Sample Individualized Education Program

I. Student Information and Instructional Profile

Student Morgan Beatrice Smith Date of Birth 6-3-91 Student Number 228-88-2100

Parent’s/Guardian’s Name Charles and Carrie Smith Address 423 Sunset Lane Small Town , USA 27779
Street City Zip Code
Parent’s/Guardian’s Phone No. 555-6176 Student’s Present School Suite High School Grade 9th

Date of IEP Meeting 8-17-05 Date of Eligibility 10-25-96 IEP Review Date 6-1-06

Child’s Primary Language English Limited English Proficiency No Braille Instruction No

Yes/No Yes/No
Assistive Technology Needs No Language/Communication Needs Yes
YES /NO YES /NO

II. Student Performance Profile

Morgan is a 14-year-old female student enrolled in the 9th grade at Suite High School. Morgan lives at home with her
mother, an older brother, and a younger sister. Morgan possesses many strengths. They include on-grade-level math skills
and above-grade-level spelling skills. Morgan exhibits inappropriate behavior at times. For example, when Morgan becomes
upset she may become self-injurious, hit others, and/or bite others. Morgan enjoys reading, using the computer, and draw-
ing. Morgan is verbal but is often echolalic. She repeats questions she is asked. Morgan’s need for social communication
has led to previous placement working with the speech and language pathologist. Morgan’s need for structure, individualized
instruction, and behavior impede her from participating in most general education classes.
Morgan’s Present Level of Performance (PLOP) includes the administration of the following intellectual, achievement,
and speech and language evaluations:
Differential Ability Scales—School Age Battery (5-13-05). G-CA of 60, Verbal Cluster SS of 62, a Spatial Cluster SS
of 69, and a Nonverbal Reasoning Cluster of 63. On 6-24-05, the Leiter-R was administered, yielding an I.Q. of 71. The
Woodcock-Johnson Tests of Achievement: Third Edition (WJ:III) were administered 4-26 & 4-29-05. Morgan obtained a
total achievement score of 55 on the WJ:III with the following subtest scores: Letter-Word Identification 82; Reading Flu-
ency 74; Spelling 91; Writing Fluency 79; and Writing Samples 45. The Composite Scores were: Broad Reading 70; Broad
Math 51; Broad Written Language 79; Academic Skills 75; Academic Fluency 71; and Academic Applications 40. Adaptive
Behavior Evaluation Scales (home and school version) were completed on 4-4 & 4-5-05, with respective composites of 64
and 58. Vision and hearing screenings were passed on 4-4-05. The OWLS administered on 4-4-05 yielded an Oral Expres-
sion score of 40, Listening Comprehension of 45, and Oral Composite of 40. The Comprehensive Receptive and Expressive
Vocabulary Test—2 administered in March 2005 yielded a General Vocabulary score of 62 with a receptive score of 75, and
an expressive score of 62.
The results of the Autism Diagnostic Observation Schedule—General (ADOS-G) indicate symptoms consistent with a
diagnosis of Autistic Disorder.

III. Program Eligibility

Eligible ✓ Not Eligible Area(s) of Disability Autism Speech-Language Impairments
PRIMARY SECONDARY
Rationale for Eligibility Morgan meets eligibility criteria for Autism and Speech-Language Impairment based on state guidelines.

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2 SAMPLE INDIVIDUALIZED EDUCATION PROGRAM

Student Morgan Beatrice Smith Date of Birth 6-3-91 Student Number 228-88-2100

IV. Annual Goals and Benchmarks

Area: Language / Social Skills
Annual Goal: Morgan will be able to maintain a conversation through at least 3 exchanges of information by the end of
the school year.
Initiation Check Mastery
Provider Evaluation Method Date Date Date
Benchmark
Morgan will maintain a conversation SLP a. Data collection e. Grades 8-17-05 12-31-05
through 3 exchanges of information Special Educator b. Teacher/Text test f. Other:
by asking questions. Paraprofessional c. Work samples
d. Classroom
observation
Benchmark
Morgan will maintain a conversation SLP a. Data collection e. Grades 1-1-06 5-31-06
through 3 exchanges of information Special Educator b. Teacher/Text test f. Other:
to include a variety of verbal Paraprofessional c. Work samples
interactions such as expanding a d. Classroom
thought, and reflecting on the observation
other person’s conversation.

Area: Social Skills

Annual Goal: Morgan will increase her interactions with her peers with the assistance of her paraprofessional.
Initiation Check Mastery
Provider Evaluation Method Date Date Date
Benchmark
Morgan will sit with peers at lunch Special Educator a. Data collection e. Grades 8-17-05 ongoing
and engage in social conversation Paraprofessional b. Teacher/Text test f. Other:
daily. c. Work samples Observation
d. Classroom
observation
Benchmark
Morgan will interact with peers in Special Educator a. Data collection e. grades 8-17-05 ongoing
structured and unstructured Paraprofessional b. Teacher/Text test f. Other:
classroom settings. c. Work samples Peer mentors/
d. Classroom social stories
observation

Area: Reading Comprehension

Annual Goal: Morgan will improve reading comprehension and increase her understanding of vocabulary.
Initiation Check Mastery
Provider Evaluation Method Date Date Date
Benchmark
Morgan will read a short paragraph Special Educator a. Data collection e. Grades 8-17-05 10-31-05
and correctly answer 2 out of b. Teacher/Text test f. Other:
3 questions by end of the first c. Work samples
10 weeks. d. Classroom
observation
 SAMPLE INDIVIDUALIZED EDUCATION PROGRAM 3
Student Morgan Beatrice Smith Date of Birth 6-3-91 Student Number 228-88-2100

Initiation Check Mastery

Provider Evaluation Method Date Date Date
Benchmark
Morgan will read a simple paragraph Special Educator a. Data collection e. Grades 11-1-05 2-15-06
and correctly answer 5 out of b. Teacher/Text test f. Other:
5 questions by end of the second c. Work samples
10 weeks. d. Classroom
observation
Benchmark
Morgan will correctly spell and Special Educator a. Data collection e. Grades 2-16-06 5-31-06
identify the meaning of 15 vocabulary b. Teacher/Text test f. Other:
words by the end of the c. Work samples
10 weeks. d. Classroom
observation

Only three representative goals are illustrated.

V. Supplementary Aids and Related Services

Services/Related Services Provider Hours per Week Location
Adaptive Physical Education Mr. Allen 5 Gymnasium

Speech-Language Therapy Mrs. Fiero 1.5 Therapy room

Occupational Therapy / Sensory Integration Mrs. Wise 2.5 Therapy room

Aids/equipment/program modifications needed to attain annual goals and progress in general education curriculum:
Provide ongoing support throughout the day to decrease anxiety and resulting self-injurious behaviors.

Frequency of use: As indicated by Occupational Therapist.

VI. Special Education Placement

Student to be placed in the following least restrictive environment:
Location of Services Duration Extent of Participation
(NO. OF HOURS IN LOCATION/
TOTAL NO. OF SCHOOL HOURS)

General education classroom 2/6 Assistance provided by paraprofessional

Special education environments:
Resource room 4/6 Assistance provided by paraprofessional

Self-contained class
Special day school
Residential school
4 SAMPLE INDIVIDUALIZED EDUCATION PROGRAM

Student Morgan Beatrice Smith Date of Birth 6-3-91 Student Number 228-88-2100

Location of Services Duration Extent of Participation

(NO. OF HOURS IN LOCATION/
TOTAL NO. OF SCHOOL HOURS)

Hospital school
Homebound services
Other __________
(e.g., Head Start, work site)
Rationale for placement in setting other
than general education class

VII. Special Services

Physical Education: Regular ______ Adaptive ✓

Transportation: Regular ______ Special ✓ Not Applicable ______

Is student provided an opportunity to participate in extracurricular and nonacademic activities with nondisabled
peers? yes
Yes/No

Are supports necessary? yes Describe: Morgan attends with paraprofessional.

Yes/No

Rationale for nonparticipation:

VIII. Transition (no later than age 14, earlier if appropriate)

Transition Service Needs Special Education Certificate
Focusing on Course of Study
Career Interest(s) Computers, drawing

Employment Outcome Morgan will work in the community and function at a job with ongoing job coaching.

Community Living Outcome Morgan will live in a supportive community living group home.

Identify Needed Transition 1. Independent Living: Morgan will be able to care for herself and her needs.
Services 2. Community Integration: Morgan will be able to participate in the community with the
assistance of her caregiver.
3. Recreation and Leisure: Morgan will identify and utilize community recreational
opportunities.
4. Transportation: Morgan will utilize transit and para-transit transportation opportunities.
5. Education: Morgan will participate in a day treatment program focusing on vocational and
adaptive skills.
Identify Interagency A case manager will be identified for Morgan at age 16 from the Mental Retardation
Responsibilities Developmental Disabilities Board (MRDD). Vocational rehabilitation will assist with
vocational evaluations.

Community Linkages MRDD Board, ARC, Private Group Homes, Inc., Vocational Rehabilitation Services,
Community Recreation Centers, Community Transit and Para-Transit Systems
 SAMPLE INDIVIDUALIZED EDUCATION PROGRAM 5
Student Morgan Beatrice Smith Date of Birth 6-3-91 Student Number 228-88-2100

IX. Assessment Modifications

Is student able to participate in state- or district-wide assessments? no
YES /NO

Are modifications required? yes

YES /NO

Identify type of modifications: Morgan’s assessment needs will be met with an alternative assessment in the form of a
competency portfolio.

Rationale for nonparticipation and alternate assessment plan: Morgan does not have traditional test-taking skills.
A portfolio that demonstrates Morgan’s competencies in the areas of her annual goals will be developed.

X. Progress Report
Parents will be informed of child’s progress toward annual goals using same reporting methods used for children with-
out disabilities.

Method Frequency
❖ Written Progress Report yes Every 10 weeks
YES /NO

❖ Parent Conference yes As requested

YES /NO

❖ Other
IDENTIFY

❖ Other
IDENTIFY

XI. Transferral of Rights

I understand that the rights under the Individuals with Disabilities Education Act will transfer to me upon reaching my
eighteenth birthday.

STUDENT’S SIGNATURE DATE

XII. Recommended Instructional and/or Behavioral Interventions

Provide a rich reinforcement schedule following each activity. Use a timer to keep Morgan on task during instructional
and reinforcement activities. Block all attempts at injuring herself or others and redirect to task at hand. Teachers working
with Morgan should watch the tone of their voice and vocabulary as she frequently becomes confused resulting in aggres-
sive behavior. A behavior management plan should be developed if self-injurious behaviors and/or aggression becomes a
problem.
6 SAMPLE INDIVIDUALIZED EDUCATION PROGRAM

Student Morgan Beatrice Smith Date of Birth 6-3-91 Student Number 228-88-2100

XIII. IEP Development Team

Name Team Member’s Signature Position/Title
Mr. Charles Smith Charles Smith Parent/Guardian
Mrs. Carrie Smith Carrie Smith Parent/Guardian
Mrs. Ruth Rhea Ruth Rhea LEA Representative
Mr. Mitchell Duff Mitchell Duff Special Education Teacher
Mr. Bruce Clark Bruce Clark General Education Teacher
Mrs. Donna Fiero Donna Fiero SLP
Morgan Beatrice Smith Morgan Beatrice Smith Student
Mrs. Lynn Wise Lynn Wise Other OT