or state that the team should identify a single school.
Supports for School Personnel: (Describe supports such as equipment, consultation, or training for school staff to meet the unique needs for the student) ______________________________________________________N/A______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT, Continued
PARTICIPATION IN THE STATE AND DIVISIONWIDE ACCOUNTABILITY/ASSESSMENT SYSTEM
Student Name: Mia Alex Date: 9/15/2021 Page: 10 of 14
Student ID Number: 5214322
This student’s participation in state and division wide assessments must be discussed annually. During the duration of this IEP:
Will the student be at a grade level or enrolled in a course for which the student must participate in a state and/or division wide assessment? If yes, continue to next question.
Yes No
Based on the Present Level of Academic Achievement and Functional Performance, is this student being considered for participation in the Virginia Standards of Learning (SOL)Assessments (select appropriate content area) Reading Math Science History/Social Science Writing
Yes No
Based on the Present Level of Academic Achievement and Functional Performance, is this student being considered for participation in the Virginia Grade Level Alternative (VGLA)? If yes, complete the “VGLA Participation Criteria” for each content area considered and attach justification statement. Science History/Social Science Writing
Yes No
Does the student meet the VGLA participation criteria? If yes, determine for specific content area.
Science History/Social Science Writing
Yes No
Based on the Present Level of Academic Achievement and Functional Performance, is this student being considered for participation in the Virginia Modified Achievement Standards Test (VMAST)? If yes, complete the “VMAST Participation Criteria” for each content considered. Math Reading
Yes No
Does the student meet the VMAST participation criteria? If yes, determine for specific content area. Math Reading
Note: Beginning in 2014-2015, the VMAST will no longer be available as a separate alternate assessment.
Yes No
Based on the Present Level of Academic Achievement and Functional Performance, is this student being considered for participation in the Special Permission Request Virginia Substitute Evaluation Program (VSEP)? If yes, complete the “VSEP Participation Criteria” for each content area considered. Reading Math Writing (Grades 3-8 only)
Yes No
Does the student meet the VSEP participation criteria? If yes, determine for specific content area
Reading Math Writing (Grades 3-8 only)
Yes No
Based on the Present Level of Academic Achievement and Functional Performance, is this student being considered for participation in the Virginia Alternate Assessment Program (VAAP), which is based on Aligned Standards of Learning? If yes, complete the “VAAP Participation Criteria”.
Yes No
Does the student meet VAAP participation criteria?
Yes No
If “yes” to any of the above, check the assessment(s) chosen and attach (or maintain in student’s educational record) the assessment page(s), which will document how the student will participate in Virginia’s accountability system and any needed accommodations and/or modifications.
State Assessments:*
__x_ SOL Assessments Reading Math Science History/Social Science Writing
___ Virginia Substitute Evaluation Program (VSEP) Math Writing Reading
___ Virginia Grade Level Alternative (VGLA) Science History/Social Science Writing
___ Virginia Modified Achievement Standards Test (VMAST) Math Reading
___ Virginia Alternate Assessment Program (VAAP)
Division wide Assessment (list):
N/A
________________________________________________________________________________________________________________________________________________________________________________________________________
*Refer to Procedures for Participation of Students with Disabilities in Virginia’s Accountability System for additional guidance on the assessment programs.
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
PARTICIPATION IN THE STATE AND DIVISIONWIDE ACCOUNTABILITY/ASSESSMENT SYSTEM (continued)
Student Name: Mia Alex Date: 9/15/2021 Page: 11 of 14
Student ID Number: 5214322
PARTICIPATION IN STATEWIDE ASSESSMENTS
Test
Assessment Type*
(SOL, VGLA, VSEP, VMAST1,VAAP)
Accommodations**
If yes, list accommodation(s)
Reading
_________________SOL______________________
Not Assessed at this Grade Level
Yes No
Graphic organizer
Math
_________________SOL______________________
Not Assessed at this Grade Level
Yes No
Manipulatives
Calculator
Science
_______________________________________
Not Assessed at this Grade Level
Yes No
N/A
History/SS
_______________________________________
Not Assessed at this Grade Level
Yes No
N/A
Writing
_______________________________________
Not Assessed at this Grade Level
Yes No
N/A
* Students with disabilities are expected to participate in all content area assessments that are available to students without disabilities. The IEP Team determines how the student will participate in the accountability system.
** Accommodation(s) must be based upon those the student generally uses during classroom instruction and assessment, including assistive technology and/or accessible materials. For the accommodations that may be considered, refer to VDOE’s Procedures for Participation of Students with Disabilities in Virginia’s Accountability System for guidance.
1 VMAST is available in mathematics 3-8 and EOC Algebra I and grades 3-8 reading only. Beginning in 2014-2015, the VMAST will no longer be available as a separate alternate assessment. Divisionwide Assessment (list): _________________________________________________________________________________________________________N/A________________________________________________________________________________________________________________________________________________________________________________________________
EXPLANATION FOR NON-PARTICIPATION IN REGULAR STATE OR DIVISION-WIDE ASSESSMENTS
If an IEP team determines that a student must take an alternate assessment instead of a regular state assessment, explain in the space below why the student cannot participate in this regular assessment; why the particular assessment selected is appropriate for the student, including that the student meets the criteria for the alternate assessment; and how the student’s nonparticipation in the regular assessment will impact the child’s promotion; or other matters. Refer to the VDOE’s Procedures for Participation of Students with Disabilities in Virginia’s Accountability System for guidance.
Alternate/Alternative Assessments Participation Criteria is attached or maintained in the student’s educational record
_____________________________________________________________________________________________________________N/A___________________________________________________________________________________________________________________________________________________________________________________________
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT, Continued
Student Name: Mia Alex. Date: 9/15/2021 Page: 12 of 14
Student ID Number: 5214322
Least Restrictive Environment (LRE)
When discussing the least restrictive environment and placement options, the following must be considered:
To the maximum extent appropriate, the student is educated with children without disabilities.
Special classes, separate schooling or other removal of the student from the regular educational environment occurs only when the nature or severity of the disability is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily.
The student’s placement should be as close as possible to the child’s home and unless the IEP of the student with a disability requires some other arrangement, the student is educated in the school that he or she would attend if he or she did not have a disability.
In selecting the LRE, consideration is given to any potential harmful effect on the student or on the quality of services that he/she needs.
The student with a disability shall be served in a program with age-appropriate peers unless it can be shown that for a particular student with a disability, the alternative placement is appropriate as documented by the IEP.
Free Appropriate Public Education (FAPE)
When discussing FAPE for this student, it is important for the IEP team to remember that FAPE may include, as appropriate:
Educational Programs and Services
Proper Functioning of Hearing Aids
Assistive Technology and/or accessible materials
Transportation
Nonacademic and Extracurricular Services and Activities
Physical Education
Extended School Year Services (ESY)
Length of School Day
SERVICES:
Identify the service(s), including frequency, duration and location that will be provided to or on behalf of the student in order for the student to receive a free appropriate public education. These services are the special education services and as necessary, the related services, supplementary aids and services based on peer-reviewed research to the extent practicable, assistive technology and/or accessible materials, supports for personnel*, accommodations and/or modifications* and extended school year services* the student will receive that will address area(s) of need as identified by the IEP team. Address any needed transportation and physical education services including accommodations and/or modifications. * These services are listed on the “Accommodations/Modifications” page and “Extended School Year Services” page, as needed.
Service(s)
Frequency
**School/location
Instructional
Setting
(classroom)
Duration
m/d/y to m/d/y
Disability Service Area:
Primary, Secondary, Tertiary ***
Percentage Special Education Service by Disability Category
Reading/Writing
4 hrs/week
1 SC 3GE
9/15/21 to 6/20/22
Mathematics
4 hrs/week
1 SC 3GE
9/15/21 to 6/20/22
Behavior
1 hrs/week
SC 1 GE
9/15/21 to 6/20/22
Speech
1 hrs/week
SC 1 GE
9/15/21 to 6/20/22
** IEP teams are required to identify the specific school site (public or private) when the parent expresses concerns about the location of the services or refuses the proposed site. A listing of more than one anticipated location is permissible, if the parents do not indicate that they will object to any particular school or state that the team should identify a single school.
***Not required for the IEP-may be included for data collection purposes. The total percent of services for the primary, secondary, and tertiary disabilities cannot exceed 100. To calculate the percentage of special education services, the amount of time required to provide all special education services described in the IEP is divided by the length of the standard instructional day multiplied by 100.
SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT, Continued
Student Name: Mia Alex Date: 9/15/2021 Page: 13 of 14
Student ID Number: 5214322
Extended School Year Services (ESY): (see attached summary sheet as a means to document discussion)
The IEP team determined that the student needs ESY services.
The IEP team determined that the student does not need ESY services. Describe. Mia’ progress on current goals will not be significantly jeopardized by the lack of services beyond the normal school term.
The IEP team will determine and/or address ESY services at a later date. Addressed by date:______________
Explain:
PLACEMENT
No single model for the delivery of services to any population or category of children with disabilities is acceptable for meeting the requirement for a continuum of alternative placements. All placement decisions shall be based on the individual needs of each student. The team may consider placement options in conjunction with discussing any needed supplementary aids and services, accommodations/modifications, assistive technology and/or accessible materials, and supports for school personnel. In considering the placement continuum options, check those the team discussed. Then, describe the placement selected in the PLACEMENT DECISION section below. Determination of the Least Restrictive Environment (LRE) and placement may be one or a combination of options along the continuum.
PLACEMENT CONTINUUM OPTIONS CONSIDERED: (check all that have been considered):
*PLACEMENT DECISION: (select the appropriate placement option)
general education class(es)
special class(es)
special education day school
state special education program / school
Public residential facility
Private residential facility
Homebound
Hospital
other
Inside regular class at least 80% of time
Inside regular class 40% to 79% of time
Inside regular class less than 40% of time
Public separate school (day) facility
Private separate school (day) facility
Public residential facility
Private residential facility
Homebound
Hospital
other
*To calculate the percentage of time in the regular class, the amount of time spent in the regular classroom is divided by length of the entire school day multiplied by 100.
Based upon identified services and the consideration of least restrictive environment (LRE) and placement continuum options, describe in the space below the placement. Additionally, summarize the discussions and decision around LRE and placement. This must include an explanation of why the student will not be participating with students without disabilities in the general education class(es), programs, and activities. Attach additional pages as needed.
Explanation of Placement Decision:
Based on Mia’ present level of performance and her goals in mathematics, reading, and writing, the IEP team agrees that the required specialized instruction, supplemental aids and services to meet her educational needs can be provided in the general education class in collaboration with the special education teacher.
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
PRIOR NOTICE AND PARENT CONSENT
Student Name: Mia Alex Date: 9/15/2021 Page: 14 of 14
Student ID Number: 5214322
PRIOR NOTICE
The school division proposes to implement this IEP. This proposed IEP will allow the student to receive a free appropriate public education in the least restrictive environment. This decision is based upon a review of current records, current assessments and the student’s performance as documented in the Present Level of Academic Achievement and Functional Performance. Other options considered, if any, and the reason(s) for rejection are attached, or can be found in the Placement Decision section of this IEP. Additionally, other factors, if any that are relevant to this proposal are attached. Parent and adult student rights are explained in the Procedural Safeguards. If you, the parent(s) and adult student, need another copy of the Procedural Safeguards or need assistance in understanding this information please contact
Mrs. Karen Matthews at (301) 423-4593 ext. 58 or e-mail kmatthews@ellises.org or
Mrs. Annie Lawson at (301) 423-4593 ext. 40 or e-mail alawson@ellises.org
.
__x__ Parent(s) initials here indicate that the parent(s) has read the above prior notice and attachments, if any, before giving permission to implement this IEP.
PARENT/ADULT STUDENT CONSENT: Indicate your response by checking the appropriate space and sign below.
_X__ I give permission to implement this IEP.
___ I do not give permission to implement this IEP.
____________________________________________________ ____/____/____
Parent Signature Date
ELEMENTARY INDIVIDUALIZED EDUCATION PROGRAM (IEP)
PROCESS CHECKLIST
Meeting notices sent to parent and agency representatives, as appropriate
Acquire written consent from parent for an agency representative to attend the IEP meeting
Welcome and introductions of team members
Review purpose of meeting
Review meeting agenda
Review rights and procedural safeguards pertaining to special education and the IEP meeting
Review of special factors to be considered by the IEP team
Develop Present Level of Academic Achievement and Functional Performance
Develop measurable annual goals
(Discuss progress report on previous annual goals, as needed.)
Determine progress report schedule
Document that the IEP team considered the need for short-term objectives or benchmarks for students other than those who take alternate assessments aligned to alternate achievement standards
Develop short-term objectives or benchmarks for the annual goals, as needed
Determine any needed accommodations and/or modifications in instruction and assessment
Determine participation in state and divisionwide assessments
Determine services and placement
Determine if student needs ESY services
Review any requests proposed and/or refused
Provide prior written notice and obtain parental consent
Identify how staff will be informed of their responsibilities for implementation of the IEP
SAMPLE
School Division Letterhead
IEP MEETING NOTICE
Date:
8/21/21
To:
Mr. Alex
and
_______________________________________
Parent(s)/Guardian(s)/Adult Student Student (if appropriate or if transition will be discussed)
You are invited to attend an IEP meeting regarding __________________Mia Alex_________________
Student’s Name
PURPOSE OF MEETING (check all that apply):
IEP Development or Review
IEP Amendment
Transition: Part C to Part B, Transition Services
Manifestation Determination
Other: ________________________________________________________________________________
The meeting has been scheduled for:
9/15/21
10:00 AM
Ellis E.S. Conference Room
Date Time Location
Meetings are scheduled at a mutually agreed upon place and time by you and the school division. If you are unable to attend this meeting you may request participation through other means. If you are unable to attend this meeting, please contact:
Ms. Karen Matthews
Special Education Coordinator
(301) 423-4593
IEP Case Manager
Title
Phone
You and the school division may invite individuals to participate in the IEP team meeting who have knowledge or expertise about the student’s educational needs. The determination of the knowledge or special expertise shall be made by the party who invited the individual. In the case of a child who was previously served under Part C that an invitation of the initial IEP team meeting shall, at the request of the parent, be sent to the Part C service coordinator or other representatives of Part C to assist with the smooth transition of services.
Below is a list of the participants (by name or position) the division will be inviting to attend the IEP meeting:
Ms. Victoria Smith, Homeroom and Reading Teacher
Mrs. Julie Martin, Math Teacher
Ms. Karen Matthews, Special Education Teacher
Ms. Caroline Sampson, Assistant Principal
Mrs. Annie Lawson, School Counselor
Reflection
In this section you will write a reflection of the IEP process from your perspective based on your experiences and reading materials.
Virginia Department of Education — Sample IEP Form—Revised November, 2013 Page 2 of 14