INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student’s Name:

INDIVIDUALIZED EDUCATION PROGRAM (IEP) School Age

Student’s Name: John Jones

IEP Team Meeting Date (mm/dd/yy): 11/29/17
IEP Implementation Date (Projected Date when Services and Programs Will Begin): 12/04/17
Anticipated Duration of Services and Programs: 6 months
Date of Birth: 11/20/12
Age: 5
Grade: Pre-k
Anticipated Year of Graduation: 2030
Local Education Agency (LEA): Jefferson County School District
County of Residence: Jefferson
Name and Address of Parent/Guardian/Surrogate: Phone (Home): (740)554-8525
Schmidt & Martha Jones Phone (Work): (740)554-5214
123 Candy Cane Lane
Weirton, WV 43952

Other Information:

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

N/A N/A

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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

John is a 5 year old boy in a universal pre-kindergarten classroom. John has been diagnosed with a social-emotional disorder. He was assessed
with the Brigance Inventory of Early Development III Standardized on November 20, 2017. This assessment identified many of John’s strengths
as well as areas in need of improvement.

When assessed in academic and cognitive skill, John measured in the 60 th percentile at the age equivalent of a 4 year 3 month child. John
successfully recited 22 out the 26 letters in the alphabet but could only visually identify 7 of the capitalized letters. Additionally John
successfully recited by memory numbers 1 through 3o and could visually identify all numerals 1 through 20. John demonstrated understanding
of quantities and greater or less than concepts when asked to differentiate various groups of objects.

When assessed in language development, John measured in the 96th percentile at the age equivalent of a 7 year 6 month child. He scored in
the 96th percentile for receptive language and in the 94th percentile for expressive language. When presented with images, John could identify
each image with ease as well as identify the use for each object. He also understood verbal concepts such as low, high, forward, backward,
above, and below. When questioned, John could identify 23 out of 23 parts of the body and 11 out of 11 colors.

When assessed in adaptive behavior skills, John measured in the 21st percentile at the age equivalent of a 4 year 9 month child. John can feed
himself, dress himself, and attend to his toileting needs. John knows his first and last name and age. However, he did not know his date of
birth, telephone number, or street address.

When assessed in social and emotional skills, John measured in the 21 st percentile at the equivalent of a 2 year 11 month child. John struggles
with communicating his emotions to adults such as sharing when he is feeling happy, sad, or in need of help. John is a social child who likes to
do things with his peers but at times he has trouble initiating play scenarios and carrying on a 2-way conversation with his peers. John is very
assertive, he likes to do what he wants and doesn’t usually wait for input from his peers. He exhibits difficulty sharing and taking turns at
times but is able to be verbally redirected. John has difficulty identifying his emotions and the feelings of others within the classroom setting.
He still gets frustrated and easily angered about things when they do not go his way. John is currently learning some conscious discipline
breathing coping strategies to help him he is feeling upset.

When assessed in physical development skills, John measured in the 19 th percentile at the equivalent of a 4 year 9 month child. John
successfully completed tasks such as various standing positions, jumping, skipping, galloping, and stair climbing. Additionally, he successfully
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grasped toys, built a 12 block tower, and added or removed objects from a container. However, John demonstrated difficulty throwing and
catching objects. John also struggled with fine motor skills such as printing his name, drawing shapes, or printing any letters of the alphabet.

John’s behavior in the classroom setting is energetic and redirect able. He tests his boundaries but is easily redirected to appropriate behavior
limits for those who he has developed rapport with. He does not respond well to people he is not familiar with. John is able to follow the daily
routine of the classroom but does need to be redirected to remain on task. He has been receptive to visual schedules that give him reminders
of what is coming next in the day. He needs consistency and repetition of activities in order to stay on task and know what is expected. John
struggles at times when he does not want to do the task at hand and can exhibit some oppositional verbiage.

Concerns of the parent include John’s need for constant redirection in the classroom setting and at home.

Strengths:
 John demonstrates understanding with math concepts including numerals up to 20, portions, size, and shape.
 John’s receptive language is above his targeted age. He loves to talk, be part of a group, and follows directions well.
 John likes to learn new things, especially movement and music activities.
 John is a hard worker who generally sticks to a task or project once he starts with minimal prompting.

Areas for improvement:

 John needs improvement in learning how to share items found in the classroom with peers.
 John needs improvement in identifying his emotions and regulating his feelings by working with his teacher to communicate his
emotions.
 John needs improvement in recognizing lowercase and uppercase alphabetic letters.
 John needs improvement in story comprehension such as recalling stories read to him and answering questions about the story by
providing details and an explanation of the story.

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.

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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

By the end of the 2017-2018 school year, John will The student’s progress Parents will be given
be able to engage in appropriate turn taking skills will be measured progress report every 6
by attending to peers’ turn and wait for own turn informally through daily weeks.
4 out 5 trials given, when given verbal prompt and anecdotal records.
cueing.

By the end of the 2017-2018 school year, given The student’s progress Parents will be given
small group instruction, individual instruction, will be measured progress report every 6
peer modeling, and scaffolding, John will identify informally through weeks.
the emotion he is feeling and work through his anecdotal records and
frustration with a corresponding breathing observation. The student
strategy to help regulate his feelings given 3 out will participate in role
of 5 trials. play scenarios at the end
of each week.

By the end of the 2017-2018 school year, given The student’s progress Parents will be given
small group instruction, use of repetition, visuals, will be monitored progress report every 9
prompts, John will correctly match uppercase informally through weeks.
letters with lowercase letters of the alphabet observation and formally
given 8 out of 10 trials. through weekly
assessment. The student
will be asked to pair
uppercase letter cards
with the corresponding
lower case letter cards.

By the end of the 2017-2018 school year, given The student’s progress Parents will be given
visuals, prompts, and story review, John will will be monitored progress report every 9
correctly respond to questions from a story read informally through weeks.
to him within the classroom setting given 4 out of teacher checklists and
5 trials. formally through
assessment every two
weeks. The student will
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be asked to recite an oral

summary of the story read
based off of questions
given.

VI. SPECIAL EDUCATION / RELATED SERVICES / SUPPLEMENTARY AIDS AND SERVICES / PROGRAM MODIFICATIONS – Include, as appropriate, for nonacademic
and extracurricular services and activities.

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
This instruction will
John will be given a 10 minute time limit to play with
take place at the play 4 weeks (or until
a desired toy. Once the time has passed, John will 2 times per week 12/04/17
centers in the mastery is achieved)
practice giving the toy to one of his peers.
classroom.

This instruction will

John will be provided with a social narrative story.
take place at a table 4 weeks (or until
The story will be read to John as explanation for how 1 time per week 12/04/17
in the back of the mastery is achieved)
to share with peers.
classroom.

John will be provided with a turn taking card. One

This instruction will
side of the card indicates when it is John’s turn to use
take place within the Until mastery is
an object and the other side of the card indicates Daily 12/04/17
classroom and the achieved
when it is a peer’s turn to use an object. John will flip
playground.
the card according to whose turn it is.

John will receive direct instruction on breathing

This instruction will
techniques which help to regulate his emotions. These
take place at a table
techniques include but are not limited to the Every other day 12/04/17 3 weeks
in the back of the
following: blowing a pin wheel, candle and flower,
classroom.
and blowing a feather.

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John will be provided with an iPad to watch video This instruction will
demonstrations that explain all the different take place on the
Once a week 12/04/17 3 weeks
emotions. The videos will include interactive elements carpet in the
and sing along songs. classroom.

John will be provided emotion cards. These cards will

contain pictures of a boy experiencing joy, sadness, This instruction will
4 weeks (Until mastery
anger, frustration, and fright. John will display the take place inside the Daily 12/11/17
is achieved)
card resembling the emotion he feels to help express classroom.
his emotions to the teacher.

This instruction will

John will be provided with a letter strip along is desk Until the end of this
take place at John’s Daily 12/04/17
to refer to each letter of the alphabet. IEP
desk.

Until John has

John will receive an iPad to play Squiggle Park games. This instruction will
mastered all the
He will be allotted 15 minutes to play the letter take place at John’s Daily 12/04/17
Squiggle Park game
recognition games. desk or on the carpet.
levels.

John will be provided with flashcards, each marked

with a different letter of the alphabet. One set of Until John has
This instruction will
cards contain all capitalized letters and one set demonstrated
take place at a small
contains all lower case levels. The teacher will go Once a week 12/04/17 mastery.
table in the back of
through these flashcards and ask John to pair each
the classroom.
upper case letter with its corresponding lower case
letter.
This instruction will
The teacher will provide a think aloud when reading Until the end of this
take place within the Daily 12/04/17
orally to the class. IEP.
classroom.
The teacher will ask John questions pertaining to the This instruction will
Until John
story as he/she reads to John. The questions will take place in small
Daily 12/04/17 demonstrates
include identification of characters, plot, setting, groups within the
mastery.
problem, resolution, etc. classroom.
This instruction will
John will be asked to orally summarize a story read to Until the end of this
take place in a one- Once a week 12/11/17
him. IEP.
on-one with the

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teacher during center

time.

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