help with IEP Assignment

STUDENT’S NAME

DOB

SCHOOL YEAR

-

GRADE

-

IEP Initiation/Duration dates

fROM

to

This IEP will be implemented during the regular school term unless noted in extended school year services.

Student Profile – will include general statements regarding:

Strengths of the student –

Include information regarding the student’s strengths in academic and functional areas.

Parental concerns for enhancing the education –

Include all information regarding the parental concerns for enhancing the education of their child.

Student Preferences and/or Interests –

This area includes information obtained from parent, teacher(s), and the student regarding preferences and interests. Include all information concerning student preferences and/or interests including transition information.

Results of the most recent evaluations –

Include all information concerning evaluation results. This information should be written in meaningful terms so that the parent and service providers have a clear understanding of the evaluation results.

The academic, developmental, and functional needs of the student –

Include all information concerning how the student’s disability affects his/her involvement and progress in the general education curriculum, and, for preschool age children, how the disability affects his/her participation in age-appropriate activities.

Other –

Include any information pertinent to the development of the IEP that was not included anywhere else on the

Student Profile page.

For the child transitioning from EI to Preschool, justify if the IEP will not be implemented on the child’s 3rd birthday –

This should only be completed if the child is not being served under IDEA on the child’s third birthday. (e.g., if a child’s birthday is during the summer or holiday(s) justification is required).

STUDENT’S NAME:

DOB:

SPECIAL INSTRUCTIONAL FACTORS

Items checked “YES” will be addressed in this IEP:

· Does the student have behavior which impedes his/her learning or the learning of others?

YES

[ ]

NO

[ ]

· Does the student have a Behavioral Intervention Plan?

[ ]

[ ]

· Does the student have limited English proficiency?

[ ]

[ ]

· Does the student need instruction in Braille and the use of Braille?

[ ]

[ ]

· Does the student have communication needs?

[ ]

[ ]

· Does the student need assistive technology devices and/or services?

[ ]

[ ]

· Does the student require specially designed P.E.?

[ ]

[ ]

· Is the student working toward alternate achievement standards and participating in the Alabama Alternate Assessment?

[ ]

[ ]

· Are transition services addressed in this IEP?

[ ]

[ ]

TRANSPORTATION

Student’s mode of transportation:

[ ] Regular bus

[ ] Bus for special needs

[ ] Parent contract

[ ] Other:

Does the student require transportation as a related service?

[ ] YES

[ ] NO

If yes, check any transportation needs:

[ ]

Bus assistance:

[ ] Adult support

[ ] Medical support

[ ]

Preferential seating

[ ]

Behavioral Intervention Plan

[ ]

Wheelchair lift and securement system

[ ]

Restraint system

Specify type:

[ ]

Other. Specify:

[ ]

Bus driver and support personnel are aware of the student’s behavioral and/or medical concerns.

NONACADEMIC and EXTRACURRICULAR ACTIVITIES

Will the student have the opportunity to participate in nonacademic/extracurricular activities with his/her nondisabled peers?

[ ]

YES.

[ ]

YES, with supports. Describe:

[ ]

NO. Explanation must be provided:

method/FREQUENCY for reporting progress OF ATTAINING GOALS TO PARENTS

Annual Goal Progress reports will be sent to parents each time report cards are issued (every

weeks).

STUDENT’S NAME:

DOB:

Transition: Beginning not later than the first IEP to be in effect when the student is 16, or earlier if appropriate, and updated annually thereafter. For all students entering 9th grade regardless of their age, transition must be addressed.

[ ]

This student was invited to the IEP Team meeting.

[ ]

After prior consent of the parent or student (Age 19) was obtained, other agency representatives were invited to the IEP Team meeting.

[ ]

Transition services based on the student’s strengths, preferences, and interests that will reasonably enable the student to meet the postsecondary goals are addressed on the transition goal page in this IEP.

[ ]

Student Interview

[ ]

Career Awareness

[ ]

Interest Inventory

[ ]

Parent Interview

[ ]

Student Portfolio

[ ]

Interest Learning Profile

[ ]

Student Survey

[ ]

Vocational Assessment

[ ]

Career Aptitude

[ ]

Other

Assessment:

Date:

Assessment:

Date:

Long-Term Goal:

If Other is selected, specify:

Assessment:

Date:

Assessment:

Date:

Long-Term Goal:

If Other is selected, specify:

Assessment:

Date:

Assessment:

Date:

Long-Term Goal:

If Other is selected, specify:

[ ]

This student is in a middle school course of study that will help prepare him/her for transition.

Anticipated Date of Exit:

Month:

Year:

Selected Pathway to the Alabama High School Diploma:

[ ]

General Education Pathway (Intended to prepare student for college and career)

[ ]

Essentials/Life Skills Pathway (Intended to prepare student for a career/competitive employment)

[ ]

Alternate Achievement Standards Pathway (AAS) (Intended to prepare students for supported/competitive employment)

Program Credits to be Earned (Complete for students in grades 9-12)

For each course taken indicate program credits to be earned next to the appropriate pathway.

ENGLISH

MATH

SCIENCE

SOCIAL

STUDIES

General Education Pathway

Essentials/Life Skills Pathway

Alternate Achievement Standards Pathway

Elective(s)

(enter total number of electives)

STUDENT’S NAME:

DOB:

Identify the area the MEASURABLE ANNUAL GOAL will address. The area may be an academic content area (e.g., math, science) and/or a functional area (e.g., behavior, organization). For all students working on Extended Standards (following the Alternate Achievement Standards pathway), each content area (e.g., reading, math, science, language arts, and social studies) must be addressed.

Area:

Present Level of academic achievement AND functional Performance:

State how the student’s disability affects his/her involvement and progress in the general education curriculum for this particular area of instruction, or for preschool age students, how the disability affects the student’s participation in age- appropriate activities.

(Link to Curriculum Guides)

MEASURABLE ANNUAL GOAL related to meeting the student’s needs:

Target the individual needs of the student resulting from the student’s disability and how the student’s disability affects his/her involvement and progress in the general education curriculum. Describe what a student can reasonably be expected to accomplish within one school year.

Date of Mastery:

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:

Check each type of evaluation that will be used to evaluate the MEASURABLE ANNUAL GOAL. (At least one must be chosen.)

[ ] Curriculum Based Assessment [ ] Teacher/Text Test [ ] Teacher Observation [ ] Grades

[ ] Data Collection [ ] State Assessment(s) [ ] Work Samples

[ ] Other:

[ ] Other:

BENCHMARKS:

Include at least two Benchmarks for students working on Extended Standards or for students in public agencies that require Benchmarks. Benchmarks are required for all students working on Extended Standards. This includes academic goals and functional goals, regardless of whether it is a testing year.

1.

Date of Mastery:

2.

Date of Mastery:

3.

Date of Mastery:

4.

Date of Mastery:

STUDENT’S NAME:

DOB:

Identify the area the MEASURABLE ANNUAL GOAL will address. The area may be an academic content area (e.g., math, science) and/or a functional area (e.g., behavior, organization). For all students working on Extended Standards (following the Alternate Achievement Standards pathway), each content area (e.g., reading, math, science, language arts, and social studies) must be addressed.

Area:

Present Level of academic achievement AND functional Performance:

State how the student’s disability affects his/her involvement and progress in the general education curriculum for this particular area of instruction, or for preschool age students, how the disability affects the student’s participation in age- appropriate activities.

(Link to Curriculum Guides)

MEASURABLE ANNUAL GOAL related to meeting the student’s needs:

Target the individual needs of the student resulting from the student’s disability and how the student’s disability affects his/her involvement and progress in the general education curriculum. Describe what a student can reasonably be expected to accomplish within one school year.

Date of Mastery:

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:

Check each type of evaluation that will be used to evaluate the MEASURABLE ANNUAL GOAL. (At least one must be chosen.)

[ ] Curriculum Based Assessment [ ] Teacher/Text Test [ ] Teacher Observation [ ] Grades

[ ] Data Collection [ ] State Assessment(s) [ ] Work Samples

[ ] Other:

[ ] Other:

BENCHMARKS:

Include at least two Benchmarks for students working on Extended Standards or for students in public agencies that require Benchmarks. Benchmarks are required for all students working on Extended Standards. This includes academic goals and functional goals, regardless of whether it is a testing year.

1.

Date of Mastery:

2.

Date of Mastery:

3.

Date of Mastery:

4.

Date of Mastery:

STUDENT’S NAME:

DOB:

Identify the area the MEASURABLE ANNUAL GOAL will address. The area may be an academic content area (e.g., math, science) and/or a functional area (e.g., behavior, organization). For all students working on Extended Standards (following the Alternate Achievement Standards pathway), each content area (e.g., reading, math, science, language arts, and social studies) must be addressed.

Area:

Present Level of academic achievement AND functional Performance:

State how the student’s disability affects his/her involvement and progress in the general education curriculum for this particular area of instruction, or for preschool age students, how the disability affects the student’s participation in age- appropriate activities.

(Link to Curriculum Guides)

MEASURABLE ANNUAL GOAL related to meeting the student’s needs:

Target the individual needs of the student resulting from the student’s disability and how the student’s disability affects his/her involvement and progress in the general education curriculum. Describe what a student can reasonably be expected to accomplish within one school year.

Date of Mastery:

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:

Check each type of evaluation that will be used to evaluate the MEASURABLE ANNUAL GOAL. (At least one must be chosen.)

[ ] Curriculum Based Assessment [ ] Teacher/Text Test [ ] Teacher Observation [ ] Grades

[ ] Data Collection [ ] State Assessment(s) [ ] Work Samples

[ ] Other:

[ ] Other:

BENCHMARKS:

Include at least two Benchmarks for students working on Extended Standards or for students in public agencies that require Benchmarks. Benchmarks are required for all students working on Extended Standards. This includes academic goals and functional goals, regardless of whether it is a testing year.

1.

Date of Mastery:

2.

Date of Mastery:

3.

Date of Mastery:

4.

Date of Mastery:

STUDENT’S NAME:

DOB:

Special Education and Related Service(s): (Special Education, Supplementary Aids and Services, Program Modifications, Accommodations Needed for Assessments, Related Services, Assistive Technology, and Support for Personnel.)

Special Education

Service(s)

Anticipated Frequency of Service(s)

Amount of time

Beginning/Ending Duration Dates

Location of Service(s)

to

to

Related Services

[ ] Needed

[ ] Not Needed

Service(s)

Anticipated Frequency of Service(s)

Amount of time

Beginning/Ending Duration Dates

Location of Service(s)

to

to

Supplementary Aids and Services

[ ] Needed

[ ] Not Needed

Service(s)

Anticipated Frequency of Service(s)

Amount of time

Beginning/Ending Duration Dates

Location of Service(s)

to

to

Program Modifications

[ ] Needed

[ ] Not Needed

Service(s)

Anticipated Frequency of Service(s)

Amount of time

Beginning/Ending Duration Dates

Location of Service(s)

to

to

Accommodations Needed for Assessments

[ ] Needed

[ ] Not Needed

Service(s)

Anticipated Frequency of Service(s)

Amount of time

Beginning/Ending Duration Dates

Location of Service(s)

to

to

Assistive Technology

[ ] Needed

[ ] Not Needed

Service(s)

Anticipated Frequency of Service(s)

Amount of time

Beginning/Ending Duration Dates

Location of Service(s)

to

to

Support for Personnel

[ ] Needed

[ ] Not Needed

Service(s)

Anticipated Frequency of Service(s)

Amount of time

Beginning/Ending Duration Dates

Location of Service(s)

to

to

STUDENT’S NAME:

DOB:

TRANSFER OF RIGHTS

(Beginning not later than the IEP that will be in effect when the student reaches 18 years of age.)

Date student was informed that the rights under the IDEA will transfer to him/her at the age of 19

The IEP Team has considered the need for extended school year services.

[ ] Yes

[ ] No

LEAST RESTRICTIVE ENVIRONMENT

Does this student attend the school (or for a preschool-age student, participate in the environment) he/she would attend if nondisabled? [ ] Yes [ ] No

If no, explain:

Does this student receive all special education services with nondisabled peers? [ ] Yes [ ] No

If no, explain (explanation may not be solely because of needed modifications in the general curriculum):

[ ] 6-21 years of age [ ] 3-5 years of age

Least Restricted Environment:

COPY OF IEP

COPY OF SPECIAL EDUCATION RIGHTS

Was a copy of the IEP given to parent/student (age 19) at the IEP Team meeting?

[ ] Yes [ ] No

Was a copy of the Special Education Rights given to parent/student (age 19) at the IEP Team meeting?

[ ] Yes [ ] No

If no, date sent:

If no, date sent:

Date copy of amended IEP provided/sent to parent/student (age 19):

Position

Signature

Date

Parent

Parent

General Education Teacher

Special Education Teacher

LEA Representative

Someone Who Can Interpret the Instructional Implications of the Evaluation Results

Student

Career/Technical Education Representative

Other Agency Representative

Position

Name

Date