Standard 2: Individualized Education Plan – Part 1
Base the IEP on the student you are following throughout your student teaching placement.
All identifiable student information should be replaced with pseudonyms for confidentiality. In addition, some information has been marked “Do not complete”’ due to confidentiality concerns.
The present level of academic achievement and functional performance (PLAAFP) will guide the development of the IEP. Teachers must describe student strengths, interests, and needs within the PLAAFP. Assessment scores and a description of how the student is performing in relationship to typically developing peers will provide the rationale for the development of IEP goals, services, testing accommodations, and supplementary aides and services. It is important that all sections of the IEP align with the PLAAFP.
Special Education Department
Individualized Education Program (IEP)
Student Name: John Smith Student Data/Cover Sheet (Form A-1) IEP Meeting Date: 12-08-2021
Demographic Information
Student Number:
12345678
Student (Pseudo) Name:
John Smith
Birthdate:
11-20-2009
Gender:
Male
Grade:
6th
Student Address:
976 Tinton Ave
Home Phone:
Do not complete
City, State, Zip:
Bronx, New York, 10456
Parent 1 (Pseudo) Name:
Tom Smith
Parent 1 Relationship:
Father
Parent 1 Address:
Do not complete.
Home Phone:
Do not complete.
City, State, Zip:
Do not complete.
Work Phone:
Do not complete.
Parent 1 Email:
Do not complete.
Parent 2 (Pseudo) Name:
Jane Smith
Parent 2 Relationship:
Mother
Parent 2 Address:
Do not complete.
Home Phone:
Do not complete.
City, State, Zip:
Do not complete.
Work Phone:
Do not complete.
Parent 2 Email:
Do not complete.
Primary Language of Home:
English
Primary Language Survey Date: 10-21-2021
Primary Language Survey Results: 10-26-2021
Language of Instruction:
English
Home District: Bronx
Attendance District: Bronx, NY
Service Coordinator:
Michelle Cooper
Home School: None
Attending School: P17x
Vision Screened On: 05-10-2020
Results: 20/20
Hearing Screened On:
04-08-2020
Results: 22DB
Meeting Date: 12-08-2021
Anticipated Duration of IEP:
From: 11-20-2021 To:
Re-evaluation Due: 12-02-2021
Current Evaluation: 11-15-2020
Special Education Primary Category 1:
Special Education Eligibility Category 2:
Special Education Eligibility Category 3:
For Students with SLD only, the following area(s) of eligibility was/were previously determined:
Level of Services: (A)
Type of Meeting:
Date Meeting Notice Sent to the Parent(s):
Date Procedural Safeguards given to the Parent(s):
This page will not need to be completed because it is a signature page.
Special Education Department
Individualized Education Program (IEP)
Student (Pseudo) Name: Student Data/Cover Sheet (Form A-2) IEP Meeting Date:
Student ID: DOB:
The following persons participated in the conference and/or the development of the IEP. Additionally, parents have been given a copy of their rights regarding the student’s placement in special education and understand that they have the right to request a review of their child’s IEP at any time.
Position/Relation to Student Participant Date (MM/DD/YY)
If during the IEP year the student turns 16, if the student is not present at the IEP meeting, the service coordinator must review the IEP with the student and obtain the student’s signature and the date of this review.
Special Education Department
Individualized Education Program (IEP)
Student (Pseudo) Name: Student Data/Cover Sheet (Form B) IEP Meeting Date:
Student ID: DOB:
PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE (PLAAFP)
Section 1: Current IEP Information
Summarize special education services the student is receiving:
Section 2: Evaluation Information
Areas of Eligibility:
Special Education Primary Category:
Special Education Eligibility Category 2:
Special Education Eligibility Category 3:
For students with SLD only, the following area(s) of eligibility was previously determined:
State and District Assessment Scores:
Section 3: Present Level of Academic Achievement and Functional Performance
Cognitive (academic performance in content areas, e.g., ELA/Reading/Writing, Math, Science, Social Studies, Technology and Fine Arts, as applicable)
Physical (gross motor, fine motor, vision, and hearing)
Oral Language and Communication
Social and Emotional Behavior
Adaptive
Current Classroom-Based Data:
Family’s Input on Student’s Current Performance:
Summary of Work Habits:
Section 4: Summary of Educational Needs and General Accommodations
Special Education Department
Individualized Education Program (IEP)
Student (Pseudo) Name: John Smith Considerations Form (Form C) IEP Meeting Date:
Student ID DOB:
ADDITIONAL DOCUMENTATION/CONSIDERATION OF SPECIAL FACTORS
Considered Not Needed
Included
Individual Transition Plan
☒
☐
Statement of Transfer of Parental Rights at Age of Majority
☒
☐
Statement of Positive Behavior Interventions, Strategies, and Supports Considered for a Student Whose Behavior Impedes his or her Learning, or That of Others
☒
☐
Statement of Language Needs in the Case of a Child with Limited English Proficiency
☒
☐
Statement of Provisions of Instruction in Braille and User of Braille for a Visually Impaired Child
☒
☐
Statement of the Language of Needs, Opportunities for Direct Communication with Peers in the Child’s Language, and Communication Mode
☒
☐
Statement of Required Assistive Technology Devices and Services
☐
☒
Statement of Communication Needs for a Child with a Disability
☐
☒
Special Education Department
Individualized Education Program (IEP)
Student (Pseudo) Name: Accommodations (Form F) IEP Meeting Date:
Student ID: DOB:
ASSESSMENTS
(Rationales for the accommodations that are being chosen specific to assessments.)
Rationale:
State Assessments
Standard Accommodation(s):
District Assessments
Standard Accommodation(s):
CURRENT STATE STANDARDIZED TEST (i.e., AIMS, PSSA) RESULTS
Testing Area
Test Results
Grade
Semester
Year
Reading
Writing
Math
Science
LEAST RESTRICTIVE ENVIRONMENT (LRE)
Provide an explanation of the extent, if any, to which the student will NOT participate with non-disabled students in the general curricular, extracurricular, nonacademic activities, and program options. §300.347(a) (4):
Consider any potential harmful effects of this placement for the child or on the quality of services that he or she needs §300.552 (a-b):
Reason for different services at school:
OR, if the above LRE information does not apply to this student, explain why:
Standard 3: Individualized Education Plan – Part 2
Special Education Department
Individualized Education Program (IEP)
Student (Pseudo) Name: John Smith Student Goals and Performance Objectives IEP Meeting Date:
Student ID:12345678 Progress Report DOB:
Skill Area:
Standard:
Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:
Skill Area:
Standard:
Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:
Skill Area:
Standard:
Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:
Skill Area:
Standard:
Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:
Special Education Department
Individualized Education Program (IEP)
Student (Pseudo) Name: Accommodations (Form E) IEP Meeting Date:
Student ID DOB:
ACCOMODATIONS
Date Given to General Education Teacher: Service Coordinator:
Accommodations
Type
Location
LEGEND FOR TYPE AND LOCATION FIELDS
Type:
1 = Class work/assignments 2 = Assessments/tests 3 = Both class work/assignments/assessments
Location:
A = All Subjects B = Language Arts/English C = Reading D = Spelling E = Math
F = Science G = Social Studies H = Health I = Electives J = Physical Education
K = Lunch L = Transition / Vocation M = Library N = Title 1 O = Special/Exploratory
Family Communication
How will the family be informed of their child’s academic progress and the extent to which that progress is sufficient to enable the child to achieve annual goals by the end of the year?
IEP Team Consideration for Extended School Year
Consideration for eligibility:
Eligible for ESY:
Written explanation as to why ESY is or is not needed:
Special Education Department
Individualized Education Program (IEP)
Student (Pseudo) Name: Services and Environment (Form I) IEP Meeting Date:
Student ID: DOB:
SPECIAL EDUCATION SERVICES TO BE PROVIDED
Special education services necessary to meet special education goals and objectives during the school calendar year.
The child is in need of specially designed instruction in the following areas:
Special Education Services
Instructional Setting/ Location
Start Date
Frequency
Provider
Duration/ End Date
Clarification:
EDUCATIONALLY RELEVANT RELATED SERVICES
Special Education Services
Instructional Setting/ Location
Start Date
Frequency
Provider
Duration/ End Date
Clarification:
EDUCATIONALLY RELEVANT SUPPLEMENTARY AIDS/ASSISTIVE TECHNOLOGY and SERVICES for STUDENTS
.
Special Education Services
Instructional Setting/ Location
Start Date
Frequency
Provider
Duration/ End Date
Clarification:
SUPPORTS FOR SCHOOL PERSONNEL
Special Education Services
Instructional Setting/
Location
Start Date
Frequency
Provider
Duration/ End Date
Clarification:
Standard 4: Preparation for IEP Meeting
The IEP team must cover mandated topics during the IEP meeting. Topics that must be addressed during the IEP include, but are not limited to, an introduction of team members, clarifying the type of meeting (initial, review, amendment/addendum to current IEP), the required components of the IEP, the procedural safeguards, and prior written notice.
IEP Meeting Planning
Required Participants/Roles: List the participants of an IEP meeting and their roles, including whether or not the student is expected to participate.
Required Agenda Outline: In 500-750 words, create an agenda for the IEP meeting. Discuss the required topics you must address (i.e., introduction of team members, whether or not this is an initial or review or an annual IEP, discussion of test results, present levels, goals, services, Least Restrictive Environment (LRE) statement, Extended School Year (ESY) services, procedural safeguards, and prior written notice.
Plan for Conflicts: Provide a description of ways you can involve parents in the development of the IEP. Discuss whether you anticipate issues or conflicts that may arise during the meeting and your plan on addressing those concerns.
Mock IEP Introduction Video
Now that you have outlined the IEP meeting agenda, you are prepared to conduct the meeting. In order to prepare for running your first official IEP meeting, record yourself as if you were conducting the IEP meeting. Your video should not exceed 15 minutes in length.
Focus your practice on the meeting introduction. Include the following components within your recording:
An introduction of all parties represented and their roles
Reason for the meeting (initial IEP or IEP review)
Meeting norms so all parties are heard and respected
Review of the PLAAFP including the discussion of test results, present levels, goals, services, Least Restrictive Environment (LRE) statement, Extended School Year (ESY) services, procedural safeguards, and prior written notice (PWN).
Conclude your video by providing an explanation of how you would actively listen to and address the needs of families and other stakeholders throughout the meeting.
After recording yourself, review and reflect upon the video below.
Mock IEP Introduction Video Link:
Video Recording Link: If you are submitting your video to OneDrive, note it here.
Reflection: In 250-500 words, reflect on your IEP meeting practice session. In what areas do you feel you did well? In what areas would you like to have more guidance and coaching before conducting your first official IEP on your own? What plan of action do you have for more coaching and guidance?
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