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Date Sent to Parent:
06-16-07
Maine Special Education Regulations Section (MSER) IX.3(G)
(State of Maine Required Form)
STATE OF MAINE
SAU:
Jersey Heights School Department
SAMPLE
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
1.CHILD INFORMATION
Child’s Name: Laura Sereyko / Date of Meeting: 06-14-07Date of Birth: 02-10-01 / Effective Date of IEP: 06-15-07
Age: 6.4 / Date of Annual IEP Review 06-13-08
School: IslandFlightSchool / Date of Re-evaluation: 10-2007
Grade: K / Date(s) of Amended IEP:
State Agency Client: Yes No
2. DISABILITY:(MSER) Section VII.2
AutismDeaf-BlindnessDeafness
Developmental Delay (ages 3-5)Developmental Delay (Kindergarten)Emotional Disturbance
Hearing ImpairmentMental RetardationMultiple Disabilities
Other Health Impairment Orthopedic Impairment Speech or Language Impairment
Specific Learning DisabilityTraumatic Brain InjuryVisual Impairment (Including Blindness)
Child’s name: Laura Sereyko
3. CONSIDERATIONS
In developing each child’s IEP, the IEP Team must consider-34 CFR 300.324;MSER Section IX.3.C
A.Thestrengths of child: 34 CFR 300.324(a)(1)(i);MSER Section IX.3.C(1)(a)
Laura is a hard worker and is very cooperative. She is doing well in most academic areas but speech and language problem effects reading acquisition skills.
B. The concerns of parents for enhancing the education of their child: 34 CFR 300.324(a)(1)(ii);MSER Section IX.3.C(1)(b)
The parents are concerned about the effect Laura’s speech will have on her reading.
C.Results of the initial evaluation or most recent evaluation of the child: 34 CFR 300.324(a)(1)(iii);MSER Section IX.3.C(1)(c)
Evaluations received from CDS showed Laura to require speech and language therapy and that pre-reading skills were scattered.
D.Academic, developmental, and functional needs of the child: 34 CFR 300.324(a)(1)(iv); MSER Section IX.3.C(1)(d) Laura has academic and developmental needs that need to be addressed.
Consideration of Special Factors: The IEP team must- 34 CFR 300.324(a)(2);MSER Section IX.3.C(2)
E. In the case of a child whose behavior impedes the child's learning or that of others consider the use of positive behavioral interventions and supports and other strategiesto address the behavior: 34 CFR 300.324(a)(2)(i);MSER Section IX.3.C(2)(a)
Check if not needed If needed, indicate where it is addressed in the IEP.
F.In the case of a child with limited English proficiency, consider the language needs of the child as those needs relate to the child’s IEP
34 CFR 300.324(a)(2)(ii); MSER Section IX.3.C(2)(b)
Check if notneeded If needed, indicate where it is addressed in the IEP.
G.In the case of a child who is blind or visually impaired, provide for instruction in Braille and the use of Braille unless the IEP Team determines, after anevaluation of the child’s reading and writing skills, needs, and appropriate reading and writing media (including an evaluation of the child’s future needsfor instruction in Brailleor the use of Braille), that instruction in Braille or the use of Braille is not appropriate for the child. 34 CFR 300.324(a)(2)(iii);MSER Section IX.3.C(2)(c)
Check if not needed If needed, indicate where it is addressed in the IEP.
H.Consider the communication needs of the child, and in the case of a child who is deaf or hard of hearing, consider the child's language and
communication needs, opportunities for direct communication with peers and professional personnel in the child’s language and communication
mode, academic level, and full range of needs including opportunities for direct instruction in the child’s language and communication mode.
34 CFR 300.324(a)(2)(iv);MSER Section IX.3.C(2)(d)
Check if not needed If needed, indicate where it is addressed in the IEP. Section 5
- Consider whether the child needs assistive technology devices and services. 34 CFR 300.324(a)(2)(v);MSER Section IX.3.C(2)(e)
Check if notneeded If needed, indicate where it is addressed in the IEP.
Child’s name: Laura Sereyko
4. PRESENT LEVEL OF ACADEMIC AND FUNCTIONAL PERFORMANCE
A statement of the child’s present levels of academic achievement and functional performance, including how the child's disability affects the child's involvement and progress in the general education curriculum, or for preschool children, as appropriate, how the disability affects the child’s participation in appropriate activities;
34 CFR 300.320(a)(1)& MSER Section IX.3.A(1)(a)(i)&(ii)
1. Laura has 21 articulation errors in isolation that put her at the 6th Percentile for her age and well below her peers. 2. Laura also has a moderate expressive language delay with a current level of 5.0 years in sentence structure and 4.8 years in vocabulary. The combination of these delays and Laura’s odd accent make it very difficult to understand her in connected speech. 3. Laura’s sound-symbol relationship is delayed and she is at a beginning Kindergarten level. Laura struggles with learning the sounds and simple words and this makes her self conscious when reading with her peers.
5. ANNUAL GOAL(S)
Measurable annual goals including academic and functional goals designed to meet the child's needs that result from the
child's disability to enable the child to be involved in and make progress in the general education curriculum; and meet
each of the child's other educational needs that result from the child's disability and how the child’s progress toward meeting
the annual goals will be measured. 34 CFR 300.320(a)(2)(i) & 300.320(a)(3)(A)(i)MSER Section IX.3.A(1)(b)&(c)
(For children in grades 9-12 the IEP shall reflect the individual goals to successfully meet the content standards of the system of Learning Results in addition to any other diploma requirements applicable to all secondary school children pursuant to 20-A-MRSA § 4722 & MSER Section IX.3.A(1)(b)(iii)
Measurable Annual Goal / *1,2,3,4 / How Goal will be Measured / **PROGRESS1a. Laura will decrease articulation errors in isolation to 10.
1b. Laura will be able to use seven of the new sounds above in words in the initial, medial and final placement with 85% accuracy.
2. Laura’s expressive language will increase to 6.5 years age level.
3. Laura will increase sound –symbol relationships and overall reading ability to a mid First Grade Level. / As measured by Speech Pathologist with Goldman-Fristoe Test of Articulation.
As measured by Speech Pathologist informal assessment quarterly.
As measured by Expressive Language Test.
As measured by classroom reading assessment. / 1st 2nd 3rd 4th
A description of when periodic reports on the progress the child is making toward meeting the annual goals such as through
the use of quarterly or other periodic reports, concurrent with the issuance of report cards will be provided.
34 CFR 300.320(a)(3)(ii) MSER Section IX.3.A(1)(c)
Progress on IEP Goals will be sent home each trimester.
*(Indicate in this column if this a goal related to kindergarten transition and use number codes below to identify the area(s) to which it relates:
16763. Transition Preparation/Adjustments
2.Program Visitation4. Skill Assessment
**1. Met Goal 2. Adequate Progress 3. Limited Progress 4. No Progress
Child’s name:Laura Sereyko
6. SHORT TERM OBJECTIVES
Only for children with disabilities who take alternate assessments aligned to alternate achievement standards, a description of benchmarks or short-term objectives: 34 CFR 300.320(a)(2)(ii) MSER Section IX.3.A(1)(a)(iii)
SHORT TERM OBJECTIVESGiven…. Child will…. As measured by…. By when…. / * PROGRESS
*(SAU’s need to add their own descriptionof progress toward meeting the objectives)
7. SPECIAL EDUCATION AND RELATED SERVICES 34 CFR 300.39 & 300.320(A)(4) & 300.320(A)(7) & MSER SECTION IX.3.A(1)(D) & SECTION IX.3.A(1)(G)
Special Education Services / Position Responsible / Location / Frequency / DurationBeginning/Ending Date
Specially Designed Instruction / Special Ed Teacher / Regular Ed Setting / 45 Minutes per day / 09-02-07 to 06-13-08
Consultation
Speech and Language Services / Speech-Language Pathologist / Special Ed Setting / 90 Minutes per week / 9-02-07 to 06-13-08
Tutorial Services
Extended School Year Services / Speech Language Pathologist / Special Ed Setting / 150 Minutes Per week / 07-09-07 to 08-15-07
Other
Child’s name:Laura Sereyko
Related Services / Position Responsible / Location / Frequency / DurationBeginning/Ending Date
Speech and Language Services
Occupational Therapy
Physical Therapy
Social Work Services
Transportation
Other
8. SUPPLEMENTARY AIDS AND SERVICES, BASED ON PEER-REVIEWED RESEARCH TO THE EXTENT PRACTICABLE, TO BE PROVIDED TO THE CHILD, OR ON BEHALF OF THE CHILD AND A STATEMENT OF PROGRAM MODIFICATIONS OR SUPPORTS FOR SAU PERSONNEL THAT WILL BE PROVIDED TO ENABLE THE CHILD TO ADVANCE TOWARD ATTAINING THE GOALS, TO BE INVOLVED IN AND MAKE PROGRESS IN THE GENERAL EDUCATION CURRICULUM AND TO PARTICIPATE IN EXTRACURRICULAR AND OTHER NONACADEMIC ACTIVITIES, AND TO BE EDUCATED AND PARTICIPATE WITH OTHER CHILDREN WITH DISABILITIES AND NONDISABLED CHILDREN IN ACTIVITIES. 34 CFR 300.320(A)(4)(I)-(III) & (7) & MSER SECTION IX.3.A(1)(D) & (G)
Supplementary aids, services,modifications, and or supports
for SAU personnel.
(34 CFR 300.42) / Position Responsible / Location / Frequency / Duration
Simplify vocabulary for difficult concepts / Regular Ed Teacher / Regular Ed Setting / All Day / 09-02-07 to 06-13-08
Ask student to repeat directions / “ / “ / “ / “
Do not penalize for errors caused by articulation errors / “ / “ / “ / “
Child’s name: Laura Sereyko
9. LEAST RESTRICTIVE ENVIRONMENT
An explanation of the extent, if any, to which the child will not participate with non disabled children in the regular class
and participate in extracurricular and other nonacademic activities: 34 CFR 300.320(a)(5)MSER Section IX.3.A(1)(e)
Laura needs to have individual or small group therapy for speech and language in a quiet environment where she can focus on the goals of her IEP.
10. STATE AND DISTRICT WIDE ASSESSMENTS
A statement of any individual appropriate accommodations that are necessary to measure the academic achievement and
functional performance of the child on State and district wide assessments: 34 CFR 300.320(a)(6)(i)& MSER Section IX.3.A(1)(f)(i)
Laura can participate in regular district-wide assessments but should not be penalized for errors caused by her articulation errors.
If the IEP Team determines that the child shall take an alternate assessment on a particular State or district wide
assessment of child achievement, a statement of why the child cannot participate in the regular assessment andwhy the particular assessment selected is appropriate for the child. 34 CFR 300.320(a)(6)(ii)(A)&(B)MSER Section IX.3.A(1)(f)(ii)(I)(II)
If this child’s IEP does not require Section 11, Secondary Transition and Section 12, Age of Majority, this will be the last page of the IEP.
Child’s name:
11. SECONDARY TRANSITION
If the purpose of the meeting will be the consideration of transition service needs and or the post-secondary goals for the child and the transition services needed to assist the child in reaching those goals and the child does not attend, document the steps taken to ensure that the child’s preferences and interests are considered. 34 CFR 300.321(b)(2) & MSER Section VI.2.C(3)(d)
Beginning not later than the first IEP to be in effect when the child is 14, or younger if determined appropriate by the IEP Team, and updated annually thereafter appropriate measurable postsecondary goals based upon age appropriate transition assessments related to: 34 CFR 300.320(b)(1) & MSER Section IX.3.A(1)(i)
CHILD’S POSTSECONDARY GOALS / AGE APPROPRIATE TRANSITION ASSESSMENTSTraining/Education
Employment
Independent Living Skills
(Where appropriate)
Child’s name:
…and the transition services (including courses of study) needed to assist the child in reaching those goals. 34 CFR 300.320(b)(2)
34 CFR 300.43(a)(2)(i)through (v)& MSER Section IX.3.A(1)(i)(ii)
Child’s Course of Study updated annually: (required for students 14 through the age either at which the child receives a regular education diploma or ages out of IDEA eligibility) (34 CFR 300.320(b)(2) & MSER Section IX.3.A(i)(ii)
Transition Services needed to assist the child in realizing their post secondary goals. / Needs and Activities / Position Responsible/Title / DateInitiated / Date
Completed
Instruction
Related Services
Community Experience
Employment
Post- School adult living objectives
If appropriate the acquisition of daily living skills
If appropriate the provision of afunctional vocational evaluation
Child’s name:
12. AGE OF MAJORITY
Beginning not later than one year before the child reaches the age of majority under state law (18), include a statement that the child has been informed of the child’s rights that will transfer to the child on reaching the age of majority. 34 CFR 300.320(7)(c)MSERSection IX.3.A(i)(iii)
Date child was informed of the transfer of rights.
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