Iep Final

INDIVIDUALIZED EDUCATION PROGRAM (IEP)
• Draft 05/06/2018 STUDENT INFORMATION
MARYLAND STATE DEPARTMENT OF EDUCATION (MSDE) DIVISION OF DRAFT TRAINING ◦ Approved

SPECIAL EDUCATION/EARLY INTERVENTION SERVICES (Form approved by MSDE for use July 1, 2017)
◦ Amended
Name: Hannah Tolbert Agency: IHE County IEP Team Meeting Date:
STUDENT AND SCHOOL INFORMATION
First Name: Middle Name: Last Name: PARENT/GUARDIAN 1:

Address : First Name: MI: Last Name:
City: State: Zip Code: Home Phone: Cell Phone:
Grade: Email:
Unique Student Identification Number (State): Parent native language, if not English:
Student Identification Number (local): Interpreter needed?
Date of Birth: PARENT/GUARDIAN 2:
Age: Gender: First Name: MI: Last Name:
Race Code: Home Phone: Cell Phone:
Student identified as an English Learner: Email:
Student's native language: Parent native language, if not English:
Residence County: Interpreter needed?
Residence School: Case Manager:
Service County: IEP Team meeting date(s):
Service School: IEP Annual Review date:
Does the student require specific accommodations for an emergency evacuation?:
If yes, state the evacuation accommodation(s) here: Native Language Translation: Parent informed: Parent requested :
Which jurisdiction is financially responsible? Projected Annual Review Date:
Is the student currently under the care and custody of a state agency? Most Recent Evaluation Date:
If yes, name of state agency: Projected Evaluation Date:
Does the student require a parent surrogate? Primary Disability: SPECIFIC LEARNING DISABILITY(Dysgraphia,Dyscalculia)
Parent Surrogate Name: Areas affected by disability: Academic - Math Problem Solving, Academic - Written
Language Expression, Academic - Written Language Mechanics
Surrogate Phone:
IEP TEAM PARTICIPANTS
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INDIVIDUALIZED EDUCATION PROGRAM (IEP) I. MEETING AND IDENTIFYING
MARYLAND STATE DEPARTMENT OF EDUCATION (MSDE) DIVISION OF DRAFT TRAINING INFORMATION
INITIAL EVALUATION ELIGIBILITY DATA (Only requred for student's initial evaluation to determine eligibility)
Identify area(s) impacted by the student's suspected disability:
-math problem solving
-written expression
-written mechanics
Discussion to support decision:
Steve struggles with written mechanics often making grammatical, spelling and punctuation errors. He scored a grade equivalency of 3.1 in spelling
on the Brigance Diagnostic Inventories meaning he preforms as well as a typically developing peer in the first month of the third grade. He also
scored 3.1 grade equivalency on the Brigance Diagnostic Inventories for writing. He showed a deficit in language when tested using the Woodcock
Johnson Psychoeducational Batter, Steve scored a grade level equivalency of 5.2 in language, meaning he preformed as well as a typically developing
peer in the second month of the fifth grade. He writes only simple sentences of approximately four words and paragraphs of no more than three
sentences. Steve was tested using Woodcock Johnson Psychoeducational Battery for math which he scored a grade equivalency of 4.7. He has trouble
completing multi-step, complex problems in mathematics. He has trouble completing in mathematics and English/language arts assignments when hey
require extensive writing.
Is a determinant factor for the student's lack of academic progress the result of:
a) a lack of an appropriate instruction in reading, including essential components of reading instruction? No
b) a lack of instruction in math? No
c) a lack of English proficiency? No
(If yes to any of the above, the student must otherwise meet the eligibility criteria as a student with an identified disability.)
Does the student require specially designed instruction in order to make adequate progress in school? Yes
Initial Eligibility (Student Ages 3-21)
Date of parent consent for initial evaluation: 04/01/2018

Date of initial evaluation: 04/25/2018
Child is eligible as a student with a disability for special education and releated services: Yes
Document basis for decision(s):
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Steve needs specially designed instruction to reduce the achievement gap between him and his typically developing peers. He preforms at about a 4th
grade level in mathematics and a writing.
Indicate Primary Disability: SPECIFIC LEARNING DISABILITY

Dysgraphia,Dyscalculia
Reason(s) for delay of initial evaluation:
Date of Parent Consent-Continue Early Intervention Services through and IFSP at age 3:
Date local school system was notified of parent decision to request services through an IEP:
Date extended IFSP services ended:
Date of initial IEP development: 05/08/2018
Date of parent consent for initiation of services: 05/08/2018
Date initial IEP is in effect: 05/08/2018
Is this student transitioning from Infants and Toddlers (Part C) to Preschool (Part B) and receiving services through an IEP? Yes
If the parent fails to respond or refuses consent to the initial provision of special education and related services, the public agency shall not provide special education and related services to the
student and will not be considered in violation of the requirement to make FAPE available in accordance with 34 CFR 300.
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STUDENT PARTICIPATION ON DISTRICT/STATEWIDE ASSESSMENTS AND GRADUATION INFORMATION
ENGLISH LANGUAGE PROFICIENCY SUMMARY

Graduation requirements explained to parents? Yes
Is the student an English Learner?
State graduation requirements can be found at www.marylandpublicschools.org.

What was the student's performance on the English language proficiency assessment?
Assessment Date: Overall Composite Proficiency Level: -
Record any additional local graduation requirements:
In addition to Frederick county's core credit requirements, Steve will OR

complete the 4 credit Culinary Arts program at the Career and
Technology Center, 3 credits for his culinary career pathway and one
What was the student's performance on the alternate English language proficiency assessment?
credit of another elective. With accommodations he will meet the
assessment requirements. Assessment Date: Overall Composite Proficiency Level: -
Has the IEP team determined that the student should participate in an alternate educational STATEWIDE PERFORMANCE SUMMARY
framework, which, if continued, will result in not earning credits toward a Maryland High School
Diploma? No What was the student's performance, if applicable, on the Kindergarten Readiness Assessment
(KRA) as of ?
Does the parent consent to the student participating in an alternate educational
framework? What was the student's performance, if applicable, on the alternate assessments as of ?
MSAA Scale Score Most Current Proficiency Level

PLAN FOR PARTICIPATION IN ASSESSMENTS TO BE ADMINISTERED DURING THE TERM OF
THE CURRENT IEP* English Language Arts
Mathematics
The student will participate in the Maryland Integrated School Assessment (MISA) aligned
with grade level academic achievement standards in assessed grade - Science (Grades 5, 8) Alt-MISA Scale Score
Science: Yes
Science (Grades 5, 8, 11 only)
The student will participate in the High School Maryland Integrated Science Assessment
(MISA) aligned with grade level academic achievement standards in assessed grade What was the student's performance on the Grades 3-8 assessments as of ?
Science: Yes Current Year's Scale Last Year's Scale Most Current
Score Score Proficiency Level
The student will participate in the Maryland High School Assessment (HSA) in assessed course?
PARCC Grade Scale Grade Scale
Government: Yes Score Score
ELA/Literacy
The student will participate in the Partnership to Assess the Readiness for College and
Careers (PARCC) Assessments for grades 3 through 8? Math
English Language Arts/Literacy: Yes Mathematics: Yes Algebra I
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MISA Grade Scale Grade Scale

The student will participate in the Partnership to Assess the Readiness for College and Score Score
Careers (PARCC) Assessments for high school?
Science (Grades 5, 8
English Language Arts/Literacy::
Algebra I: Yes Geometry: Yes Algebra II: Yes only)
Yes
Has the IEP team determined that the student should participate in an alternate assessment What was the student's performance, if applicable, on HSAs as of ?
based on alternate academic achievement standards? High School Passing Student's Student's Student's Meets Bridge Substitute
Assessments Score 1st 2nd Highest Standard Plan Assessment
Does the parent consent to the student participating in an alternate assessment based on (HSAs) Score Score Score Participant
alternate academic achievement standards in assessed grade in Reading Mathematics Science
Algebra/Data 412
(Grades 5, 8, 11 only)? Analysis
Biology 400
Document basis for assessment decision(s): English 396

Government 394
Steve does not need alternative testing. With accommodations such as
extra time, speech to text etc, Steve will be able to successfully Combined 1602
participate in assessments. Score
with Gov't
1208
Student is pursuing a: Maryland High School Diploma Combined
Score
w/out Gov't
*A student may be asked to participate in national or international assessments. Only High School
allowable accommodations on national/international assessments are permitted. MISA
Complete for high school seniors that may be eligible for an HSA waiver: What was the student's performance on the High School (PARCC) Assessments as of ?
IEP team has discussed the criteria of the waiver decision-making process for the student and
PARCC Most Previous Most Current Meets Bridge Plan Substitute
supports an HSA waiver recommendation to the local superintendent Current Scale Proficiency Standard Parcticipant Assessment
Scale Score Level
Score
ELA/Literacy
Algebra I
Geometry
Algebra II
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INDIVIDUALIZED EDUCATION PROGRAM (IEP) II. PRESENT LEVEL OF ACADEMIC
MARYLAND STATE DEPARTMENT OF EDUCATION (MSDE) DIVISION OF DRAFT TRAINING ACHIEVEMENT AND FUNCTIONAL
SPECIAL EDUCATION/EARLY INTERVENTION SERVICES (Form approved by MSDE for use July 1, 2017) PERFORMANCE
ACADEMIC Math Problem Solving Document student's academic achievement and functional performance levels in academic areas, as appropriate
Source(s): Brigance Inventory of Basic Skills, Observation, Woodcock Summary of Assessment Findings (including dates of administration):
Johnson III - Tests of Achievement
Instructional Grade Level Performance: 4.4 Steve responds well to mathematic instruction when given multiple visual
representations and tangible manipulatives. His mathematics worksheets
(Consider private, state, local school system, and classroom based assessments, as
contain many errors, with a highest score of 62% accuracy. He struggles
applicable.)
with multi-step, complex problems. In the Woodcock Johnson
Psychoeducational Battery Steve scored a 4.7 grade level in math. He
scored a 4.2 grade level in Problem Solving Math Skills for the Brigance
Diagnostic Invitatories.
Does this area impact the student's academic achievement and/or functional performance? Yes
ACADEMIC Written Language Mechanics Document student's academic achievement and functional performance levels in academic areas, as appropriate
Source(s): Brigance Inventory of Basic Skills, Observation Summary of Assessment Findings (including dates of administration):
Instructional Grade Level Performance: 3.1
Steve can compose simple sentences with an average of 4 words. He can
(Consider private, state, local school system, and classroom based assessments, as
create paragraphs that consist of typically three sentences, but lack
applicable.)
detail. His writing has grammatical and punctuation errors and spelling
mistakes. Steve scored a 3.1 grade level on the Brilliance Diagnostic
Inventory for Writing and a 3.1 grade level on the Brilliance Diagnostic
Inventory for Spelling.
ACADEMIC Written Language Expression Document student's academic achievement and functional performance levels in academic areas, as appropriate
Source(s): Brigance Inventory of Basic Skills, Observation, Woodcock Summary of Assessment Findings (including dates of administration):
Johnson III - Tests of Achievement
Instructional Grade Level Performance: 4
(Consider private, state, local school system, and classroom based assessments, as Steve can compose simple sentences with an average of 4 words. He can
applicable.) create paragraphs that consist of typically three sentences, but lack
detail. His writing has grammatical and punctuation errors and spelling
mistakes. Steve often struggles to complete assignments that require
extensive writing, only turning in 2 out of 10 writing samples during an
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eight-week period. Steve scored a 3.1 grade level on the Brilliance
Diagnostic Inventory for Writing and a 3.1 grade level on the Brilliance
Diagnostic Inventory for Spelling. Steve scored 5.2 grade equivalency in
language for the Woodcock Johnson Psychoeducational Battery.
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SCHOOL AGED - PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
What is the parental input regarding the student's educational program?
N/A
What are the student's strengths, interest areas, significant personal attributes, and personal accomplishments? (Include preferences and interests for post-school outcomes, if appropriate.)
Steve is an active youngster at Frederick Middle School. He is very social, has many friends and a younger brother. He participates in a community
tennis league and performs well in baseball. Steve's strength is word recognition, scoring above grade level (9.1) for the Brigance Diagnostic
Inventories. He is diploma bound and plans on enrolling at the Culinary Arts program at the Carrier and Technology Program. Then, after high school
he hopes on continuing is culinary education at his local community college. During his transition meeting he said he wishes to be a chef one
day.
How does the student's disability affect his/her involvement in the general education curriculum?
Steve's disability inhibits him from accessing a progressing through the general curriculum.
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INDIVIDUALIZED EDUCATION PROGRAM (IEP) III. SPECIAL CONSIDERATIONS AND
MARYLAND STATE DEPARTMENT OF EDUCATION (MSDE) DIVISION OF DRAFT TRAINING ACCOMMODATIONS
COMMUNICATION (required)
Does the student have special communication needs? No

(If yes, describe the specific needs.)
ASSISTIVE TECHNOLOGY (AT) (required)
Consider AT device(s) and service(s) that are needed to increase, maintain or improve functional capabilities of a student with a disability.
The student needs an AT device(s): Yes The student needs an AT service(s): Yes
If yes, AT device(s) will be addressed through: If yes, AT service(s) will be addressed through:
• Supplementary Aids, Services,Program Modifications, and Supports • Supplementary Aids, Services,Program Modifications, and Supports
• Instructional and Testing Accommodations • Related Services
• Instructional and Testing Accommodations
Significant deficits in written mechanics. Assistive technology devices and services are critical for Steve to access and progress through the
general curriculum. Currently, Steve is writing on a 3rd grade level without the support of technology such as word processors/spell check to help
his written mechanics deficits and graphic organizers to help plan his extended writing assignments.
Steve also has significant deficits in Math problem solving and currently preforms on a 4th grade level without supports. He would benefit from low
tech assistive technology to provide concrete means of representation such as manipulatives.
These are all new AT devices, therefore services are needed to train Susan's teachers.
SERVICE FOR STUDENTS WHO ARE BLIND OR VISUALLY IMPAIRED
Is the student blind or visually impaired? No
In the case of a student who is blind or visually impaired, provide for instruction in Braille and the use of Braille unless the IEP Team determines, after an evaluation of the student's reading and
writing media that instruction in Braille is not appropriate for the student.
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Braille Evaluation date:

Is instruction in Braille appropriate?
In the case of a student who is blind or visually impaired, provide for instruction in Orientation and Mobility (O&M) unless the IEP Team determines, after an assessment of the student's current and
future travel needs, that instruction in O&M is not appropriate for the student.
O&M Evaluation date:

Is instruction in O&M appropriate?

Were parents provided information regarding Maryland School for the Blind?
BEHAVIORAL INTERVENTION
In the case of a student whose behavior impedes the student's learning or that of others, consider the use of positive behavioral interventions and supports, and other strategies to address that
behavior.
Functional Behavior Assessment(FBA): No Assessment Date:
Does the student require Behavior Intervention Plan? No
Behavior Intervention Plan: No Implementation Date:
Has the IEP team determined that restraint and/or seclusion may be required as a part of the Behavior Intervention Plan? No
Does the parent consent to the use of restraint and/or seclusion as a part of the Behavior Intervention Plan?
Steve does not have a BIP, nor does he need one. He is not a danger to himself or others. His behavior does not impede on other student's learning.
His attention behavior supports can be imbedded in the IEP.
SERVICE FOR STUDENTS WHO ARE ENGLISH LEARNERS
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In the case of a student who is an English Learner, consider the language needs of the student as such needs relate to the student's IEP.
Steve is not an English language learner, additionally his speech and language development is adequate according to his assessment by Ms. Jenkins,
the speech and language clinician at Frederick MS, using the Test of Language Development, Vocabulary Comprehension Test and Picture Story Language
Test.
INSTRUCTIONAL AND ASSESSMENT ACCESSIBILITY FEATURES
HSA
I
N G K ALT
S O A
T V C A A
FEATURES FOR ALL STUDENTS (Available to ALL students, either through the R E C C C
online platform or externally provided) U R HSA ALT E C C
C P N S E E
T A M M M M M S S S N
I R E I I I S for S S A
O C N S S S A ELLs for for E
N C T A A A A 2.0 ELLs ELLs P
1p: Spell Check or External Spell Check Device yes yes yes yes yes
1u: Graphic Organizer yes
* Consult assessment specific guidelines for detailed information.
Document basis for decision:
1p:Steve spells on a 3rd grade level which interferes with his writing, spellcheck will address this deficit.
1u: Steve writes on a 3th grade level and has difficulty writing paragraphs longer than three sentences, so he would benefit from a graphic
organizer to plan his writing.
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HSA
I
N G K ALT
S O A
ACCESSIBILITY FEATURES FOR ALL STUDENTS (Must be identified in advance and T V C A A
documented in the student's Student Registration/Personal Needs Profile R E C C C
[SR/PNP]) Accessibility features MUST be used in instruction to provide adequate U R HSA ALT E C C
time and fairness for the student to be familiar with the tools/devices. C P N S E E
T A M M M M M S S S N
2g: Reduce distractions to self yes yes yes yes yes yes yes yes yes yes yes
2g: To addresses Steves' attention deficits he would benefit from reducing distractions to himself by having alternative seating alone.
INSTRUCTIONAL AND ASSESSMENT ACCOMMODATIONS
HSA
I
N G K ALT
RESPONSE ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES (Intended for S O A
students with disabilities who have the accommodation documented in an T V C A A
approved IEP or 504 Plan prior to the date of test administration; and who use R E C C C
the accommodation routinely (with rare exceptions) during instruction and U R HSA ALT E C C
locally administered assessments, both before and after the test is C P N S E E
administered.) T A M M M M M S S S N
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4n: ELA/L, Science, Government Constructed Response Speech-to-Text yes yes yes yes yes yes yes yes
4q: ELA/L, Science, Government Constructed Response External Assistive Technology Device yes yes yes yes yes yes yes yes
4s: Word Prediction External Device yes yes yes yes yes
4n, 4q: Steve has trouble completing assignments for all content areas which require extensive writing. Without these supports he also might have
difficulty typing due to is fine motor deficits.
4s: Steve spells on a 3rd grade level, he would benefit from a word prediction external device.
HSA
I
N G K ALT
TIMING ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES (Intended for S O A
students with disabilities who have the accommodation documented in an T V C A A
approved IEP or 504 Plan prior to the date of test administration; and who use R E C C C
the accommodation routinely (with rare exceptions) during instruction and U R HSA ALT E C C
locally administered assessments, both before and after the test is C P N S E E
administered.) T A M M M M M S S S N
5a: Extended Time yes yes yes yes yes yes* yes
5a: Steve will have 50% more time to complete assessments due to his attention deficits.
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SUPPLEMENTARY AIDS, SERVICES, PROGRAM MODIFICATIONS AND SUPPORTS
Instructional Support(s)
Nature of Service Frequency Begin Date End Date Provider(s):

(P)=Primary, (O)=Other
Instructional Support(s) - Anticipated Frequency 05/08/2018 05/08/2019
Monitor independent work • (P) General Education Teacher
Daily
• (O) Special Education Classroom
Duration: 36 Weeks
Teacher
Clarify location and manner:
Steve will be monitored during independent work to insure he is on task. He will be monitored on daily independent assignments by his general
education and special education teachers. If off task, the teacher will redirect his attention back to his work by signally to what he should be
working on.

Provide alternative ways for Daily • (P) Special Education Classroom
students to demonstrate Teacher
learning Duration: 36 Weeks
• (O) General Education Teacher
Steve will express learning through using multiple means of representation, he should represent ideas concretely (with manipulatives),
representational (with pictures) and abstractly (with symbols). Steve's Special education teacher will provide Steve with alternative ways to
represent his learning in his regular education classroom and in his pull out services.

Instructional Support(s) - Allow Anticipated Frequency 05/08/2018 05/08/2019
use of manipulatives • (P) Special Education Classroom
Daily
Teacher
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Duration: 36 Weeks
Steve will be provided math manipulatives in his regular education classroom and during pull out services by his Special Education Teacher daily.
He will be allowed to use a variety manipulatives during his mathematics instruction.

Provide proofreading checklist • (P) Special Education Classroom
Daily
Teacher
Duration: 36 Weeks
The special educator will provide Steve with proofreading checklists daily to use within the general education classroom and pull out
services for extended response prompts.
Program Modification(s)

Program Modification(s) - Break Anticipated Frequency 05/08/2018 05/08/2019
down assignments into smaller • (P) General Education Teacher
Daily
units
Duration: 36 Weeks
Steve's general education teacher will provide Steve with a break down of his writing assignments into small units for his general education
classroom. If Steve must write extensively, he will be allowed to do so in chunks.

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Program Modification(s) - Anticipated Frequency 05/08/2018 05/08/2019

Modified grading system • (P) Special Education Classroom
Daily
Teacher
Duration: 36 Weeks
The special educator will provide Steve with a modified grading system. Steve will not be penalized for grammatical errors for daily class
writing assignments in his general education classroom.
Documentation to Support Decision:
Steve can compose simple sentences with an average of 4 words. He can create paragraphs that consist of typically three sentences, but lack
detail. His writing has many grammatical errors and spelling mistakes, punctuation errors. Steve scored a 3.1 grade level on the Brilliance
Diagnostic Inventory for Writing and a 3.1 grade level on the Brilliance Diagnostic Inventory for Spelling. He scored a 5.2 grade level for
language using the Woodcock Johnson Psychoeducational Battery. He also struggles to complete multi-step, complex problems which have progressed
throughout middle school. He scored a 4.2 grade level in the Brigance Diagnostic Inventories for problem solving math skills. He scored a 4.7
grade level in the Woodcock Johnson grad math sub-tests.
To bridge his performance level gap, it is important Susan receives supplementary aids, services and program modifications and supports in order
for him to access and progress through the general curriculum.
Supplementary Aids, Services, Program Modifications and Supports were considered and none are required at this time. No
Discussion to support decision(s):
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EXTENDED SCHOOL YEAR (ESY)
The IEP Team should determine if any of the factors below will significantly jeopardize the student's ability to receive some benefit from the student's educational program during the regular school
year, if the student does not receive ESY services. ESY services are the individualized extension of specific special education and related services that are provided beyond the normal school year of
the public agency, in accordance with the IEP, at no cost to the parents.
When considering ESY, answer YES or NO and document the decision:

1. Does the student's IEP include annual goals related to critical life skills? No
Steves' IEP goals are not related to critical life skills.
1a. Is there a likely chance of substantial regression of critical life skills caused by the normal school break and a failure to recover those lost skills in a reasonable time? No
There are no critical life skills represented in Steves' IEP goals. It is anticipated that he will make progress and throughout the year and no
substantial regression will occur over the school break.
1b. Is the student demonstrating a degree of progress toward mastery of IEP goals related to critical life skills? No
There are no critical life skills represented in Steves' IEP goals. It is anticipated that he will make progress throughout the year and no
substantial regression will occur over the school break.
2. Is there a presence of emerging skills or breakthrough opportunities? No

There are no emerging skills or breakthrough opportunities for Steve.
3. Are there significant interfering behaviors? No

There are no significant interfering behaviors.
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4. Does the nature and severity of the disability warrant ESY? No

The nature and severity of the disability does not warrant ESY.
5. Are there other special circumstances that require ESY? No

There are no other special circumstances that require ESY.
After considering the above questions, will the benefits that the student receives from his/her educational program during the regular school year be significantly jeopardized if the student is not
provided ESY? NO, student is not eligible for ESY service
The benefits Steve receives during the regular school year will not be significantly jeopardized by the normal school break.
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TRANSITION (To be completed annually, beginning at age 14 or younger, if determined appropriate.)
STUDENT PREFERENCES AND INTERESTS:

The post secondary goal(s) are to be based on the student's interests,preferences and age appropriate transition assessment(s).
Date of Annual Student Interview: 04/26/2018
Discussion of student's interests, preferences and age appropriate transition assessment(s):
At the time of his interview he was involved in extra curricular actives for a community tennis league and excels in baseball. He gets along well
with others and prefers to work in a group. He expressed interests in being a chef and loves going out to eat. He said he would like to pursue his
interests in culinary.
POSTSECONDARY GOALS (Outcomes):

Postsecondary goal(s) are to be recorded here.At least one goal must be indicated for training and/or education.
Employment (required):
Steve would like to graduate high school with a diploma.
After graduation he would like to work 20 hours a week in a kitchen in a restaurant.
Steve would like to continue training in a two year program for culinary arts.
Training:
During high school, Steve will complete the Culinary Arts program at the Carrier and Technology Center.
Education:
After graduating from high school with a diploma, Steven will attend his local community college and enroll in a two year culinary arts program.
Independent Living (if appropriate):
n/a
COURSE OF STUDY:
The course of study is to support the stated postsecondary goal(s)
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Human Consumer Services, Hospitality & Tourism
Student is enrolled in the following Functional and Skill Development Activities:
Job Sampling & Employment Training
Based on the interview, Steven expressed an interest in being a chef at a restaurant. He is very excited to attend the Culinary Arts program at the
CTC. He is learning to self advocate for his interests and goals.
PROJECTED CATEGORY OF EXIT:

The student is projected to exit with: Maryland High School Diploma: (with 4 credits of Career and Technology Program)
PROJECTED DATE OF EXIT:

The student is participating in a 4 year program and is projected to exit/graduate school Apr 26, 2024 (month, day, year)
Have the student and parents been informed that rights under IDEA do not transfer to students with disabilities on reaching age of majority, except under limited circumstances. as described in
Education Article 8-412.1, Annotated Code of Maryland? Yes
TRANSITION ACTIVITIES
TRANSITION SERVICES/ACTIVITIES
Transition services are a coordinated set of activities for a student with a disability that is designed within a results oriented process that will facilitate the student's movement from school to
postsecondary activities.
Academic:
Steve will shadow at CTC in the Culinary Arts program.
Responsible Party:
Steve, Case Manager, CTC staff
Academic:
Steve will pass required courses, assessments and service learning hours to earn his high school diploma.
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Responsible Party:
Steve, Case Manager, School
Employment Training:
Steve will participate in field experiences and internships in restaurants during his program at CTC.
Responsible Party:
Steve, CTC staff, Case Manager
Annual date student and parent were provided a copy of the Transition Planning Guide: 11/08/2018
AGENCY LINKAGE
*The student has been referred to: *Agency Representatives were invited to the IEP Team Meeting: Anticipated Services for Transition:
Division of Rehabilitation Services (DORS) No No No
Developmental Disabilities Administration (DDA) No No No
Behavioral Health Administration (BHA) No No No
*If no or N/A, document basis for decision:
Steves' disability does not make him eligible for these services. His school and family is able to support his transition goals, therefore, adult
agencies are not anticipated at this time.
Steve shared his interest and post secondary goals, which include working in a restaurant and becoming a chef with the School Based Transition
Coordinator.
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INDIVIDUALIZED EDUCATION PROGRAM (IEP) IV. GOALS
MARYLAND STATE DEPARTMENT OF EDUCATION (MSDE) DIVISION OF DRAFT TRAINING
GOAL Academic - Math Problem Solving
Goal:
When given a multi-step math word problem Steve will use multiple representations to solve the problem with 90% accuracy for four consecutive weeks.
By: 05/08/2019
Evaluation Method: Classroom Based Assessment
With: 90 % Accuracy
ESY goal? No
"
Objective 1 : Objective 2 :
When given a multi-step math word problem Steve will use When given a multi-step math word problem Steve will use
visual representations to solve the problem with 70% accuracy visual representations to solve the problem with 80% accuracy
for four consecutive weeks. for four consecutive weeks.
Objective 3 :
When given a multi-step math word problem Steve will use
visual representations to solve the problem with 85% accuracy
for four consecutive weeks.
GOAL Academic - Written Language Mechanics
Goal:
Given a prompt, Steve will write a paragraph of 5-6 sentences containing 3 or less errors (grammatical errors, spelling) on 4 out of 5 trials for 4
consecutive weeks.
By: 05/08/2019
Evaluation Method: Portfolio Assessment
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With: 4 out of 5 trials
ESY goal? No
"
Given a prompt, Stevewill write a paragraph of 5-6 sentences Given a prompt, Steve will write a paragraph of 5-6 sentences
containing 10 or less errors containing 8 or less errors (grammatical
(grammatical/spelling/punctuation) on 4 out of 5 trials for errors/spelling/punctuation) on 4 out of 5 trails for four
four consecutive weeks. consecutive weeks.
Objective 3 :
Given a prompt, Steve will write a paragraph of 5-6 sentences
containing 5 or less errors (grammatical/spelling/punctuation)
on 4 out of 5 trials for four consecutive weeks.
GOAL Academic - Written Language Expression
Goal:
Given a prompt Steve will write a paragraph of 5-10 sentences containing a variety of sentence structures (simple/compound/complex/compound-complex)
on 4 out of 5 trials for four consecutive weeks.
By: 05/08/2019
Evaluation Method: Portfolio Assessment
With: 4 out of 5 trials
ESY goal? No
"
Given a prompt Steve will write a paragraph of 5-10 sentences Given a prompt Steve will write a paragraph of 5-10 sentences,
containing simple sentences on 4 out of 5 trials for 4 containing simple and compound sentences on 4 out of 5 trials
consecutive weeks. for four consecutive weeks.
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Objective 3 :
Given a prompt Steve will write a paragraph of 5-10 sentences
containing simple, compound, and complex sentences on 4 out of
5 trials for four consecutive weeks.
How will the parent be notified of the student's progress toward the IEP goals? progress report
How often? Quarterly
Page 24 of 31
INDIVIDUALIZED EDUCATION PROGRAM (IEP) V. SERVICES
SERVICES
SPECIAL EDUCATION
Service Nature Location Service Description Begin Date End Date Provider(s): Summary of
(P)=Primary, (O)=Other Service
Classroom Instruction Outside Number of Length of Frequency: 05/08/2018 05/08/2019 (P) Special Education Total service
(Identifying the number of General
Sessions: Time: Weekly Classroom Teacher time:
sessions for Classroom Education
2 0 Hr.45 Weekly
Instruction is optional)
Min. Duration: 1 Hr.
36 Weeks 30 Min.
Classroom Instruction In General Number of Length of Frequency: 05/08/2018 05/08/2019 (P) Special Education Total service
(Identifying the number of Education
Sessions: Time: Weekly Classroom Teacher time:
sessions for Classroom
5 0 Hrs.30 Weekly
Min. Duration: 2 Hrs.
36 Weeks 30 Min.
Classroom Instruction Outside Number of Length of Frequency: 05/08/2018 05/08/2018 (P) Special Education Total service
(Identifying the number of General Sessions: Time: Weekly Classroom Teacher time:
sessions for Classroom Education
2 0 Hr.30 Weekly
36 Weeks 0 Min.
RELATED SERVICES
Assistive Technology Services Outside Number of Length of Frequency: 05/08/2018 05/08/2019 (P) Special Education Total service
General Sessions: Time: Weekly Classroom Teacher time:
Education
2 0 Hr.15 Weekly
36 Weeks 30 Min.
Page 25 of 31
CAREER AND TECHNOLOGY EDUCATION
Career and Technology Education In General Number of Length of Frequency: 05/08/2018 05/08/2019 (P) General Education Total service
Program w/Support Services Education
Sessions: Time: Daily Teacher time:
5 0 Hrs.30 Daily
(O) Special Education
Min. Duration: 2 Hrs.
Classroom Teacher
36 Weeks 30 Min.
Discussion of service(s) delivery including description of Transportation services if provided:
Special Education - Classroom Instruction:
The need for specialized designed instruction for writing to decrease the current achievement gap between Steve and his typically developing
peers.
This will allow for one to one instruction, in an environment with less distractions. Steve will receive specialized instruction to tech written
mechanics (proofreading skills) and written expression (focus on sentence detail and types).
Because Steve is writing at the 3rd grade level, he requires specialized instruction and accommodations within the general education, English
classroom to enable him to access and progress within the general education curriculum.
The need for specialized designed instruction for math to decrease the current achievement gap between Steve and his typically developing peers.
This will allow for one to one instruction, in an environment with less distractions. Steve will receive specialized instruction to tech how to
dissect and solve a math word problem using multiple representations.
Related Services - Assistive Technology Services:
Steve will receive training and practice time during pull outs, by the special education teacher for his assistive technology devices.
Career and Technology Education - Career and Technology Education Program w/Support Services:
Page 26 of 31
Steve will participate in the Career and Technology Education Program in their Culinary Arts Program. He will receive instruction form the
program's general education teacher, with accommodations given by his special education teacher for appropriate written and
mathematic assignments.
Discussion of ESY service(s) delivery including description of Transportation services if provided:
Page 27 of 31
INDIVIDUALIZED EDUCATION PROGRAM (IEP) VI. PLACEMENT DATA
LEAST RESTRICTIVE ENVIRONMENT (LRE) DECISION MAKING & PLACEMENT SUMMARY

A student with disability is not removed from general education in an age-appropriate instructional setting solely because of needed modifications to the general curriculum.
What placement options did the IEP team consider?
Full inclusion in general education and partial inclusion in general education with accompanying pull out services for reading and math to bridge
the gap.
If removed from the regular early childhood program/general education environment, explain reasons why services cannot be provided in that setting with the use of supplementary aids and services:
The team determined that intensive writing and math intervention is needed and will most appropriately be provided as a pull out service with
specialized instruction provided in a resource room which is quiet and free of distractions. Services will be provided by a special education
teacher with a lower teacher student ratio than can be provided in the general eduction classroom.
Steve will benefit from individualized placement because writes on a 3rd grade level and preforms on a 4th grade level for math. Intensive
intervention is needed to bridge the gap between Steve and his typically developing peers.
Special education placement (ages 3-5):

Special education placement (ages 6-21): Average 91.43%/day - INSIDE GENERAL EDUCATION (80% or more)
Total time in school week: 35 hrs. 00 minutes/week Total time in General Education: 32 hrs. 00 minutes/week
Total time outside of General Education: 3 hrs. 00 minutes/week
In selecting the LRE, are there any potential harmful effects on the student or quality of services he or she needs? Yes
A potential harmful effect on the student for being removed from the general education classroom may be the social separation from her typically
developing peers.
Are the services i n the student's home school (the school the student would attend if not disabled)? Yes If no, document basis for decision(s):
If no, is placement as close as possible to the student's home? If no, document basis for decision(s):
Consideration of Transportation Needs: Is the Related Service Transportation needed based on the unique needs of the student or to allow student access to special education services? No If Yes,
consider:
Is specialized equipment needed to assist the student during transportation? If yes, explain:
Are personnel needed to accommodate the student during transportation? If yes, list type(s) of personnel:
Are other supports needed to assist the student during transportation? If yes, explain:
Page 28 of 31
INDIVIDUALIZED EDUCATION PROGRAM (IEP) VI. PLACEMENT DATA
Document basis for decision(s) (including consideration of the amount of time and distance involved in travel):
Provide an explanation to the extent, if any, the student will not participate with non-disabled peers in academic, non-academic, and extracurricular activities?
Steve will participate with non disable peers in non academic and extra curricular activities such as tennis. He will participate in academic
activities with his non-disabled peers for the majority of the day, excluding the time that he is receiving pull out services.
SSIS Resident County: Frederick SSIS Resident School: Gov. Thomas Johnson Middle
SSIS Service County: Frederick SSIS Service School: Gov. Thomas Johnson Middle
CHILD COUNTY ELIGIBILITY CODES
(1)Eligible student with a disability served in a public or placed in a nonpublic school by the public agency to receive FAPE
Page 29 of 31
INDIVIDUALIZED EDUCATION PROGRAM (IEP) VII. AUTHORIZATION(S)
MARYLAND STATE DEPARTMENT OF EDUCATION (MSDE) DIVISION OF DRAFT
AUTHORIZATION(S)
CONSENT FOR INITIATION OF SERVICES (initial IEP only)

I have received a copy of the Evaluation Report informing me in writing of the reasons for this action.
The special education and related services will be provided as described in the IEP. I understand that the IEP will be reviewed periodically but not less than annually.
I understand that records will not be released without my signed and written consent except under the provisions of the Family Education Rights and Privacy Act (FERPA). This law allows the release of
educational records to a public school or educational agency.
I understand that my consent is voluntary and that I may revoke consent at any time. Should I revoke consent it is not retroactive. If I revoke consent, in writing, for my child to receive special
education services after my child is initially provided special education and related services, the public agency is not required to amend my childs education records to remove any references to my
childs receipt of special education and related services because of my revocation of consent.
I understand that the public agency will submit information that will be used for the special services information system. This system will be used by the MSDE and other State Agencies, as
appropriate, to enable funding of programs and to assure my child's rights to any needed assessment.
I have been informed of the determinations(s) of the IEP team in my native language or other mode of communication.
I have been informed of my rights, as explained in the Procedural Safeguards Parental Rights document, I have received.
I consent to the initiation of special education and related services for my child, as specified in my child's IEP.
Parent Signature: Date:
Page 30 of 31
INDIVIDUALIZED EDUCATION PROGRAM (IEP) VII. AUTHORIZATION(S)
MARYLAND STATE DEPARTMENT OF EDUCATION (MSDE) DIVISION OF DRAFT
MEDICAL ASSISTANCE (MA)
Parental consent must be obtained before the provider agency discloses, for billing purposes, their child's personally identifiable information to the Maryland Department of Health and Mental Hygiene
(DHMH), the State agency responsible for the administration of the Medical Assistance Program, consistent with the Family Educational Rights and Privacy Act (FERPA) and the Individuals with
Disabilities Education Act (IDEA). By providing consent, you understand and agree in writing that the public agency may access your child's Medicaid to pay for services provided to your child.
In order to provide a free appropriate public education (FAPE) to your child, the provider agency may not:
• Require you to sign up for or enroll in State's Medical Assistance in order for your child to receive FAPE under IDEA,
• Require you to incur an out-of-pocket expense such as the payment of a deductible or co-pay amount incurred in filing a claim for services,
• Use your child's benefits under Medical Assistance if that use would:
◦ Decrease available lifetime coverage or any other insured benefit;
◦ Result in your family paying for services that would otherwise be covered by Medical Assistance and that are required for your child outside of the time your child is in school;
◦ Increase premiums or lead to the discontinuation of benefits or insurance; or
◦ Risk loss of eligibility for home and community-based waivers, based on aggregate health-related expenditures.
You have the right to withdraw your consent to disclosure of personally identifiable information to State's Medical Assistance Program at any time.
If you withdraw consent for the provider agency to disclose your child's personally identifiable information it does not relieve the provider agency of its responsibility to ensure that all required
services are provided to your child at no cost to you.
Is the student eligible for MA? MA Number

I agree to Service Coordination for Children with Disabilities and that the Service Coordinator(s) identified on this IEP may be appointed as MA Service Coordinator(s). (COMAR 10.09.52)
I understand that I am free to choose an MA Service Coordinator for my child. At this time, I accept the following Service Coordinator(s).
MA Service Coordinator Name:
MA Service Coordinator Name:
I understand that if I wish to change the MA Service Coordinator in the future, I can call the school to make a change.
I understand that the purpose of this service is to assist in gaining access to needed medical, social, educational, and other services.
I give my consent for the provider agency to disclose my child's personally identifiable information to the State's Medical Assistance Program in order to access Medical Assistance Benefits.
I give permission to the provider agency to recover costs from Medicaid for service coordination, as well as health-related services, related to the implementation of my child's IEP goals.
I understand that if I refuse to allow the provider agency access to MA funds, it does not relieve the public agency of its responsibility to ensure that all required services are provided to my child at
no cost to parent.
I understand that this service does not restrict or otherwise affect my child's eligibility for other Medical Assistance benefits. I also understand that my child may not receive a similar type of case
management service under Medical Assistance if he/she qualifies for more than one type.
Parent Signature: Date:
Page 31 of 31

Iep Final

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)

• Draft 05/06/2018 STUDENT INFORMATION

MARYLAND STATE DEPARTMENT OF EDUCATION (MSDE) DIVISION OF DRAFT TRAINING ◦ Approved

STUDENT AND SCHOOL INFORMATION

First Name: Middle Name: Last Name: PARENT/GUARDIAN 1:

IEP TEAM PARTICIPANTS

Identify area(s) impacted by the student's suspected disability:

-math problem solving

Discussion to support decision:

Initial Eligibility (Student Ages 3-21)

Date of parent consent for initial evaluation: 04/01/2018

Indicate Primary Disability: SPECIFIC LEARNING DISABILITY

Reason(s) for delay of initial evaluation:

STUDENT PARTICIPATION ON DISTRICT/STATEWIDE ASSESSMENTS AND GRADUATION INFORMATION

ENGLISH LANGUAGE PROFICIENCY SUMMARY

State graduation requirements can be found at www.marylandpublicschools.org.

In addition to Frederick county's core credit requirements, Steve will OR

MSAA Scale Score Most Current Proficiency Level

MISA Grade Scale Grade Scale

Document basis for assessment decision(s): English 396

SCHOOL AGED - PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

What is the parental input regarding the student's educational program?

Does the student have special communication needs? No

ASSISTIVE TECHNOLOGY (AT) (required)

Document basis for decision(s):

SERVICE FOR STUDENTS WHO ARE BLIND OR VISUALLY IMPAIRED

Is the student blind or visually impaired? No

Braille Evaluation date:

O&M Evaluation date:

Document basis for decision(s):

Functional Behavior Assessment(FBA): No Assessment Date:

Does the student require Behavior Intervention Plan? No

Behavior Intervention Plan: No Implementation Date:

Document basis for decision(s):

SERVICE FOR STUDENTS WHO ARE ENGLISH LEARNERS

Document basis for decision(s):

INSTRUCTIONAL AND ASSESSMENT ACCESSIBILITY FEATURES

* Consult assessment specific guidelines for detailed information.

Document basis for decision:

* Consult assessment specific guidelines for detailed information.

Document basis for decision:

INSTRUCTIONAL AND ASSESSMENT ACCOMMODATIONS

O C N S S S A ELLs for for E

* Consult assessment specific guidelines for detailed information.

Document basis for decision:

* Consult assessment specific guidelines for detailed information.

Document basis for decision:

SUPPLEMENTARY AIDS, SERVICES, PROGRAM MODIFICATIONS AND SUPPORTS

Nature of Service Frequency Begin Date End Date Provider(s):

Clarify location and manner:

Nature of Service Frequency Begin Date End Date Provider(s):

Clarify location and manner:

Nature of Service Frequency Begin Date End Date Provider(s):

Clarify location and manner:

Nature of Service Frequency Begin Date End Date Provider(s):

Clarify location and manner:

Nature of Service Frequency Begin Date End Date Provider(s):

Clarify location and manner:

Nature of Service Frequency Begin Date End Date Provider(s):

Program Modification(s) - Anticipated Frequency 05/08/2018 05/08/2019

Clarify location and manner:

Documentation to Support Decision:

Discussion to support decision(s):