Individualized Educational Program (IEP) Form for Physical Education

Name: Aiden Rencher Age: 11 Educational Placement Disability:

Present level of performances:

Aiden Rencher is s 11-year-old boy that has Cri Du Chat. Aiden enjoys activities that are cause
and effect such as: knocking cones down, kicking, bowling and picking up bean bags and putting
them into a bucket. His core strength is great. In ASAPP, Aiden participates in a 30 minute
individual time which is followed by a 30 minute group activity so he can receive social
interaction with other children. Aiden is nonverbal but is easily understood when he does not
want to do something. Aiden is very silly and likes to laugh but can be resistant to participating
in activities, if this happens, Aiden tends to sit down and not want to get up onto his feet. Aiden
was evaluated with the Curriculum, Assessment, Resource, and Evaluation Revised (CARE-R)
on September 2019. CARE-R was used to assess Aiden’s performance in gross motor and object
control. According to Aiden’s results, Aiden’s age equivalence is 2 years. For Gross Motor,
Aiden was able to walk carrying an object and runs unsupported, rudimentary form at least 15’.
For object control, Aiden is able to pick up objects from the floor and hurl objects. Aiden has
difficulty with walking for long periods of time, he also has a hard time controlling his limbs. So
based on the CARE-R we will be focusing on improving his walking and kicking skills.

1.Annual Goal:
Aiden will be able to walk (arms moving in opposition, one foot in front of the other, in an
upright position) for 10 minutes with only a verbal prompts over two consecutive days by June
2020.

Benchmarks
1. Aiden will be able to walk (arm moving in opposition, one foot in front of the other, in an
upright position) for four minutes around the building with verbal and physical prompts
by October 2019.
2. Aiden will be able to walk (arm moving in opposition, one foot in front of the other, in an
upright position) for six minutes around the building with verbal and physical prompts by
January 2020.
3. Aiden will be able to walk (arm moving in opposition, one foot in front of the other, in an
upright position) for eight minutes around the building with verbal prompts by April
2020.
Materials/Methods:
Poly spots will be needed to indicate where Aiden should be standing. In order to motivate him
to walk we will use a speaker to play music. When Aiden sits down teachers will use a physical
prompt to get Aiden back-up and walking.
2. Annual Goal:
Aiden will kick a stationary soccer ball towards a target 15 feet in front of him using his right
(dominant) leg, stepping towards ball with non kicking foot, using any part of his foot with a
verbal prompt in 4 out of 5 trials with 75% accuracy by June 2020.

Benchmarks:
1. Aiden will kick a stationary soccer ball towards a target 8 feet in front of him using his
right (dominant) leg, with non kicking foot next to ball, using any part of his foot with
verbal and physical prompts, while standing in place in 2 out of 5 trials by October 2019.
2. Aiden will kick a stationary soccer ball towards a target 10 feet in front of him using his
right (dominant) leg, with non kicking foot next to ball, using any part of his foot with
verbal and physical prompts, while standing in place in 3 out of 5 trials by January 2020.
3. Aiden will kick a stationary soccer ball towards a target 15 feet in front of him using his
right (dominant) leg, stepping towards ball with non kicking foot, using any part of his
foot with verbal and physical prompt 3 out of 5 trials by April 2020.
Materials/Methods:
Soccer ball, a poly spot with an arrow for his non kicking leg, round poly spots where he will
start the kick, bowling pins. Aiden gets distracted easily, so we need open space away from
others as well as for safety reasons.

3.Annual Goal
Aiden will high five or blow kisses to at least 6 students during group time in ASAPP when
verbally prompted (Aiden can you give (name of student) a high five) by June 2020.

Benchmark
1. Aiden will high five or blow kisses to at least 2 students during group time in ASAPP
when verbally prompted (Aiden can you give (name of student) a high five/blow kisses)
by October 2019.
2. Aiden will high five or blow kisses to at least 4 students during group time in ASAPP
when verbally prompted (Aiden can you give (name of student) at high five/blow kisses)
by January 2020.
3. Aiden will high five or blow kisses to at least 5 students during group time in ASAPP
when verbally prompted (Aiden can you give (name of student) at high five/blow kisses)
by April 2020.
Materials/Methods:
In ASAPP, during group time Aiden will be verbally prompted to high five/blow kisses to a
student after each activity (warm up, activity one activity two and closure)