Rita G.

IEP Assignment
Directions: Use the numbered pages at the end of this document on which to write your answers. Fill in the blanks of
this IEP with creative answers that would facilitate learning for Rita and help her become successful in school. Use the
pages at the end of this document for your answers.

INDIVIDUAL EDUCATION PLAN – Rita G.

Reason for Development of IEP
X Student identified as exceptional by IEP
Student not formally identified but requires special education program/services including modified/alternative
learning expectations and/or accommodations.

Name: Rita G. Gender: F Date of Birth: 2/26/2004

School: Rock Star Academy
Student ID: 1234567 Principal: Mrs. Riceberg
Current Grade: 3.6 School Year: 2013-2014
Date of last IEP Date: 2/26/2013 Date of current IEP: 10/25/2013
Exceptionality: Specific Learning Disability
IEP Placement Decision: (check one)
Regular class with indirect support Special Education class with partial integration
X Regular class with Resource assistance Special Education class full time
Regular Class with withdrawal assistance

IEP Participation: Sources Consulted in Development of IEP:

Principal / LEA Mrs. Riceberg X Multidisciplinary Team Eligibility Statement
Regular Education Teacher Mr. Mild X Current Assessment Data
Special Education Teacher Mr. Frank District Report Card
Sp. Ed. Instructional Assistant Mrs. OK Previous IEP
School Psychologist Ms. Good X Parents/Guardians
Parent Ms. G X Student
Student Not in attendance Other Sources: (list below)

Eligibility Date: 10/20/2013 IEP Services Begin: 10/25/2013

Anticipated 3-year Reevaluation: 10/20/2016 Duration of IEP: 10/25/2014

Procedural Safeguards:
__ Parent/Guardian attended via telephone conference.
__ I have received a statement of procedural safeguards under the Individuals with Disabilities Education Act (IDEA)
and these right have been explained to me in my primary language.
Parent Signature ____________________________________

AT LEAST ONE YEAR PRIOR TO REACHING AGE 18, STUDENTS MUST BE INFORMED OF THEIR RIGHTS UNDER IDEA AND
ADVISED THAT THESE RIGHTS WILL TRANSFER TO THEM AT AGE 18.
X Not applicable. Student will not be 18 within one year, and the student’s next annual IEP meeting will occur no
later than the student’s 17th birthday.
The student has been informed of her/his rights under IDEA and advised of the transfer of these rights at age 18.
Assessment Data: List relevant educational, detailed medical/health (hearing, vision, physical, neurological),
psychological, speech/language, occupational, physiotherapy, and behavioral assessments.

Information Source Date Summary of Results

Keystone Visual Screening Service 10/01/2013
Wechsler Intelligence Scale for Children– 10/03/2013
3rd Ed. (WISC-III)
Peabody Individual Achievement Test– 10/09/2013
Revised (PIAT-R), Brigance
Comprehensive Inventory of Basic Skills–
Revised. (Math)
Brigance Comprehensive Inventory of 10/11/2013
Basic Skills–Revised, Woodcock Reading
Mastery Tests–Revised, and Gray Oral
Reading Tests, 3rd Ed. (Reading)
Brigance Comprehensive Inventory of 10/15/2013
Basic Skills – Revised, and observation.
(Written Expression)
Spelling – Brigance Comprehensive 10/17/2013
Inventory of Basic Skills–Revised, and
Woodcock-Johnson Psychoeducational
Battery–III (WJ-III), and Wide Range
Achievement Test–III
Vineland Adaptive Behavior Scales 10/23/2013
Normal range
Tested high in verbal skills. Tested low in test-taking while
visualizing object in space.
Math 1 ½ to 2 years below grade level.
Satisfactory scored in word recognition. Performance
dropped considerably when reading comprehension was
required.
Written expression is significantly below grade level.
Handwriting is a major problem for her.
Scored at 2nd grade level. Analysis of her spelling errors
showed that she usually spelled words according to
phonics rules.
Lowest scores are in daily living and socialization

Developmental Test of Visual-Motor 10/25/2013 Scored 3 years below chronological age

Integration (Learning strengths and
weaknesses)

Student’s Strengths and Needs

Areas of Strength Areas of Need
 Word recognition  Working independently
 Areas that use language  Reading comprehension
 Auditory discrimination (organization, makes sense of  Penmanship (manuscript and/or cursive)
language)  Word problem (Math)
 _________1__________  Numerical reasoning
 _________2__________  _________3___________
 _________4___________

Specialized Health Support Services/Personal Support Required ____ Yes (list below) X No
Subjects, courses, or alternative programs to which the IEP applies: Identify by placing an “X” in each box that applies
as Modified (MOD) and/or Accommodation (AC).

1. Writing skills MOD X AC 4. Reading MOD X AC

Comprehension
2. Arithmetic MOD X AC 5. Cognitive learning X MOD AC
(calculation) skills
3. Word Problems X MOD X AC 6. Social Skills X MOD AC

Elementary Program Exemptions or Secondary School Compulsory Course Substitutions

YES (Education rationale required) X NO

Student is currently working toward the attainment of: X Secondary School Diploma
Secondary School Certificate
Certificate of Accomplishment
 Environmental Assessment/Testing
Instructional Accommodations
Accommodations Accommodations
Writing Skills:  Work in small group settings  Portfolio assessment
 The rate of producing written work or in pairs  Shorten tests
 The volume/quantity or work  Actively involve Rita in  Computer visual learning
 The complexity of the written task lesson plans using Smart Board in group
 The tools used to produce the written product  Give Rita credit for class settings and i-Pad for
 The format of the written product participation and effort individual learning
 Change the demands of the writing rate
 Modify physical education  Notes
 Allow more time for written tasks, including
note taking, copying, and tests  Alter location of personal or  Extended time to test
 ___________5______________ classroom supplies for  Audio text books
 ___________6______________ easier access or to minimize  Use positive reinforcements
distraction  Establish a weekly progress
Mathematics:  Seat Rita away from doors report with signature
 Extra time on tests and windows required by Rita’s parent for
 Provide frequent checks for understanding, and  ________17__________ accountability of
accuracy when working independently  ________18__________ home/school communication
 List and color code steps and procedures and behavior monitoring
 Keep sample math problems on the board or in  Write a contract for child
front of student for models behavior
 ___________7_____________  __________19_________
 ___________8_____________  __________20_________
Word Problems:
 Incorporate Smart Board for visual learning
 ___________9_____________

Reading Comprehension:
 Rita will have a list of important vocabulary
before reading
 Rita will use a study guide prior to a test
 Rita will use sticky notes and/or highlighters to
mark important information
 __________10_____________
 __________11_____________

Cognitive Learning Skills:

 Repetition of new concepts
 Prompts to remain on task
 Positive praise
 Study guides for tests
 __________12_____________
 __________13_____________

Social Skills:
 Rita will work with a variety of peer models
 Participate in peer support group
 __________14_____________
 __________15_____________
 __________16_____________
 Individualized Equipment: X YES (list below) ___ NO

Electronic dictionary, i-Pad, Wii (in Resource room with Mr. Frank as reward), a timer

IEP Goals, Including Academic and Functional Goals, and Benchmarks/Short-term Objectives

To be completed for each subject/course with modified expectations Student ID: ___1234567_

An Annual Program Goal statement describes what a student can reasonably be expected to accomplish by the end of
the school year in a particular subject, course, or alternative program.

Written Expression: By annual review date in a classroom setting, Rita will edit her writing independently to provide
proper uppercase and lowercase letters, ending marks, and proper syntax achieving a criteria of 80% as measured by
observation, progress monitoring, documentation, and teacher-made assessments as implemented by the Regular
Education Teacher, Special Education Teacher, and teaching staff.
 Rita will edit her writing to provide correct uppercase letters.
 Rita will edit her writing to provide correct uppercase and lowercase letters.
 Rita will edit her writing to provide correct uppercase and lowercase letters, and correct ending marks.
 Rita will _________________________21_________________________.

Mathematics: By annual review date in a classroom setting, Rita will solve multi-digit addition and subtraction equations
achieving a criteria of 80% as measured by observation, progress monitoring, and work samples as implemented by the
Regular Education Teacher, Special Education Teacher, and teaching staff.
 Rita will solve multi-digit addition equations with teacher supports.
 Rita will solve multi-digit subtraction equations without regrouping with teacher supports.
 Rita will solve multi-digit addition equations with regrouping with teacher supports.
 Rita will _________________________22_________________________.

Mathematics (Word Problems): By annual review date in a classroom setting, Rita will solve multi-digit addition and
subtraction word problems without regrouping achieving a criteria of 80% as measured by observation, progress
monitoring, and work samples as implemented by the Regular Education Teacher, Special Education Teacher, and
teaching staff.
 Rita will solve single-digit addition word problems.
 Rita will solve single-digit subtraction word problems.
 Rita will solve multi-digit addition word problems.
 Rita will _________________________23_________________________.
Reading Comprehension: By annual review date in a classroom setting, Rita will use key ideas and details to increase
comprehension by identifying who, what, where, when and why, as well as the main idea of a text achieving a criteria of
80% as measured by observation, progress monitoring, and work samples as implemented by the Regular Education
Teacher, Special Education Teacher, and teaching staff.

 Rita will use clarifying and rereading comprehension strategies to demonstrate understanding of instructional
level text.
 Rita will answer who, what, and where questions to demonstrate understanding of instructional level text.
 Rita will answer when, why, and how questions to demonstrate understanding of instructional level text.
 Rita will _________________________24_________________________.

Cognitive Learning Skills: By annual review date in a classroom setting, Rita will remain on task during independent
tasks, in group discussions, classwork, and non-preferred activities with no teacher prompts achieving a criteria of 80%
as measured by observation and progress monitoring as implemented by the Regular Education Teacher, Special
Education Teacher, and teaching staff.
 Rita will remain on task for 10 minutes during independent tasks and group discussions with no more than 3
teacher prompts.
 Rita will remain on task for 15 minutes during independent tasks and group discussions with no more than 3
teacher prompts.
 Rita will remain on task for 15 minutes during independent tasks, group discussions, and non-preferred tasks
with no more than 3 teacher prompts.
 Rita will _________________________25_________________________.

Social Skills: By annual review date in a classroom setting, Rita will participate in conversations with peers and adults
during social settings in 4 out of 5 opportunities over 3 consecutive days as measured by observation and progress
monitoring as implemented by the Regular Education Teacher, Special Education Teacher, and teaching staff.
 Rita will appropriately ask questions to clarify or receive more information when she does not understand a task
or question.
 Rita will initiate interactions with peers and/or adults using appropriate social rules.
 Rita will maintain conversations by staying on topic.
 Rita will ________________________26_________________________.

NOTE about grading: Each benchmark/short-term objective of this IEP will be reported on each school year quarter.
Since this IEP begins in February, her first official progress report will be for the 3rd quarter, then 4th quarter, 1st quarter of
the next school year, and finally for the 2nd quarter. After the 1-year time period of this IEP, a new annual IEP will be
written to reflect her present levels at that time. Her Regular Education teacher will provide grades for the regular
education setting. It is not uncommon to include an accommodation stating that all report card grades should be
determined by the regular education and special education teacher be included in the IEP.

NOTE about Transition: Transition goals are required for students who are 15 or who will turn 15 during the current IEP
year. Because Rita G. is 10 years sold at the time this IEP is being written, she does not require any Transition goals.
Implementation and Monitoring

Human Resources (teaching/non-teaching):

Special Education Teacher:
Mr. Frank will work with Rita G. in the Special Education (Resource) classroom for 1.5 hours per day. Rita will be in a
low stress environment where she will be working at her instructional level. She will be working on her academics
(Reading, Written Expression, and Mathematics) and will participate in a social skills group once a week.

Special Education Instructional Assistant:

Mrs. OK will work with Rita G. in the Regular Education setting _________________27_________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________.

Related Services (if required)

Related Service Location of Service

Speech/Language Speech room

___ Therapy
Occupational Therapy Special Education
___ setting

Participation in Statewide and/or District-Wide Assessments

Indicate how the student will participate If the student will participate in a regular assessment, does the student require
in statewide or district-wide assessments accommodations?

State Criterion-Referenced Test (CRT) ___ No _X_ Yes

_X_ Yes ___ N/A ___Alternate If YES, list accommodations below:
__________________28__________________
__________________29__________________
__________________30__________________

IEP Implementation
___ Parent/Guardian attended via phone conference.

___ As the parent, I agree with the component of this IEP. I understand that its provision will be implemented as soon
as possible after the IEP goes into effect.

___ As the parent, I disagree with all or part of this IEP. I understand that the school district must provide me with
written notice of any intent to implement the IEP. If I wish to prevent the implementation of this IEP, I must
submit a written request for a due process hearing to the school district superintendent.

___ Parent did not attend the meeting.

Parent Signature ____________________________________

___ A copy of this IEP was provided to the student’s parent on: __________ by _________________________________
(Date) (Print Name) (Print Title)
 Answer Sheet for Rita G.’s IEP

Name: Jasmine Vazquez Date: 9/20/18

Student’s Strengths and Needs

1. High Verbal Skill.

2. Understands and uses phonics rules.

Areas of Need

3. Visualizing objects as she reads.

4. Spelling words with out phonics.

Instructional Accommodations

Written Expression Skills

5. May have access to print out notes.

6. Can type her assignment.

Mathematics

7. May have access to times table.

8. Rita will have a study guide prior to a test.

Word Problems

9. Change the wording to make the assignment less complicated for Rita.

Reading Comprehension

10. Once Rita reads ask to summarize what she read.

11. During test Rita may read out loud (can be moved to a different room).

Cognitive Learning Skills

12. Minimize task to focus on a single one.

13. Surround with positive influnces.

 Social Skills

14. Rita will ask peers for help first before asking the teacher.

15. She can rotate between groups for additional help on assignments.

16. She may choose who to work with.

Environmental Accommodations

17. Rita should be near peers who can motivate her.

18. Rita should have an easy access to the teacher if need be.

Assessment Accommodations

19. Extra time on exams.

20. May have access to extra information needed on the subject as sates before.

Benchmarks/Short-Term Objectives

Written Expression – Benchmark

21. Rita will edit her writing to provide correct uppercase and lowercase, and correct endign marks and proper
syntax.
Mathematics – Benchmark

22. Rita will solve multi-digit subtraction equations without teacher support.

Mathematics (Word Problems) – Benchmark

23. Rita will solve multi-digit subtraction word problems.

Reading Comprehension – Benchmark

24. Rita will answer the main idea of a text to demonstrate understanding of instructional level text.

Cognitive Learning Skills – Benchmark

25. Rita will remain on task for 20 minutes during independent tasks, group discussions , non-preferrerd task and
classwork with no more than 3 teacher promts.
Social Skills – Benchmark

26. Rita will initiate/or maintain a conversation with adults and stay on topic during the conversation.
Implementation and Monitoring

27. Mrs. OK will work with Rita G. in the Regular Education setting assisting Rita on her assignment to
clarify, or have her understand in a different way.

Participation in Statewide and/or District-Wide Assessments (Accommodations)

28. Extra time.

29. Allow highlighters sticky notes/ paper.

30. Be seated away from distractions, mostly doors and windows.