EDSP 521
Virginia Department of Education’s Sample IEP Form
For Use with Students up to Age Thirteen, as Appropriate
COMPLETE ALL COMPONENTS HIGHLIGHTED IN YELLOW
Alyson Crosby
EDUC 521
Date:
Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 1 of 27
EDSP 521
INDIVIDUALIZED EDUCATION PROGRAM
PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Student Name__Elli Smith_________________________________________________ Date_9 /_20 /_2022 Page ___of___
Student ID Number_____________________________________________________
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.
_______________________________________________________________________________________________
Elli Smith is a cheerful 8-year-old girl currently entering the 2nd grade. Elli was found eligible for service for Specific
Learning Disability. Elli loves school, her friends, enjoys art and anything craft related. She works hard and always seems
ready for a challenge. Elli also has asthma and needs access to her inhaler, as well as regular check-ins with the school nurse.
According to the psychological evaluation, Elli demonstrates an overall ability in the average range. She demonstrates
substantially less developed long-term retrieval associative memory and auditory processing, specifically phonemic
awareness. These relative weaknesses coupled with difficulties in the aspect of auditory processing, such as phonemic
awareness, which is the understanding of the smallest units of sound (phonemes), might make the acquisition of reading
difficult. Also, the spelling of unfamiliar words might also prove to be a challenging task. Elli’s social functioning, as
assessed through rating scales, teacher interviews, and direct observation appears to be a challenging at times, but not a major
concern. According to achievement assessment, Elli demonstrates average oral language skills, mathematics and written
expression in the low average range with significant deficient range. Teacher reports indicate that Elli demonstrates an
independent reading level of pre-primer 1. Her auditory comprehension is very good, but her word attack is very poor. She
has received PALS remediation and Title I supports for reading for a period of 6 months and has made very minimal progress
despite supplemental instruction interventions targeting her identified areas of deficit.
Student’s Areas of Need (Deficits that Require Supports)
Elli’s areas of need resulting from her disability related deficits include:
Decoding
Reading
Spelling
Written language
Prolonged or moderate/heavy physical activity (Asthma) Medical aspect, not related to the SLD category.
