INDIVIDUALIZED EDUCATION PROGRAM
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Any County Schools
School Anywhere Date 5/15/14
PART I: STUDENT INFORMATION
Student’s Full Name Jane Doe
/DOB 2/18/04
Parent(s)/Guardian(s)/ Surrogate Parent John and Mary Doe /Age 10
Address P.O. Box 12345
/Grade 6
(Address continued) Anytown, WV 25123
/WVEIS# 110001234
Telephone Home: 555-1234 Work: Cell:Reevaluation Due Date: 11/25/2013
Initial Annual Review Reevaluation Review Amendment (Incorporated)
Parent Requested Teacher Requested
Transfer: (from) / DatePART II: Documentation of Attendance
Signature
/ Position______/ Parent
______/ Parent
______/ Student
______/ General Education Teacher
______/ Special Education Teacher
______/ Birth to Three Representative
______/ Chairperson
______
______
______
______
______
______
The following people participated in the IEP team meeting via an alternate method:
Name / Position / Alternate Method
INDIVIDUALIZED EDUCATION PROGRAM
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Student’s Full Name Jane Doe / Date 5/15/14PART III: EXTENDED SCHOOL YEAR (ESY) DETERMINATION
Will ESY be considered while developing this IEP?
____ Yes _X__ N/A (Student is gifted)
The IEP Team in making its determination of a student’s need for ESY shall review documentation that the student exhibits, or may exhibit:
· Significant regression during an interruption in educational programming;
· A limited ability to recoup, or relearn skills once programming has resumed;
· Regression/recoupment problem(s) that interfere with the maintenance of identified critical skills as described in the current IEP; and
· Others factors that interfere with the maintenance of identified critical skills as described in the current IEP, such as predictive data; degree of progress; emerging skills and breakthrough opportunities; interfering behaviors; nature and/or severity of the disability; and special circumstances
The lack of clear evidence of such factors may not be used to deny a student ESY services, if the IEP Team determines the need for such services and includes ESY in the IEP.
Does the student need ESY services?
____ Yes __X_ No Defer until: ______
(ESY shall be determined annually)
PART III B: EXTENDED SCHOOL YEAR (ESY) DETERMINATION
ESY Services
/ Direct/ Indirect (D or I) /Location of Services
* General EducationEnvironment = GEE
* Special Education
Environment = SEE
* Other = / Extent/Frequency
per / Initiation Date m/d/y / Duration m/y
The parent(s)/guardian(s) / adult student accept(s) reject(s) extended school services
West Virginia Department of Education February 2010
INDIVIDUALIZED EDUCATION PROGRAM
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Student’s Full Name Jane Doe / Date 5/15/14PART IV: CONSIDERATION OF FACTORS FOR IEP DEVELOPMENT/ANNUAL REVIEWS
The IEP Team considers for all students:
· The strengths of the student
· The concerns of the parent
· Results of the initial or most recent evaluation of the student. Are additional evaluations needed? (specify) ______
· Academic, developmental and functional needs of the student
· Revisions needed to address lack of progress
Additional Considerations (must be documented in Part IV Present Levels Narrative) / Yes / No1. / Is the student identified as gifted?
If yes, consider whether acceleration will be provided and document its effect on graduation. / X
2. / Does the student need assistive technology devices or services?
If yes, document the type of device and provision for home use, if any, and/or the nature and amount of services. / X
3. / Does the student have communication needs?
If yes, address in the IEP. / X
4. / Does the student’s behavior impede his or her learning or that of others?
If yes, consider the use of positive behavior interventions and supports and other strategies to address the behavior. / X
5. / Does the student have blindness or low vision?
If yes, document provision of instruction in Braille and the use of braille, OR after an evaluation of the student’s reading and writing skills, needs and appropriate reading and writing media, including an evaluation of the student’s future needs for instruction in braille or the use of braille, document in the Present Levels a justification that instruction in braille or the use of braille is not appropriate for the student.. / X
6. / Is the student deaf or hard-of-hearing?
If yes, consider the language and communication needs of the student, opportunities for direct communication with peers and professional
personnel in the student’s language and communication mode, the student’s
academic level and full range of needs, including opportunities for
direct instruction in the student’s language and communication mode. / X
7. / Does the student have limited English proficiency?
If yes, consider the language needs of the student. / X
8. / Will the student’s next IEP address transition services?
If yes, permission must be obtained to invite other agency representatives to the next meeting. (See Activities/Linkages section under Transition Planning) / X
INDIVIDUALIZED EDUCATION PROGRAM
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Student’s Full Name Jane Doe / Date 5/15/14PART V: ASSESSMENT DATA
Student Summative Assessment Data (WESTEST)
TEST YEAR / Reading/Language Arts / Math / Science / Social Studies / OtherSS / PL / LX / SS / PL / QT / SS / PL / SS / PL / SS / PL
2008 / 705 / 5 / 720 / 5 / 703 / 5 / 710 / 5
2009 / 708 / 5 / 657 / 5 / 719 / 5 / 726 / 5
2010 / 708 / 5 / 657 / 5 / 719 / 5 / 726 / 5
2011 / 708 / 5 / 657 / 5 / 719 / 5 / 726 / 5
2012 / 708 / 5 / 657 / 5 / 719 / 5 / 726 / 5
2013 / 708 / 5 / 657 / 5 / 719 / 5 / 726 / 5
(SS = scale score) (PL = performance level) (LX = Lexile) (QT = Quantile)
Student Summative Assessment Data (APTA)
TESTYEAR / Reading/Language Arts / Math / Science / Other / Other
PL / PL / PL / PL / PL
2008
2009
2010
2011
2012
2013
(PL = performance level)
Formative Assessment Data
Using current, annual data, list benchmark and formative assessments that have been used with the student and describe the results and implications for specially designed instruction. Also the data may describe information relevant to student behavior, setting demands, work habits/learning skills, technology skills, workplace skills, independent living skills, performance based assessment and describe the results and implications for specially designed instruction.Assessment / Description
Acuity custom-made math 7th test and quiz questions / Demonstrated above mastery skills in 7th Math CSOs (one grade-level above).
Writing rubric – Reading/LA and social studies informational essay / Demonstrated distinguished level in 6th grade CSO in writing standard and social studies standard. Five performance levels from Novice to Distinguished.
Teacher made checklist – Portfolio of writing / Demonstrated mastery of 6th grade CSOs in English/Language Arts writing standard
Scoring guide – debate / Demonstrated mastery of 5-8 grades CSOs in Learning Skills in reasoning, critical thinking and decision making skills
Problem solving rubric / Demonstrated 3rd level skills in science problem solving. (5-level rubric)
Learning Skills Rubric / 5-Level Rubric of Learning Skills – Scored at the Developing Level (2)
INDIVIDUALIZED EDUCATION PROGRAM
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Student’s Full Name Jane Doe / Date 5/15/14PART VI: TRANSITION PLANNING (for students beginning no later than the first IEP to be in effect when the student is 16, or younger if appropriate) (Refer to Policy 2510 and IEP instructions)
Age of Majority (for students reaching age 17 within the next 12 months)
The student and parent have been informed of the transfer of educational rights that will occur on reaching age 18.
Yes / No / Date / ______/ Student Initials / _____ / Parent Initials / _____Transition Planning Considerations:
How were the student’s preferences and interests considered? (Check all that apply):
Student interview/survey Interest inventory (specify)
Parent interview/survey Other (specify)
Functional vocational evaluation
Transition Assessments Reviewed (specify):
The student’s educational program will lead to a: standard diploma modified diploma
Post-Secondary Goals
Anticipated post-secondary education goals:
Anticipated post-secondary employment goals:
Anticipated post-secondary adult living goals:
Career Pathway/Cluster/Concentration the student selected on the Individualized Student Transition Plan (ISTP) is:
Pathway (8th grade) / Cluster (8th grade) / Concentration (10th grade)Entry(for 9th graders 04-05 through 07-08 only)
Skilled / Arts and Humanities
Business/Marketing
Engineering/Technical
Professional / Health Sciences
Human Services
Science/Natural Resources
Transition Services: Indicate areas identified through IEP goals.
Instruction Employment and other adult living objectives
Related Services Daily living skills (if appropriate)
Community experiences Functional vocational evaluation (if appropriate)
Lead Party/AgencyActivities/Linkages / Parent /
Student / School / Agency
(Specify) / Description of Service
Instruction/education
Vocational aptitude/interest assessment
Career awareness/work-based learning
Employment
Independent living/mobility
Agency referral/application
Activities/Linkages: Identify activities needed for attaining post-secondary outcomes and the lead party/agency responsible for those services.
*Should the identified agency fail to deliver transition activities outlined in the IEP, the IEP team must reconvene to identify alternative strategies to meet the transition needs of the child.
West Virginia Department of Education July 2010
INDIVIDUALIZED EDUCATION PROGRAM
______COUNTY
Student’s Full Name: Jane Doe / Page ____ of ____Date: May 15, 2014
PART VII: PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Narrative Descriptions of Present Levels of Academic Achievement and Functional Performance (refer to IEP Instructions) Add pages as needed.
Mathematics:
Grade- Level General Education Curriculum Expectations:
Seventh grade students 1) develop understanding of and applying proportional relationships; 2) develop understanding of operations with rational numbers and working with expressions and linear equations; 3) solve problems involving scale drawings and informal geometric constructions and work with two-three dimensional shapes to solve problems involving area, surface area and volume; and 4) draw inferences about populations based on samples.
21 Century Learning Skills and Technology Tools:
Fifth through eighth grade students are flexible in approach to solving problems and completing tasks, consider alternative methods, solutions and perspectives, abandon strategies that do not work, and reallocate time and resources as priorities change.
Present Level:
Jane scored at the Distinguished Level in English/Language Arts, Math, Science and Social Studies on the 6th grade WESTEST 2. Using the Acuity assessment tool, she demonstrated proficiency in 7th grade Mathematics using above-grade level custom-made tests. However, general education teachers report that she does not always complete assignments. During a grading period, she turns in an average of eight out of ten assignments.
Given the Learning Skills/Behavior Rubric, Jane scored in the Developing range overall. Her weakest area was in “Persisting” – sustaining the problem solving process over time.
Given a learning styles inventory, Jane is a logical/mathematic learner who learns best by using logic and patterns to solve problems. She may benefit from the provision of logic problems and from activities that develop problem-solving skills.
Given an interest inventory, Jane shows an interest in math and computers and wishes to pursue a career that involves math.
Impact Statement:
Jane’s exceptional intellectual ability and classroom achievement indicates she may be under-challenged in the grade-level content instruction normally provided in the general education classroom. This impacts her educational progress in that she may need grade-level curriculum enriched to include more depth and complexity and acceleration to above-grade level content in mathematics.
Targeted NxG Objective:
21C.O.5-8.3.LS2 (Learning Skills) is flexible in approach to solving problems and completing tasks, considers alternative methods, solutions and perspectives, abandons strategies that do not work, and reallocates time and resources as priorities change.
INDIVIDUALIZED EDUCATION PROGRAM
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Student’s Full Name Jane Doe / Date 5/15/14PART VIII A: ANNUAL GOALS, Part A (for students who are taught the WV CSOs)
GOALS (Continued)
* Denotes critical skill(s) to consider for extended school year.
Critical Skill
/Timeframe
/ Condition / Behavior / Evaluation Procedure with Criteria / Mastery/ProgressCodes (optional)
(per Grade Period)
By the end of the 2014-2015 school year / using Paul’s reasoning model and presented with real-life projects / Jane will apply the steps of a problem-solving model to complete a project / at the highest level of proficiency on a 4-level problem solving rubric in 4 of 5 work samples. / Mastery (ESY)
Progress
By the end of the 2014-2015 school year / given a variety of resource materials, (electronic and non-electronic,) and a research model / Jane will plan, develop, organize, and deliver a research project with documented sources, in-text citations to avoid plagiarism, and computer-generated graphic aids. / demonstrating a highest level of proficiency on a 4-level research rubric for 3 out of 4 trials. / Mastery (ESY)
Progress
By the end of the 2014-2015 school year, / given extension activities within the 7th grade social studies curriculum, / Jane will communicate her research effectively using spoken, written, and visual language for a variety of audiences and for different purposes / at the distinguished level on a teacher-made rating scale for 4 out of 5 trials. / Mastery (ESY)
Progress
· Progress
How and when will the student’s progress toward the IEP goals be reported to the parent(s)? Specify.
How? Progress Report mailed / When? End of 9 week period
Record dates on which Progress Reports have been provided to parents.
· Mastery Code: 0 = Regression 1 = Maintained 2 = Recouped
· Student Progress Code: P = Progress Sufficient A = Achieved
IP = Insufficient Progress NA = Not Applicable
West Virginia Department of Education February 2010
INDIVIDUALIZED EDUCATION PROGRAM
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Student’s Full Name Jane Doe / Date 5/15/14