INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student’s Name: Jenny Johnson

INDIVIDUALIZED EDUCATION PROGRAM (IEP) School Age

Student’s Name: Jenny Johnson

IEP Team Meeting Date (mm/dd/yy): 04/20/17
IEP Implementation Date (Projected Date when Services and Programs Will Begin): 05/10/17
Anticipated Duration of Services and Programs: 6 months
Date of Birth: 08/25/09
Age: 7
Grade: 1st
Anticipated Year of Graduation: 2027
Local Education Agency (LEA): Hancock County School District
County of Residence: Hancock
Name and Address of Parent/Guardian/Surrogate: Phone (Home): (123)456-7890
Gary and Karen Johnson Phone (Work): (423) 999-9999
165 Redwood Dr.
Steubenville, OH 43952

Other Information: N/A

The LEA and parent have agreed to make the following changes to the IEP without convening an IEP meeting, as documented by:
N/A

Date of Revision(s) Participants/Roles IEP Section(s) Amended

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: Jenny Johnson

II. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Include the following information related to the student:

 Present levels of academic achievement (e.g., most recent evaluation of the student, results of formative assessments, curriculum-based
assessments, transition assessments, progress toward current goals)
 Present levels of functional performance (e.g., results from a functional behavioral assessment, results of ecological assessments, progress
toward current goals)
 Present levels related to current postsecondary transition goals if the student’s age is 14 or younger if determined appropriate by the IEP team
(e.g., results of formative assessments, curriculum-based assessments, progress toward current goals)
 Parental concerns for enhancing the education of the student
 How the student’s disability affects involvement and progress in the general education curriculum
 Strengths
 Academic, developmental, and functional needs related to student’s disability

Jenny is a first-grade student in a self-contained special education classroom with Down Syndrome and Autism, who was assessed with the
Brigance Inventory of Early Development III Standardized on April 11, 2017 and April 18, 2017. This assessment helped determine Jenny’s
developmental progress across several domains. This assessment helped identify several areas of strength and indicated the need for
improvement in others.

First of all, in the area of academics, Jenny’s performance in the domain of literacy revealed that she performs at the age level of 4 years 0
months. Jenny has a raw score of 69 and a composite score of 69. Jenny could recite 5 out of 26 of the letters of the alphabet from memory
without singing the “ABC” song. However, when shown lowercase letters on a page, Jenny recognized all of the assigned letters. Jenny
correctly identified 17 out of 26 uppercase letters. Reading words, including those from common signs, was more difficult for Jenny. She
identified only 1 out of 16 common signs correctly and could recognized 1 out of 20 sight words presented. Jenny’s performance with
presented with different math questions and skills was higher than her literacy skills. She earned a raw score of 45 and a composite score of
59. She could count by rote memory from 1-17, can correctly compare different quantities (e.g., 9 vs. 4), can sort objects by up to three
different attributes, and solve math word problems. Jenny was unable to solve any addition problems or any subtraction problems in the
assessment, and needs practice in learning to identify the names of numerals at a glance.

Jenny is typically a well-behaved, affectionate student. During circle time or when the Smart Board is being used during instruction, Jenny
usually sits quietly on her assigned spot on the rug. When called upon, she loves to participate and answer questions. However, she normally
does not answer questions unprompted. In recent weeks, Jenny has been squirming in her seat more during instruction. She sometimes wears
an inflatable, weighted vest to help her from becoming overstimulated and help her remain calm. Jenny typically follows directions very well,
unless she is tired. When tired, sometimes Jenny will put her head down on the table or lose focus during circle time, which results in less eye
contact. Sometimes Jenny will also hum or sing softly to herself during instruction. If the teacher asks her to be quiet, however, she usually
listens immediately.

As far as communication, Jenny falls into the average range of her typically developing peers when it comes to receptive language. During the
assessment, Jenny’s receptive language earned a raw score of 101 and a composite score of 80. Her receptive language skills reflected an age
equivalence of 5 years 2 months old. She can follow verbal directions with a minimum of three steps, can understand the noises that different
animals make, and shows comprehension of questions through nodding. Jenny’s expressive language skills were not as strong as her receptive
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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: Jenny Johnson

language skills, earning a raw score of 116 and a composite score of 80. She is able to communicate when she needs to go the bathroom, basic
needs and wants, and uses sentences of at least six words. She can verbally identify 21 of 23 body parts and roughly 75% of Jenny’s speech is
intelligible. However, Jenny attends Speech Therapy regularly, which is helping her overcome her difficulty in articulating words clearly.
Sometimes, she also skips some words when speaking, especially when she is excited.

Socially speaking, Jenny is on target with a typically developing student of her age, scoring an age equivalent of 7 years 3 months in this
domain. She is a very affectionate, loving girl who loves to gives hugs and smiles at everyone. Her natural affection for everyone, however,
means that sometimes she does not understand that is not the social norm or wise to hug every person. Her special education teacher is
working on teaching Jenny to differentiate between friends and strangers and become aware of who she hugs. Jenny has age-appropriate
social interactions with the adults in her life, but sometimes finds it difficult to interact in the same way with peers. Although she will
occasionally interact with children her age, Jenny typically prefers companionship of adults to children. She is compassionate and is
perceptive enough to ask if a person is “okay” if they have a cold or seem tired. In prosocial skills and behaviors, such as turn taking, sharing
toys, helping put things away, and being self-aware of inappropriate behavior, Jenny earned an almost perfect score in the assessment.
Overall, in the social domain, Jenny received a raw score of 44 and a composite score of 98.

Finally, in adaptive skills, Jenny had a raw score of 36 and a composite score of 67. Jenny can feed herself, dress herself (except for putting
on her shoes), and attend to her toileting needs (except bathing herself). Jenny knows her first and last name, her age, and the month and day
of her birthday. Jenny’s age equivalent for her adaptive skills is that of a child who is 3 years 9 months old.

Strengths (per above information):

 Jenny has well-developed social skills, especially with adults. She understands prosocial behavior, especially in the classroom, and
scored high in both interpersonal and self-regulatory behaviors.
 Jenny’s receptive language is on target for a student her age. She is a great listener, follows directions well, and can comprehend a
story with different elements.
 Jenny has strong gross motor awareness. She can roll, throw, and catch a small ball with both hands.
 Jenny also a decent level of control over fine motor skills. She can draw a plus sign, an “x,” and a square.
 Jenny demonstrates independence in daily living skills, as she can attend to her toileting needs, with the exception of bathing and
dress herself, with the exception of putting on and tying her shoes.

Areas Needing Improvement:

 Jenny needs improvement in learning how to write her first and last name.
 Jenny needs improvement in learning to memorize her telephone number and street address.
 Jenny needs more instructional time in learning how to identify and name the 26, uppercase letters of the alphabet, especially when
presented in a random order.
 Jenny needs more instruction time to help her learn how to read numerals from 0-20, and match these numerals with their respective
quantities.

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: Jenny Johnson

V. GOALS AND OBJECTIVES – Include, as appropriate, academic and functional goals. Use as many copies of this page as needed to plan appropriately.
Specially designed instruction may be listed with each goal/objective or listed in Section VI.

Short term learning outcomes are required for students who are gifted. The short term learning outcomes related to the student’s gifted program may be
listed under Goals or Short Term Objectives.

MEASURABLE ANNUAL GOAL Describe HOW the

Describe WHEN periodic
Include: Condition, Name, Behavior, and Criteria student’s progress toward
reports on progress will be Report of Progress
(Refer to Annotated IEP for description of these meeting this goal will be
provided to parents
components) measured

When presented with a worksheet, Jenny will be Jenny’s special education Quarterly, with report card.
able to write her first and last name in correct teacher and/or the
order and in a similar font size without assistance paraeducators will keep a
80% of opportunities per school week by the end written record of each
of this IEP. time Jenny writes her
name in the correct
manner and the adult will
calculate Jenny’s progress
at the end of each week.

When asked, Jenny will be able to recite her Each time the questions Quarterly, with report card.
telephone number and street address, 4 out of 5 are asked, the observer
times she is asked to do so over the course of a who prompts Jenny to
week, by the end of this IEP. answer these questions
will use a two-item
checklist and mark the
times when she can
successfully list both
pieces of information in
their entirety.

When presented with the 26 letters of the The observer recording Quarterly, with report card.
alphabet (uppercase) arranged in a random order, the data will have an
Jenny will be able to verbally identify (name) 80% identical sheet to the
of the letters (roughly 20 letters) 4 times a week students, that has the 26
by the end of this IEP. letters in a random order.
As the observer points to
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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: Jenny Johnson

each letter in the

sequence, on his or her
own sheet, he or she will
mark above each letter
with a checkmark for
correctly identified
letters and circle
incorrectly identified
letters (or those that
were not recognized at
all). The observer will use
this data to calculate if
the 80% recognition goal is
being met each week and
adjust accordingly.
Quarterly, with report card.
The observer recording
When presented with a randomly arranged list of the data will have an
numerals from 0-20 and upon a pointed prompt, identical sheet to the
Jenny will be able to identify 15 out of 20 (75%) of students, that has
these numerals that appear on the page 80% of numbers 0-20 arranged
opportunities per school week. letters in a random order.
As the observer points to
each number in the
sequence, on his or her
own sheet, he or she will
mark above each letter
with a checkmark for
correctly identified
letters and circle
incorrectly identified
letters (or those that
were not recognized at
all). The observer will use
this data to calculate if
the 75% recognition goal is
being met each week and
adjust accordingly.

VI. SPECIAL EDUCATION / RELATED SERVICES / SUPPLEMENTARY AIDS AND SERVICES / PROGRAM MODIFICATIONS – Include, as appropriate, for nonacademic
and extracurricular services and activities.
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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: Jenny Johnson

A. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION (SDI)

 SDI may be listed with each goal or as part of the table below.
 Include supplementary aids and services as appropriate.
 For a student who has a disability and is gifted, SDI also should include adaptations, accommodations, or modifications to the general
education curriculum, as appropriate for a student with a disability.

Projected Beginning
Modifications and SDI Location Frequency Anticipated Duration
Date

Jenny will receive a three-sided, triangular pencil grip

to slide on to her pencil which will help her correctly
hold her pencil. This grip will assist Jenny in learning This instruction will 4 weeks (or until
the correct finger position for grasping a pencil and take place at a table Jenny can correctly
help her hone her fine motor skills so that she can at a learning center Daily 05/10/17 hold a pencil without
form the letters to write her name. She can use this table in the back of the use of a three
grip to trace her name, in order to learn the the classroom. sided grip).
orientation of the letters that compose her first and
last name.

Jenny will use lined “penmanship” paper with larger

lines than a typical sheet of notebook paper, with red,
blue, and black lines. These lines will help Jenny to
remember what size different letters should be in This instruction will
relationship to each other (especially the two take place at a table
uppercase letters at the beginning of her first and last at a learning center 3 times per week 05/15/17 3 weeks
name). If Jenny struggles to write her full name, table in the back of
freehand, at first, the teacher may allow Jenny to the classroom.
trace her name until she is confident enough to write
it independently.

Jenny will be provided with a printed coloring sheet This instruction will
that has her first and last name written in a large take place at a table
font. She must color in each letter, staying within the at a learning center 2 times per week. 05/10/17 3 weeks
lines. This will help Jenny learn the shape, size, and table in the back of
orientation of each individual letter that composes the classroom.
her name.

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: Jenny Johnson

Jenny be provided with index cards that have her

This instruction will
address broken down into separate components on
take place at a table
each one. For example, one card shows her house
at a learning center
number, another shows her street name, another 4 weeks (or until
table in the back of
portrays her city, then her state, and, finally, her zip 1 time per week 05/15/17 memorization has
the classroom, on the
code. The teacher/paraeducator will scramble the occurred).
carpet, or at a
order of these note cards and Jenny must arrange
separate learning
these cards in the proper order of her full address.
table in the hallway.

Jenny will be provided lyrics to a song that uses her

This instruction will
phone number and address as the lyrics. She will sing
take at a separate 3 weeks (or until
this song with the teacher/paraeducator, reciting her
learning table in the Jenny can sing the
telephone number to the tune of “Frere Jacques.”
hallway so that the 2 times per week 05/15/17 song independently
This song will help her memorize the sequence of
singing does not and without
numbers that compose her telephone number. The
disrupt the other prompting)
same song can be used to help her memorize her
students’ work.
home address.

Jenny will use a toy phone with real numbers can be This instruction will
pressed to practice dialing her telephone number. She take place at a table
will dial her number, including the area code, which at a learning center 2 times per week 05/15/17 2 weeks
will help her connect the tangible action of dialing to table in the back of
the sequence of her telephone number. the classroom.

Jenny will be provided with a poster board that This instruction will
5 weeks (or until
displays all 26 uppercase letters cut out of rough grit take place at a table
letters are
sandpaper. Jenny will trace each letter with her at a learning center
immediately
finger, following the proper writing pattern, and say table in the back of 3 times per week 05/10/17
recognized when
the name of each letter as she traces. This will help the classroom or on
pointed to)
Jenny connect the shape of each letter to its name, the floor at the
and prepare her for later writing endeavors. carpet.
Jenny will be provided with an iPad with educational This instruction will
literacy games on it, specifically those which help her occur at a learning
2 times per week 05/15/17 6 weeks
learn the names and shapes of different letters. The center, or in a
game must include a feature where the name of the beanbag where Jenny
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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: Jenny Johnson

letter is spoken orally, so that Jenny can associate the can sit and use
spoken name with the orientation of the letter. headphones to focus
on the iPad game.
This instruction will 4 weeks (or until
Jenny will be provided with a paper with all of the take place at a table Jenny can locate and
uppercase letters scattered in a cloud arrangement at a learning center circle each letter
and colorful markers. The teacher/paraeducator will table in the back of 2 times per week 05/10/17 within 5 seconds or
name a certain letter, and Jenny will have to locate the classroom or at an less of the prompt)
the letter on the page and circle it. instructional table in
the hallway.
Jenny will be provided with flashcards, each marked This instruction will
with a different numeral from 0-20. The take place at a table
3 weeks (or until
teacher/paraeducator will go through these flashcards at a learning center 2 times per week 05/10/17
mastery is achieved)
with Jenny and ask Jenny to orally identify the name table in the back of
of the numeral. the classroom.
Jenny will receive a number line displaying the
numerals 0-20 in order that will be taped to the top of This instruction will
Until the end of this
her desk. She can regularly reference this number take place within the Daily 05/10/17
IEP.
line, especially during math instruction, and it will classroom.
help her learn the sequence of these numbers.
This instruction will
Jenny will receive a book where each page contains a
take place at a table
numeral from 0-20 cut out of colorful felt. The
at a learning center
teacher/paraeducator will flip to a random page in 3 weeks (or until
table in the back of 3 times per week 05/15/17
the book and Jenny will have to trace that number mastery is achieved)
the classroom or at an
with her finger and say the name of the numeral
instructional table in
orally.
the hallway.

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