IEP

Elementary/Secondary IEP Module

Updated Spring 2022

Directions: There are four sections to the IEP Module. Note: use of the template is required. You must use the same students as in the assessment module.

Note: it is not permissible for students to work with their own children, or any child in their care or home

Section One: Write a complete description of your target student to include all of the required information below.

· Give student/parents a fictitious name that you will use throughout this module.

· Description of the family (i.e. family background, siblings, etc.)

· Birth date, age, gender and grade

· Thorough description of student (i.e. include any health issues, birth history, achievement of developmental milestones, history of education, previous diagnosis and special education settings/services etc.)

Section Two: You will write an IEP for your target student using the IEP template below. Use the assessment information from the diagnostic summary you reviewed, the observation and the informal assessment that you conducted on the target student to complete the IEP.

· Annual Goals should be measurable.

· Short term objectives should contain the 4 elements.

· Learner, behavior, condition, criteria

· Quarterly Progress section on goals/objectives page should have dates entered when you will be giving out progress reports to parents.

· You should write as many goals and objectives that are needed. There are three goal/objective pages within the template. You can copy and paste more into the template if you need more. Remember, you should be writing enough goals and objectives that you believe the child will be able to accomplish within a year. You should be addressing all areas of concerns within the goals and objectives.

Section Three: Read the following scenario and provide your answer in the textbox.

a) Scenario: It is annual review time for your target student’s IEP. The parents are at the IEP meeting and ready to review what goals and objectives the student has met for the year. The mother asks, “What do you have to show me that my child can really do these things?” Discuss how you will go about demonstrating to the parents that the goals/objectives on the IEP have been met?

Section Four: Write a reflection discussing what you have learned from completing this module in addition to answering the following questions.

a) What does the IEP mean to a general education teacher and a special education teacher, are their roles in the IEP the same or different?

b) How does writing an IEP impact your perception of a student; and how does it impact the type of instruction or services you provide?

c) What are your strengths and weaknesses in writing an IEP?

The reflection should be in paragraph form, double spaced, 12 inch Times New Roman font, with 1 inch margins with a minimum of 250 words.

Be sure to read through the grading rubric that appears at the end of this document.

SCROLL DOWN FOR TEMPLATE

IEP TEMPLATE

Note: Remove all directions

Section 1: Provide a description of your target student . Make sure and include the following:

· Give student/parents a fictitious name that you will use throughout this module.

· Description of the family (i.e. family background, siblings, etc.)

· Birth date, age, gender and grade

· Thorough description of student (i.e. include any health issues, birth history, achievement of developmental milestones, history of education, previous diagnosis and special education settings/services etc.)

Name: Ray Charles - Date: 8/17/15 - Page 1 of 11

Name: Ray Charles - Date: 8/17/15 - Page 1 of 11

Updated Spring 2022

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Section 2:

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student Name: __________________________________ Age: ________ Grade: ________

Parents Name: __________________________________

Address: _____________________________________________________________________

School District Attending: ______________________________________________________

Date IEP Developed: ________________________Duration of Services: ________________

From:_____________________________________To:________________________________

STATEMENT OF PARENTAL PARTICIPATION AND CONCERNS

PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

I. Provide a statement of the child’s present levels of academic achievement and functional performance including:

-Child’s strengths and needs (include data used to determine strengths and needs). Consider the academic, developmental, and functional needs resulting from the child’s disability, which may requires special education, related services, supplementary aids, supports from personnel, or modifications.

-Effect of the child’s disability on his/her involvement and progress in the general education curriculum

-Achievement of annual goals, performance in related service areas, and description of any significant lack of progress.

Here is a resource with strong phrases for a good PLAAFP:

https://www.pacer.org/parent/php/PHP-c253.pdf

II. For Secondary Students 16 or older: Describe the strengths and needs of the student in relation to post-secondary goals (based on age-appropriate transition assessments). Consider how the student’s disability will affect the student’s ability to reach his/her post-secondary goals (what the student will do after high school):

IEP Goals with Objectives Child’s Name: Date: Annual Goals: Provide measurable annual goals, including academic and functional goals to enable the child to be involved in and make progress in the general education curriculum and to meet other educational needs that result from the disability. Goal # Goal Area: Annual Goal: Objectives: Provide short-term objectives for the student that will lead to the mastery of the goal. 1. 2. 3. 4. 5. Type(s) of Evaluation (check all that apply): Curriculum Based Assessment Observation Charts Teacher/Text Test Work Samples Student Conferences Grades Portfolios Checklists Scoring Rubrics Other (specify): Progress Reports Completed Each Grading/Progress Period, As Scheduled By the District Obj. # Quarter 1 Progress Report Date Results Quarter 2 Progress Report Date Results Quarter 3 Progress Report Date Results Quarter 4 Progress Report Date Results Key for Results of Goals/Objectives: C=Continued D= Discontinued M= Mastered N= Not Initiated IEP Goals with Objectives Child’s Name: Date: Annual Goals: Provide measurable annual goals, including academic and functional goals to enable the child to be involved in and make progress in the general education curriculum and to meet other educational needs that result from the disability. Goal # Goal Area: Annual Goal: Objectives: Provide short-term objectives for the student that will lead to the mastery of the goal. 1. 2. 3. 4. 5. Type(s) of Evaluation (check all that apply): Curriculum Based Assessment Observation Charts Teacher/Text Test Work Samples Student Conferences Grades Portfolios Checklists Scoring Rubrics Other (specify): Progress Reports Completed Each Grading/Progress Period, As Scheduled By the District Obj. # Quarter 1 Progress Report Date Results Quarter 2 Progress Report Date Results Quarter 3 Progress Report Date Results Quarter 4 Progress Report Date Results Key for Results of Goals/Objectives: C=Continued D= Discontinued M= Mastered N= Not Initiate

IEP Goals with Objectives

Child’s Name:

Date:

Annual Goals: Provide measurable annual goals, including academic and functional goals to enable the child to be involved in and make progress in the general education curriculum and to meet other educational needs that result from the disability. Goal # Goal Area: Annual Goal:

Objectives: Provide short-term objectives for the student that will lead to the mastery of the goal.

1.
2.
3.
4.
5.

Type(s) of Evaluation (check all that apply):

	Curriculum Based Assessment		Observation Charts
	Teacher/Text Test		Work Samples
	Student Conferences		Grades
	Portfolios		Checklists
	Scoring Rubrics		Other (specify):

Progress Reports Completed Each Grading/Progress Period, As Scheduled By the District

Obj. #	Quarter 1 Progress Report Date	Results	Quarter 2 Progress Report Date	Results	Quarter 3 Progress Report Date	Results	Quarter 4 Progress Report Date	Results

Key for Results of Goals/Objectives: C=Continued D= Discontinued M= Mastered N= Not Initiated

Services (Schedule of Services)
Special Education Services	Time/Amount	Frequency	Setting
☐ Co-taught services in Biology ☐ Indirect Services in ☐ Direct instruction in ☐ Speech/Language services in ☐ Other:	Number of Minutes: Hours: Periods: Sessions:	☐ 1x ☐ Day ☐ 2x ☐ Week ☐ 3x ☐ Month ☐ 4x ☐ Quarter ☐ 5x ☐ 6x ☐ 7x ☐ 8x ☐ 9x	☐ Regular Classroom ☐ Special Ed Classroom ☐ Therapy Room ☐ Other (Specify):
☐ Co-taught services in ☐ Indirect Services in ☐ Direct instruction in ☐ Speech/Language services in ☐ Other:	Number of Minutes: Hours: Periods: Sessions:	☐ 1x ☐ Day ☐ 2x ☐ Week ☐ 3x ☐ Month ☐ 4x ☐ Quarter ☐ 5x ☐ 6x ☐ 7x ☐ 8x ☐ 9x	☐ Regular Classroom ☐ Special Ed Classroom ☐ Therapy Room ☐ Other (Specify):
☐ Co-taught services in ☐ Indirect Services in ☐ Direct instruction in ☐ Speech/Language services in ☐ Other:	Number of Minutes: Hours: Periods: Sessions:	☐ 1x ☐ Day ☐ 2x ☐ Week ☐ 3x ☐ Month ☐ 4x ☐ Quarter ☐ 5x ☐ 6x ☐ 7x ☐ 8x ☐ 9x	☐ Regular Classroom ☐ Special Ed Classroom ☐ Therapy Room ☐ Other (Specify):
☐ Co-taught services in ☐ Indirect Services in ☐ Direct instruction in ☐ Speech/Language services in ☐ Other:	Number of Minutes: Hours: Periods: Sessions:	☐ 1x ☐ Day ☐ 2x ☐ Week ☐ 3x ☐ Month ☐ 4x ☐ Quarter ☐ 5x ☐ 6x ☐ 7x ☐ 8x ☐ 9x	☐ Regular Classroom ☐ Special Ed Classroom ☐ Therapy Room ☐ Other (Specify):

Services Summary
Related Services ☐ None Needed	Time/Amount	Frequency	Setting
Related Service(s):	Number of Minutes: Hours: Periods: Sessions:	☐ 1x ☐ Day ☐ 2x ☐ Week ☐ 3x ☐ Month ☐ 4x ☐ Quarter ☐ 5x ☐ 6x ☐ 7x ☐ 8x ☐ 9x	☐ Regular Classroom ☐ Special Ed Classroom ☐ Therapy Room ☐ Other (Specify):
Related Service(s):	Number of Minutes: Hours: Periods: Sessions:	☐ 1x ☐ Day ☐ 2x ☐ Week ☐ 3x ☐ Month ☐ 4x ☐ Quarter ☐ 5x ☐ 6x ☐ 7x ☐ 8x ☐ 9x	☐ Regular Classroom ☐ Special Ed Classroom ☐ Therapy Room ☐ Other (Specify):
Related Service(s):	Number of Minutes: Hours: Periods: Sessions:	☐ 1x ☐ Day ☐ 2x ☐ Week ☐ 3x ☐ Month ☐ 4x ☐ Quarter ☐ 5x ☐ 6x ☐ 7x ☐ 8x ☐ 9x	☐ Regular Classroom ☐ Special Ed Classroom ☐ Therapy Room ☐ Other (Specify):

Consideration of Special Factors Check yes or no whether the IEP team considers each special factor to be relevant to this child. For factors checked yes, explain any services and supports that are needed in the IEP.
Language needs as related to the IEP for a child who is an English Learner	☐ Yes ☐ No	If yes, explain
Instruction in Braille if the child is blind or visually impaired, unless determined inappropriate based on evaluation	☐ Yes ☐ No	If yes, explain
Communication needs, and for the child who is deaf or hard of hearing, the language and communication needs and opportunities for communication and instruction in the child’s native language and communication mode	☐ Yes ☐ No	If yes, explain
Assistive technology devices and services	☐ Yes ☐ No	If yes, explain
Positive behavioral interventions and supports and other strategies to address behavior	☐ Yes ☐ No	If yes, explain
Supplementary aids and services, program modifications and accommodations and/or supports for personnel in general education or other education-related settings	☐ Yes ☐ No	If yes, explain
Are there other factors that need consideration	☐ Yes ☐ No	If yes, explain

Assessment Decision

1. Can the child participate in regular statewide and districtwide required assessments? ☐ Yes ☐ No A. List Accommodations needed (if any) consistent with IEP and general test administration guidelines. ☐ None needed ☐ Accommodations needed: 2. If the child will participate in the State Alternate Assessment Program, has the IEP team considered the guidelines for participation in alternate assessment? ☐ Yes ☐ No A. if the child will participate in the State Alternate Assessment Program, please provide a statement of why the child cannot participate in regular assessment.

Least Restrictive Environment Considerations

Extent of Participation in General Education

For K-12: The general education environment includes all academic as well as meals, recess, assemblies, field trips, etc. Will this child participate 100% of the time with non-disabled peers in the general education environment? ☐ Yes ☐ No Indicate the reasons why the IEP team determined that provision of services in the general education setting was not appropriate for the child. ☐ The child’s acquisition of academic/developmental skills cannot be addressed through modification/adaptation of the general curriculum. ☐ Small group instruction is necessary for the child to acquire skills specified in the IEP ☐ Behavior intervention strategies established in the child’s IEP require a degree of structure that cannot be implemented in a large group setting. ☐ The child’s needs cannot be achieved in the general education environment even when supplemental aids and supports are provided ☐ The child’s behavior significantly impedes his or her learning and that of others. ☐ Additional individualized instruction is needed to facilitate learning. ☐ A more structured environment is needed than can be provided in the general education setting. Is this placement in the school the child would normally attend if nondisabled? ☐ Yes ☐ No If no, is the placement as close as possible to the child’s home? ☐ Yes ☐ No If no, explain why the IEP requires other arrangements:

The continuum of placements for the least restrictive environment (LRE) includes regular classes with indirect service (RG), regular class 80% or more (RG), regular class 40% to 79% (RR), regular class less than 40% (SC), School-based Day Treatment, Special Day School, Residential School, Hospital Program, and Homebound Instruction. Continuum of Placement: ☐ Regular Class with Indirect Service (RG) ☐Regular Class 80% or more (RG) ☐ Regular Class 40% to 79% (RR) ☐ Regular Class Less Than 40% (SC) ☐ School-based Day Treatment ☐ Special Day School ☐ Residential School ☐ Hospital Program ☐ Homebound Instruction Amount of time IN general education setting: % of the time per week

SIGNATURES OF IEP TEAM PARTICIPANTS

Provide fictious names and positions of those who are required to attend the IEP meeting

NAME	SIGNATURE	POSITION

Name: Ray Charles - Date: 8/17/15 - Page 1 of 11

Name: Ray Charles - Date: 8/17/15 - Page 1 of 11

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Section Three: Read the following scenario and provide your answers below.

Scenario: It is annual review time for your target student’s IEP. The parents are at the IEP meeting and ready to review what goals and objectives the student has met for the year. The mother asks, “What do you have to show me that my child can really do these things?” Discuss how you will go about demonstrating to the parents that the goals/objectives on the IEP have been met.

Section Four: Write a reflection discussing what you have learned from completing this module in addition to answering the following questions.

a) What does the IEP mean to a general education teacher and a special education teacher, are their roles in the IEP the same or different?

b) How does writing an IEP impact your perception of a student; and how does it impact the type of instruction or services you provide?

c) What are your strengths and weaknesses in writing an IEP?

The reflection should be in paragraph form, double spaced, 12 inch Times New Roman font, with 1 inch margins with a minimum of 250 words.

IEP Module Rubric

100 points

Revised February 2020

Standards	Exemplary	Acceptable	Unacceptable
1. Description of Targeted Student Standard 4 ICSI 4 S1	Candidate gathers relevant background information and provides an excellent comprehensive description of the student, including all of the required information in directions. -Give student/parents a fictitious name -Description of the family (i.e. family background, siblings, etc.) -Birth date, age, gender and grade -Thorough description of: · student (i.e. include any health issues, birth history · achievement of developmental milestones, · history of education, · previous diagnosis · previous special education settings/services etc.) · current diagnosis	Candidate gathers relevant background information and provides a sufficient description of the student, including: -Give student/parents a fictitious name -Description of the family (i.e. family background, siblings, etc.) -Birth date, age, gender and grade General description of: · student (i.e. include any health issues, birth history · achievement of developmental milestones, · previous special education settings/services etc.) · current diagnosis	Candidate provides an insufficient description of the student and/or did not gather relevant information and does not include the following: Give student/parents a fictitious name. -Description of the family (i.e. family background, siblings, etc.) Birth date, age, gender and grade General description of: · student (i.e. include any health issues, birth history · achievement of developmental milestones, · previous special education settings/services etc.) · current diagnosis
2. Identifying Info & Demographics	Candidate provides excellent identification and demographics of student, schedule of services, using pseudonym to protect confidentiality. Includes all of the following: Thorough description of placement (give amount of time in all settings) Description of related services (i.e. speech, P.T., O.T. etc.)	Candidate provides basic identification and demographics, with some minor omissions in placement description or related services.	Candidate provides insufficient identification and demographics, and/or failed to use pseudonym to protect confidentiality. Includes only one of the items below or none of them. Thorough description of placement (give amount of time in all settings) Description of related services (i.e. speech, P.T., O.T. etc.)
3. Identify Parents, Parental participation & Concerns Standard 5 ICSI 5 S2	Candidate demonstrates exemplary skill in involving the family in setting instructional goals and monitoring progress. Provides a comprehensive description of the family’s role in development of the IEP; and parents’ concerns,	Candidate provides a basic description of the parents’ concerns.	Candidate provides an unclear or inadequate description of parents’ concerns and parent participation.
Standards	Exemplary	Acceptable	Unacceptable
4. Present Levels of Performance (PLAAFP) Standard 4 ICSI 4 S5	Candidate provides exemplary PLAAFP. - based on information from evaluation; -includes student strengths -includes student weaknesses -includes effect on academic and non-academic areas; - provides exact information that can be translated directly into relevant goals/objectives	Candidate provides acceptable PLAAFP. - based on information from evaluation -includes student weaknesses - includes effect on academic areas. -provides adequate information to translate directly into relevant goals/objectives	Candidate provides unacceptable PLAAFP. PLAAFP is not clearly based on information from evaluation At least one of the following items is missing: -includes student weaknesses - includes effect on academic areas. -provides adequate information to translate directly into relevant goals/objectives

5. Annual Goals Standard 3 ICSI 3 K3 (national, state or provincial, and local curricula standards)	Candidate demonstrates exemplary skill in writing annual goals for IEP. -Goals cover all needs identified in PLAAFP All goals are comprehensive, measurable, and based on standards to meet the student’s individual area(s) of need annually.	Candidate demonstrates acceptable skill in writing annual goals for IEP. -80% of goals cover needs identified in PLAAFP -80% of goals are written correctly based upon national, state and local standards as well as individual needs. -80% of goals are comprehensive to address a need area for one year . -80% of goals are measurable.	Candidate demonstrates unacceptable skill in writing annual goals. -less than 80% of goals cover needs identified in PLAAFP -less than 80% of goals are written correctly based upon national, state and local standards as well as individual needs. -less than 80% of goals are comprehensive to address a need area for one year. -less than 80 % of goals are measurable.
6. Objectives Standard 5 IGC-IIC 5 S24	Candidate demonstrates exemplary skill in the planning and implementing of age/ability appropriate instruction for the child with exceptionalities. -writes short term objectives clearly -all objectives cover all needs identified in PLAAFP -All objectives relate directly to the goal to which they are linked. -All objectives contain the four elements.	Candidate demonstrates acceptable skill in the planning and implementing of age/ability appropriate instruction for the child with exceptionalities. -writes short term objectives clearly -80% of objectives cover needs identified in PLAAFP -80% of objectives relate directly to the goal to which they are linked. -80% of objectives contain the four elements.	Candidate demonstrates unacceptable skill in the planning and implementing of age/ability appropriate instruction for the child with exceptionalities. -writes short term objectives unclearly -less than 80% of objectives cover needs identified in PLAAFP -less than 80% of objectives relate directly to the goal to which they are linked. -less than 80% of objectives contain the four elements.
Standards	Exemplary	Acceptable	Unacceptable
7. Consideration of Special Factors Standard 2 ICSI 2 K1	The candidate addresses and/or identifies the special factors and/or other demands of the learning environment that clearly meet the needs of the student with exceptionalities. Special factors include: Needs for English Learners; Braille Instruction; Communication Needs for Deaf/Hard of Hearing; Assistive Technology Needs; Positive Behavioral Interventions and Supports;	The candidate provides some special factors addressed of the learning environment; may be missing detail or relevance of the needs of the student with exceptionalities.	Candidate does not address and/or identify special factors and/or other demands of the learning environment that clearly meet the needs of the student with exceptionalities. Some factors are either missing or too brief, and/or unclear as to relevance to student. Special factors include: Needs for English Learners; Braille Instruction; Communication Needs for Deaf/Hard of Hearing; Assistive Technology Needs; Positive Behavioral Interventions and Supports;
8. Modifications, Supplemental Aids, and Supports STANDARD 5 ICSI 5 S16	The candidate demonstrates exemplary skill in using strategies to facilitate maintenance and generalization of skills across learning environments. -Provides detailed description of instructional strategies and materials used to make accommodations and/or modifications -addresses supplementary aids and services. -instructional strategies are directly relevant to identified needs. -all areas of accommodation are addressed.	The candidate demonstrates acceptable skill in using strategies to facilitate maintenance and generalization of skills across learning environments. -Provides basic description of instructional strategies and materials used to make accommodations and/or modifications -addresses supplementary aids and services. -instructional strategies are directly relevant to identified needs. -a minimum of one element of the accommodation area is not addressed.	The candidate demonstrates unacceptable skill in using strategies to facilitate maintenance and generalization of skills across learning environments. -Provides limited description of instructional strategies and materials used to -make accommodations and/or modifications -makes limited attempt to address supplementary aids and services. -instructional strategies are not directly relevant to identified needs. -more than one element of the accommodation area is not addressed.
9. Assessment STANDARD 3 ICSI 3 S1	Provides clear statement and rationale for the type of accommodations that the student needs for the general curriculum testing.	Provides basic rationale and statement with minor omissions or lack of clarity.	Either fails to provide a clear statement and/or rationale for the type of accommodations that the student needs for the general curriculum testing
10. LRE/Placement Considerations Standard 2 IGC-IIC 2 K3	Candidate provides recommendations for placement and related services that are clearly the least restrictive environment for the student ensuring academic success in one on one, small or large group settings.	Candidate provides recommendations generally addressing the LRE, with some minor issues.	Candidate provides unacceptable recommendations for placement and/or related services and/or not the least restrictive environment for student academic success in one on one, small or large group settings.
11. Participants ICSI 7 K2	Candidate demonstrates knowledge of the roles of individuals with exceptionalities, families, and school and community personnel in planning of an individualized program. Candidate lists all of the required participants in the IEP meeting and their position/roles.	Candidates minimally demonstrate knowledge of the roles of individuals with exceptionalities, families, and school and community personnel in planning of an individualized program. Candidate partially lists the required participants in the IEP meeting and their position/roles	Candidate does not demonstrate knowledge of the roles of individuals with exceptionalities, families, and school and community personnel in planning of an individualized program. Candidate provides partial or no list of the required participants in the IEP meeting and their position/roles.
Section 3 12. Scenario ICSI 5 S5	The candidate demonstrates exemplary skill in implementing and evaluating the IEP. Student will discuss methods used to determine the progress made toward goals/objectives. -provides thorough discussion of methods to be used	The candidate demonstrates adequate skill in implementing and evaluating the IEP. Student will discuss methods used to determine the progress made toward goals/objectives. -student provides adequate discussion of methods to be used.	The candidate does not demonstrate adequate skill in implementing and evaluating the IEP. Student does not discuss methods used to determine the progress made toward goals/objectives. -student provides vague or loosely organized discussion.

Section 4 13. Reflection: Professional and ethical Practice STANDARD 6 ICSI 6 S2	Candidate provides a clear and thorough discussion of how one will practice high standards, integrity, and sound judgment to improve their instruction within the classroom through the IEP and teaching the student with exceptionalities -provides detailed answers to all questions.	Candidate provides a general description of how one will practice high standards, integrity, and sound judgment to improve their instruction within the classroom through the IEP and teaching the student with exceptionalities. -provides brief answers to all questions.	Candidate provides little or no description of how one will practice high standards, integrity, and sound judgment to improve their instruction within the classroom through the IEP and teaching the students with exceptionalities. -answers are vague or did not provide answers to all questions.
14. Format STANDARD 6 ICSI 6 S5	IEP is exceptionally well written demonstrating the candidate’s commitment to the child education and quality of life. There are virtually no errors, providing all the correct information in a comprehensible form.	IEP is adequately written, with few errors, providing information in a comprehensible form.	IEP is not adequately written. Contains several errors, and/or provides information that is unclear and/or flawed.
15. Style, Format and Grammar for Reflections	Candidate follows the required, doubled spaced, 12” font, Times New Roman with 1” margins. No more than 2 spelling or grammatical errors were made.	Candidate follows the required, doubled spaced, 12” font, Times New Roman with 1” margins. No more than 4 spelling or grammatical errors were made.	Candidate does not follow the, doubled spaced, 12” font, Times New Roman with 1” margins. More than 4 spelling or grammatical errors were made.
Total Points: ___/100pts. Comments: