Sample Indwidualized Education Program Student Information Student _MorganBeatrceSmith Date of Birth 04-08-05 Student Number _228:88-2100 Parent’s/Guardian’s Name_CharlesandCarrieSmith Address _423 Surset Lane suratford NY 13470 ‘Steet wy Zip Code Parent’s/Guardian’s Phone No. _ 555-6176 ___Student’s Present School __Suite High School Grade _tith Date of IEP Meeting __05-70-11 Date of Eligibility _10-25-00 IEP Review Date _05-21-2. Child’s Primary Language English Il. Student Performance Profile Morgan is a 16-year-old female student: enrolled in the Itth 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 grade-level mavh skills and above-grade-level spelling sklls. 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 drawing. Morgan Is verbal but is often echolalic. She repeats questions she is asked. Morgan's need for social communication has led to her working with a speech-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 includes the administration of the following intellectual, achievement, and ‘speech and language evaluations: The Woodcock Johnson Tests of Achievement: Third Edition was administered on 4/20/11, Morgan obtained a total achievement score of 56 with the following eubtest scores: Letter Word Identification 62: Reading Fluency 74; Spelling 9; Writing Fluency 79; and Writing Samples 45, The composite scores were: Broad Reading 70: Broad Math St; Broad Written Language 72; Academic Skils 75; Academic Fluency 71:and Academic Applications 40. “The Adaptive Behavior Evaluation Scale—Revised (home and school version) was completed on 4/26 and 4/27/11 wth respective composite scores of 64 and 5B, ‘The Differential Ability Scales—IL was given on S/8/l. Morgan's performance revealed a General Conceptual Ability of 60, a Verbal Ablity Cluster of 62. a Spatial Abilty Cluster of 69, and a Nonverbal Reasoning Cluster of 63. On S/G/I! the Letter R was administered ylelding an LQ. of 7. ‘The Oral and Written Language Scales administered on 5/9/It yielded an Oral Expression score of 40, a Listening Comprehension score of 45, and an Oral Composite of 40. The Comprehensive Receptive and Expressive Vocabulary Test=2 given on 5/12/11 revealed a General Vocabulary score of 62 with a receptive score of 75 and an expressive score of 62. The results of the Autism Diaanostic Observation Schedule indicate symptoms consistent with a diagnos spectrum disorder: Yision and hearing screenings were successfully passed on 4/14/11 of autiom Ill. Program Eligibility Eligible YZ not Eligible __ Area(s) of Disability _Autism ___SpeechLanauage Irparents Rationale for Eligibilty Morgan meets cliiiisy criteria for Autism and Speect|anguage impairment: based on state quidein22 SAMPLE wornDUALIZED EDUCATION PRoGRAM ‘Student Morgan Beatrice Smith Date of Birth __04-0.95 ‘Student Number _228-88-2100 IV. Special Instructional Considerations Items checked ‘yes" must be addzessed in this IEP. XES NO Does the student exhibit behaviors which impede his/her learning or the learning of others?) o 4 Does he student have limited Etish proficiency? a a 4 Does he student requ insction in Brille and the use of Brae? o a 4 ows he student have communication needs (ea or hearing impaired ony)? o a 4 Does he student ned assistive technology devices andor services? a a 415 the stent working toward slemate achievement standard assessed via lemate Ssesimea a a 6 Ate tansion services adresse? a a V. Annual Goals and Benchmarks vc: Language Socal Sl Annual Goa Byte endot the school yeac Magan ile able to manana conersation raugh atleast exchagesct information 75% of the time. Initiation Check Mastery Provider Evaluation Method Date Date __Date Benchmark Morganvilmaintan acomersation SLE @Patacollection . Grades een tirouph 3 exchanges oftformation SpecislFaucator . Teacher/Text test f, Other: by asking questions. Faraprofessional_c. Work samples @lassroom observation Benchmark Morgan vwilaintan acomersation SLE @Patacollection ¢.Grades 19:2 518.12 Through 3 exchanges of information Special Educator b. Teacher/Text test f. Other: ko nclude avaroty of verbal araprofeccional_c. Work samples teractions suchas expanding @©hssroom phought and reflecting on the observation ther person's conversation, ‘Area: Social Stils ‘Annual Goal: By the end of che schoo! vear Morgan. with the assistance of her yaraprofessional wilincrease her interactions with her peers by BO%,SAMPLE NIVIDUALZED EDUCATION PROGRAM 3 Student __Morgan Beatrice Smith Date of Birth __04-03.95 Student Number _228-88: 10 Initiation Check Mastery Provider Evaluation Method Date Date ate Benchmark Morgan uileitwithosers atlunch Special Educator (@)Data collection e.Grades _8-15-11_ ongoing ngage in social Faraprofessional, b. Teacher/Text test Other: day cork samples servation 4. Classroom observation Benchmark Morgan wilicoractwithyeersin Special Educator (@)Data collection Grades _B.15-11_ _ argon ‘structured and unstructured Pataprofescional b. Teacher/Texttest(Q)Other: classmom settings, e.Work samples Feetmentors/ @classroom eachl twin ‘observation Area: Reading Comprehension ‘Annual Goal: Bythe end of the schoo! year Morgan wil mprove readin comprehension and increase her understanding of sh 0 Initiation Check Mastery Provider Evaluation Method Date Date Date Benchmark Morganuilreadashortvaraqaph SyecialEduzator a.Datacollection .Grades & 10. and comectiy answer? ovsoF 3 (DyTeacher/Text test {Other the fret Work samples Swneks Classroom observation Benchmark Morganuilreadasivpleparagraph SpevilEducator (@)Data collection Grades OAT 126-1 and comectiy answer 5 out of 5 (DyTeacher/Text test £ Other: tions s Work samples 2 <4. Classroom observation Morganuilcorrectlyepeland _ SpevilEdwator a. Datacollection @Grades 1-9-2 deri the meant of 5 vocabulary (@Teacher/Text test F. Other 8 f (© Work samples & Classroom observation Only three representative goals are illustrated.44 same mormouaze eDucaTION ProgRAM ‘Student __Morgan Bestrice Smith Date of Birth Student Number _228-88-2100 VI. Supplementary Aids and Related Services Services Related Services Provider Hours per Week: Location be Physical Fuca Me Alen a Gynmasin Speechelanassge Therapy Mrs Fiero 18 Therapy room Occupational Therapy/Sensory Intearation Mrs, Wise 25 Therapyroor Aids/equipment/program modifications needed (o attain annual goals and progress in general education curriculum: Frovide ongoing support throughout the day to decrease anety and resulting self-injurious behaviors Frequency of use: As taicated by Occupational Therap VII. Special Education Placement ‘Student tobe placed in the following least restrictive environment Location of Services Duration Extent of Participation General education classroom 2 Assistance pov raprofession Special education environments: Resource room, 46 ‘Assistance provided by paraprofecsional Self-contained class Special day school Residential sebool Hospital school Homebound services Other: (eg. Head Start, work site) Rationale for placement in setting other than general education class VIIL. Special Services Physcial Education: Regular ‘Adaptive ‘Transportation: Regular Special_v Not ApplicableSAMPLE NIVIDUALIZED EDUCATION PROGRAMS ‘Student __Morgan Beatrice Smith Date of Birth __04-03-95 Student Number _228-88-2100 Is student provided an opportunity to participate in extracurricular and nonacademic activities with nondisabled peers? __yes Yeso ‘Are supports necessary?__yes Describe:_Moraan attends with paraprofessional Yeo Rationale for nonparticipation: IX. Transition Services ‘Transition Service Needs ‘Special Education Certifies’ Focusing on Course of Study Career Interest(s) cs Employment Outcome ‘Community Living Outcome Identify Needed Transiton Services 4 Transportation Moraan wil tilze transit and para transit transportation opporcunties 5, Education Morgan willparticivate in a day treatmert wragram focusing on vocational and adaptive ski, Identify Interagency Responsibilities (ODS) Office Vocational eehablitation wil assist with vocational evaluations, Community Linkages 15 Office Ph es, Inc Ve habitation Services, Community Recreation Centers, Community Trans and Para Trans‘ Systems, X. Assessment Modifications Is student able to participate in state- or district-wide assessments? __ro Yate ‘Are modifications required”. YeatNo Identify type of modifications: Morgan's assessment needs wilbe met with an altemative assessment inthe form of a competency portfoi Rationale for nonparticipation and alternative assessment plan: Morgan does not have traditional test-taking eile A portfolio that demonstrates Maraaris competencies in the areas of har annua goals wile developec6 SAMPLE wormouALIZeD EDUCATION PRogRAM ‘Student Morgan Beatrice Smith Date of Birth __04-0.95 ‘Student Number _228-88-2100 XI. Progress Report Parents will be informed of child's progress toward annul goals using same reporting methods used for children without disabilities Method Frequency Written Progress Report __yes Every __9 weeks Yexo ‘Parent Conference yes Asrequestied Yeao Other Mentty © Other entity XIL. Transferral of Rights understand thatthe rights under the Individuals with Disabilities Education Improvement Act will wansfer to me upon reaching my eighteenth birthday Stadents Siaatre| Dac Ill. Recommended Instructional and/or Behavioral Interventions Provide a rich reinforcement se lowing each activity, Use a timer to keep Morgan on task during instr and reinforcement activities. Block al attempts at injuring herself or others and redirect to task at hand. Teachers working with Morgan should wattch the tone of their voice and vocabulary as she frequently becomes confused resulting in aggressive behavier. ABchavior management plan ehould be developed if self-injurious behaviors and/or aggression becomes a problem, XIV. IEP Development Team Name ‘Team Member's Si Position/Title Mr Charles Smith Charles smith ParenGuardian Mrs, Carrie Smith Carrie swith Parent/Guardian (rs Ruth Rd 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 Lyne Wise Other OT