IEP Assignment

Directions: Fill in the blanks of this IEP with answers that would facilitate learning for the student. At
the end of the IEP you will find an answer sheet. Attach a cover sheet to this assignment and submit it
via canvas.

STUDENT/PARENT INFORMATION

Student: John Doe Student ID: 10684626 Sex: M Birth Date: 7/4/2006 Grade: 05

Student Primary Language: SPANISH

Address: 3481840 Main St. City/State/Zip: Towson MD 21204 Student Phone: (410) 555-4262

Parent/Guardian/Surrogate: Mariah Scott Parent Phone (Home): (410) 555-4262

Parent Phone (Work): (410) 555-4279
 Optional (Cell): (000) 000-0000

Primary Language Spoken at Home: ENGLISH 


Interpreter or Other Accommodations Needed: Interpreter in attendance

Current School: CSN Elementary

ELIGIBILITY CATEGORY

Primary: Autism Spectrum Disorder

ELIGIBILITY DATE: 09/25/2015 ANTICIPATED 3-YR REEVALUATION: 09/24/2018

MEETING INFORMATION
DATE OF MEETING: 915/2016

PURPOSE OF MEETING:
Interim IEP Revision to IEP Dated: _________
Annual IEP
 Exit/Graduation IEP
Initial IEP Other: ________________
IEP Following 3-Yr Reevaluation

DATE OF LAST IEP MEETING: 09/25/2015 IEP SERVICES WILL BEGIN: 9/15/2016
ANTICIPATED DURATION OF SERVICES: 9/15/2017

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IEP Assignment

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 IEP Assignment
PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

ASSESSMENTS ASSESSMENT EFFECT ON STUDENT'S

CONDUCTED RESULTS INVOLVEMENT AND
PROGRESS IN GENERAL
EDUCATION CURRICULUM
OR, FOR EARLY
CHILDHOOD STUDENTS,
INVOLVEMENT IN
DEVELOPMENTAL
ACTIVITIES
Multidisciplinary Team As noted in the MDT Report, John was below
Report (MDT) dated average in reading, both in decoding and
comprehension. He could identify all 26
XX/XX/XXXX
letters, short and long vowels. John could
answer factual questions at the middle first
grade level that were read to him. His
functional skills were within grade level
expectations.
Reading:
 John knows all the letters and
sounds of the alphabet. He reads CVC
Core, XX/XX/XXXX, (consonant/vowel/consonant) words and
AIMSweb, "silent e" words with 90% accuracy. He has
XX/XX/XXXX difficulty with dipthongs (such as: ow, ou, ie,
igh, oo), digraphs (such as ph, ng, rh, gh, ea, 5th grade peers can read grade
General education and ee, ie, ew), and breaking words into syllables. level text with fluency
special education He is not consistent when decoding 2 or more (approximately 110 words per
teacher observations, syllable words. In the 5th grade basal, John minute) and answer factual and
XX/XXXX, Student reads 15 words per minute. If material is read inferential questions. Due to John's
work samples- aloud to him, he can answer literal/factual
reading deficit in reading fluency
comprehension questions. At his instructional level, middle
2nd grade, he can read 70 words per minute. and comprehension, he cannot
questions, XX/XXXX read independently at a 5th grade
John can answer literal comprehension
questions at the middle 2nd grade level reading level.
independently. John struggles to answer
higher order questions (interpretive and
critical). John was administered the AIMsweb
Oral Reading Fluency on 3 different days. His
median score was 76 at the 2nd grade level.
On the same dates, John was given the
AIMsweb MAZE assessment. His median
score was 24 with 8 errors.

Reading
 K-TEA II
Letter & Word Recognition: Standard Score
(SS): 74
Reading Comprehension: SS: 70

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 IEP Assignment
Overall Reading: Standard Score SS: 70
Normal range on the KTEA is 85-115; 68%
of students score within the normal range.
Kaufman Test of John is scoring below the normal range in
Educational reading. John has difficulty reading multi-
syllabic words consistently. He has made
Achievement, Second
progress with identifying some blends (cl, str,
Edition (K-TEA II) bl, br) and digraphs (sh, th, ch). He has
XX/XX/XXXX difficulties with unusual blends (tch, and
General and Special schwas). He can identify words such as:
Education Teacher ocean, behind, understood, point, and guess.
Observations, John struggles with identifying words such as:
kneel, quiet, company, and several. He often
XX/XXXX
 Informal
asked several questions and had to be
Assessments redirected towards trying his best to
XX/XX/XXXX-XX/ independently answer. He shuts down when
XX/XXXX, given more difficult material even with
assistance. John has difficulties with
Work Samples, identifying key elements to text such as main
idea, details, when given grade level text. He
XX/XX/XXXX
struggles with putting information into
sequential order. John is able to make
predictions and will orally revise them during
readings.
Behavior:
 The general education teachers'
progress reports indicate the following: John
is social and friendly. John can display very
respectful behavior and has no difficulty
speaking up or advocating for himself.
Behaviors of concern include talking during
instruction (on the average of 10 times in a 50
minute period, distracting others (average of 3
General Education times per 50 minute period), being off-task (in
Teachers' Progress a 10 minute observation period, taken 3 times
during the week, he was off-task, 5 of the 10
Reports, XX//XXXX
minutes) and he does not hand in homework
General and Special and in-class assignments.
Education Teacher
John's Level of Language Acquisition:
observations, Speaking: Level 4-Advanced Intermediate
XX/XXXX
Reading: Level 3-Intermediate
 Writing:
Level 2- Emerging Comprehension: Level 3-
Intermediate Overall Level 3: Intermediate
Students are considered proficient when
reaching a minimum of Level 4 in Listening,
Fifth grade standards and
curricular expectations require that
students be able to use combined
knowledge of all letter-sound
correspondences, syllabication
patterns and knowledge of roots
and affixes to read accurately
unfamiliar multisyllabic words in
isolation and within context. They
read on-level text with purpose,
understanding and fluency.
Students are able to determine two
are more main ideas of text and
explain how those main ideas are
supported by key details. By end
of fifth grade students read and
comprehend information texts
including reading content area
material. Due to John's deficits in
reading fluency and
comprehension, John experiences
difficulty with the pace and rigor
of grade level materials. John
cannot read at grade level,
therefore, he is unable to answer
comprehension questions
independently.
Typical peers are able to listen to
class instruction and complete
class and homework in a timely
manner. Due to John's difficulty in
attending to instruction and
staying on task, he struggles with
completing work on time.
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 IEP Assignment
English Language Speaking, Reading, Writing and reaching a
Proficiency Scores minimum Level 5 in Overall.
 John has
(ELPA) XX/XX/XXX shown a great deal of academic improvement
General and Special in his reading and writing skills. At times, he
Education Teachers struggles with correct subject/verb agreement
when speaking and in writing. He is
observations,
comfortable speaking with peers and shows
XX/XXXX no hesitation in participating in class
discussions.
Kaufman Test of
Educational
Students in the 5th grade are
Achievement, Second Math
 proficient in using whole numbers,
Edition (K-TEA II)
Math Concepts & Appl.
 SS: 72 fractions, and decimals to solve
XX/XX/XXXX problems. The standards focus on
General and Special Math Computation
 SS: 85 multiplying and dividing decimals
Education Teacher Overall Math
 SS: 77 by whole numbers and generating
Observations, and solving addition, subtraction,
documentation, work multiplication, and division
Normal range is 85-115, 68% of students problems using whole numbers
samples, informal score in that range. John is able to perform and decimals in practical
assessments math computations within the low average situations. Due to John's
XX/XXXX range of his typical peers. John requires weaknesses in math concepts and
extensive time to complete computations. He applications, he experiences
is performing within the representational difficulty when solving multi-step
stage in multiplication and division; he draws and higher level math problems.
an array to solve multiplication and division
problems. He is inconsistent with regrouping
within multi-digit addition & subtraction
problems. He has difficulty answering multi-
step problems, and answering problems that
contain money, time, and basic number
concepts such as skip counting. Additionally,
he struggles with problems that require the
use of measurement, geometry, and
fractions.
 Math computation is John's
academic strength. He is able to apply
different strategies to solve more complex
computations. John struggles with identifying
important information from word problems.
He has difficulties with answering multi-step
problems. John will often omit important
steps or make simple errors when solving
problems that require more than one step.
John enjoys participating in math and is
comfortable with his abilities. He is willing to
attempt problems that are more difficult for
him without prompts or assistance. John
struggles with multi-step problems and
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 IEP Assignment
requires math assignments to be broken down
into single steps.
Kaufman Test of The 5th grade content core
Educational standards in the area of writing
emphasize the development of
Achievement, Second
students' writing, speaking, and
Edition (K-TEA II) listening skills. The curriculum
Writing

XX/XX/XXXX focuses on writing summaries of
Written Expression SS: 64
 oral and written stories, and
General and Special
Spelling
 SS: 71 writing paragraphs and
Education Teacher compositions with topic sentences,
observations, student variety of sentences, logical
work samples Written expression and spelling are areas of sequence, and main ideas that are
need. He was administered the K-TEA II on supported by details and a
XX/XXXX
XX/XX/XXXX. 68% of students fall in the conclusion, and using correct
normal range, 85-115. During testing, John grammar, capitalization and
was able to spell words such as: you, as, bath, punctuation when writing. Due to
open, very, and said. He was unable to spell John's weakness in written
words such as: of (uv), what (wut), went expression, such as spelling and
(wint), dry (drie), and phone (fone). In the writing connected text, he
general education classroom, John attempts to experiences difficulty with writing
spell words phonetically, and his written work essays and constructed response
is illegible. He does not consistently utilize answers.
correct capitalization. He struggles with
applying basic and complex forms of
punctuation. In the special education
classroom, John writes basic simple
sentences. He has difficulty with writing
compound/complex forms of sentences. He
has a difficult time with planning and
organization of his written work and does not
consistently write in sequential order. John
will attempt to write detailed sentences. He
requires several prompts to correct his written
work. John is able to apply capitalization and
ending punctuation when directly dictated a
simple sentence in the special education
classroom. He struggles with independently
utilizing correct capitalization and
punctuation. He is consistent with applying
ending punctuation. John does not apply
complex forms of punctuation such as:
commas, apostrophes, and quotations. When
writing, John struggles with verb tense and
often leaves words out. He has made progress
with adding some details to simple sentences.
He is unable to consistently write two or three
sequential sentences.

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IEP Assignment

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 IEP Assignment
STRENGTHS, CONCERNS, INTERESTS AND PREFERENCES

Statement of Student Strengths:

John is a very hard worker. He likes to help the teachers and gets along well with his peers. John's addition
and subtraction math computation skills are very good.

Statement of Parent Educational Concerns:

John's parent was unable to attend the meeting, but let the special education teacher know that she is
concerned about John's reading and writing ability.

Statement of Student’s Preferences and Interests:

John loves to play video games, talk about cars, and enjoys going on the computer to play educational games.

CONSIDERATION OF SPECIAL FACTORS

1. Does the student's behavior impede the student's learning or the learning of others? 

If YES, team must provide positive behavioral strategies, supports and interventions, or other strategies,
supports and interventions to address that behavior. 


Yes, addressed in IEP. No action needed.

2. Does the student have limited English proficiency? 
 If YES, team must consider language needs of the
student as those needs relate to the student's IEP. 


Yes, addressed in IEP. No action needed.

3. Is the student blind or visually impaired? 
 If YES, team must evaluate reading and writing needs and
provide for instruction in Braille unless determined not appropriate for the student. 


Yes, addressed in IEP. No action needed.

4. Is the student deaf or hard of hearing?
 If YES, team must consider communication needs. 


Yes, addressed in IEP. No action needed.

5. Does the student require assistive technology devices and services?
 If YES, team must determine
nature and extent of devices and services. 


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 IEP Assignment
Yes, addressed in IEP. No action needed.

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 IEP Assignment
IEP GOALS, INCLUDING ACADEMIC AND FUNCTIONAL GOALS,
AND BENCHMARKS OR SHORT-TERM OBJECTIVES

Measurable Annual Goal (including how progress toward the annual goal will be measured)
By annual review date, in a classroom setting, during instruction and seatwork, John will work independently
and quietly at his assigned location, achieving a criteria of 25 minutes in 4 out of 5 trials as measured by
documentation as implemented by Special Education Staff.
Benchmark or Short-Term Objective
#1 By end of second trimester of XXXX-XXXX school year, in a classroom setting, John will work quietly and
independently, without disturbing others, achieving a criteria of 10 minutes as implemented by Special Education
Staff.
#2 By end of third trimester of XXXX-XXXX school year, in a classroom setting, John will work quietly and
independently, without disturbing others, achieving a criteria of 15 minutes as implemented by Special Education
Staff.
#3 1. Create a benchmark for this goal.
#4 2. Create a benchmark for this goal.

Measurable Annual Goal (including how progress toward the annual goal will be measured)
By annual review date, in a classroom setting, John will demonstrate knowledge by applying phonics and
word analysis skills in decoding words (RF.5.4) at a middle 3rd grade level, 100 words per minute, achieving
a criteria of 80% in timed readings, as measured by curriculum based assessments as implemented by Special
Education Staff.
Benchmark or Short-Term Objective
#1 By end of second trimester of XXXX-XXXX school year, in a classroom setting, John will fluently decode words
with two and three letter blends (e.g., sp, spr) achieving a criteria of 80% as implemented by Special Education
Staff.
#2 By end of third trimester of XXXX-XXXX school year, in a classroom setting, John will fluently decode words
with consonant trigraphs (e.g., sch, str, spr, squ) achieving a criteria of 80% as implemented by Special Education
Staff.
#3 By end of first semester of XXXX-XXXX school year, in a classroom setting, John will fluently decode words
with digraphs (e.g., qu, ph) achieving a criteria of 80% as implemented by Special Education Staff.
#4 By annual review date, in a classroom setting, John will know and apply phonics and word analysis skills in
decoding words (RF.5.4) at a middle 3rd grade level, 100 words per minute, achieving a criteria of 80% in timed
readings, as measured by curriculum based assessments as implemented by Special Education Staff.

Measurable Annual Goal (including how progress toward the annual goal will be measured)

3. Create a goal for writing.

Benchmark or Short-Term Objective

#1 4. Create a benchmark for your goal.
# 2 5. Create a benchmark for your goal.
# 3 6. Create a benchmark for your goal.
# 4 7. Create a benchmark for your goal.

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 IEP Assignment
Measurable Annual Goal (including how progress toward the annual goal will be measured)
By annual review date, in a classroom setting, John will solve three step word problems, with extraneous
information, that are read aloud, involving combinations of addition, subtraction, multiplication, division,
(NV 5.5.4) achieving a criteria of 80% as measured by teacher-made tests and student work samples as
implemented by Special Education Staff.
Benchmark or Short-Term Objective
#1 8. Create a benchmark for this goal.
# 2 9. Create a benchmark for this goal.
# 3 10. Create a benchmark for this goal.
# 4 11. Create a benchmark for this goal.

SPECIAL EDUCATION SERVICES

Specially Designed Service Type Beginning and Frequency of Location of

Instruction End Dates Services Services
Behavior Direct 9-15-2016 – 9-15-2017 30 Min/Wk General Education
Reading Direct 9-15-2016 – 9-15-2017 12. Select Mins 13. Select Location
Math Direct 9-15-2016 – 9-15-2017 14. Select Mins 15. Select Location
16. Any additional if yes include all
services needed? columns

RELATED SERVICES

Related Service Service Type and / Beginning and Frequency of Location of

or Description End Dates Services Services

SUPPLEMENTARY AIDS AND SERIVICES

Modification, Beginning and Frequency of Location of Services

Accommodation, or Support End Dates Services
for Student or Personnel
17. Create an accommodation
or support.
18. Create an accommodation
or support.
19. Create an accommodation
or support.
20. Create an accommodation
or support.
21. Create an accommodation
or support.

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 IEP Assignment
PLACEMENT

Placement: 9/15/2016 – 9/15/2017 Total Minutes per week in school: 1855

Placement Considerations:

Regular class with supplementary aids and services (no removal)

Regular class and special education class (e.g. resource) combination
Self-contained program

Special School
Residential
Hospital
Home
Other: ____________

22. Select placement for John based on the services you selected.

JUSTIFICATION FOR PLACEMENT INVOLVING REMOVAL FROM REGULAR EDUCATION

ENVIRONMENTS*

23. In what areas does John require special instruction?

24. What supports are needed to make John successful in the general education setting? (summarize)

25. Why can John’s needs not be met in the general education setting? (summarize, consider social
emotional impact as well)

IEP IMPLEMENTATION

As the parent, I agree with the components of this IEP. I understand that its provisions 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 this IEP. If I wish to prevent the implementation of this IEP, I
must submit a written request for a due process hearing to the local school district superintendent.

Parent not in attendance. Parent participated via telephone.

A copy of this IEP was provided to the student's parent on: 9/15/2016 by: Special Education Teacher

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 IEP Assignment
Answer Sheet: Please fill in answers here.

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