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INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student’s Name: James

INDIVIDUALIZED EDUCATION PROGRAM (IEP) School Age

Student’s Name: James Smith


IEP Team Meeting Date (mm/dd/yy): 4/9/2018
IEP Implementation Date (Projected Date when Services and Programs Will Begin): 4/11/18
Anticipated Duration of Services and Programs: one year
Date of Birth: 4/10/2015
Age: 3
Grade
: Pre-K
Anticipated Year of Graduation: 2030
Local Education Agency (LEA): Pugliese West Elementary
County of Residence:
Name and Address of Parent/Guardian/Surrogate: Phone (Home):
Phone (Work):

Other Information:

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

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

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: James

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

James is a Pre-k student. He attends Pugliese west elementary school, and is three years old. When taking to James, it is obvious that he does
not speak very much and when he does speak it is hard to understand what he is saying. However, he does communicate in other ways. He is
currently on an IEP for cognitive and developmental delays. James’ results from the Brigance test showed that he performed around average
to high for his age. For many sections, he was in the 90th percentile.

In the physical development category, James had a raw score of 90 and a composite score of 115. He performed at the age level of 3 years and
8 months and he was in the 84th percentile.

In the language and development section, James had a raw score of 209 and a composite score of 133. He performed at the age level of 4
years and 9 months and he was in the 99th percentile.

In Mathematics, James was asked performed tasks such as counting, comparing sizes, completing word problems, sorting objects into groups,
and matching quantities to numerals. In this section, James scored a raw score of 49, and a composite score of 145. James performed at the
age level of 4 years 8 months, and performed in the 99th percentile.

In Literacy, James was asked to complete tasks such as identifying the letters alphabet, identifying rhyming words, and interacting with text.
James scored a raw score of 70, and a composite score of 129. She performed at the age level of 4 years. He is in the 97th percentile for his
age group.

In the adaptive behavior section, James had a raw score of 36 and a composite score of 130. He performed at the age level of 3 years 9
months and was in the 98th percentile for his age.

The final section was the Social and Emotional Development. In this section, James had a raw score of 30 and a composite score of 102. James
performed at the age level of 3 years 8 months and was in the 55th percentile for his age group.

James scored very high in almost all of the sections, but his strongest section was the language development, and academic/cognitive
sections.

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: James

Strengths:
-James knew the body parts and was able to draw those shapes (he struggled with other shapes besides body parts)
-James could identify most images
-James knew his colors
-James knew most of the letters of the alphabet

Areas for improvement:


-James performed well on most tasks, but he lost interest and had trouble staying focused
-James had a lot of trouble in the section “A-3”. He had trouble walking backwards. James also struggled to walk “toe heel”
-James also struggled with drawing. He could not consistently hold a pencil correctly, or draw shapes

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

Page 3 of 6 April 2014


INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: James

James will be able to sit and or lay down on his A paraeducator will watch Each day the paraeducator
mat for 80% of the 30 minute naptime, for 2 James during naptime. will write a note in James’
weeks by the end of this IEP She will split nap time planner and to update his
into partial intervals and parents on his progress that
then calculate the day.
percentage of intervals
that James spent sitting
or laying down on his
matt.
Every friday a Each day the paraeducator
James will be able to walk 6 “heel-to-toe” and paraeducator will pull will write a note in James’
walk 6 backwards 4 out of 5 every times per james out of class to planner and to update his
weekly session (5 times each=1 session) for 10 practice these skills with parents on his progress that
consecutive sessions by the end of this IEP him. He will do each skill day. The teacher and
5 times and have 80% paraeducator will also meet
accuracy (4 out of 5 once a week to talk about
correctly) James’ progress.

James will be able to draw these shapes, circle, Every other wednesday, After each test, the results
square, triangle, vertical line, horizontal line, on James will be given a 5 will be sent home to James’
a biweekly assessment with 80% accuracy over 5 question test that asks parents.
consecutive assessments by the end of this IEP. him to draw each shape.
He must get 80% for five
consecutive tests.

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.

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: James

● 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

(Goal #1) James will receive a sticker for every 5


minutes of nap time that he remains sitting or laying In the classroom everyday during
4/11/18 2 weeks
down on his matt. After 25 stickers, he can have his during naptime naptime
favorite treat

(Goal #1) James will be given a visual schedule to In the classroom look at everyday
4/11/18 2 weeks
remind him how long naptime will last what he is during naptime before nap time
doing after naptime

(Goal #2) Will watch a video on the Ipad before every outside of the
weekly session that shows him how to walk “heel to classroom, in the once a week 4/11/18 2 weeks
toe” and backwards hallway

(Goal #2) James will meet with an physical therapist


outside the classroom, once every other
once every other week to work on balance and 4/18/18 2 weeks
in the PT’s office week
coordination

(Goal #3) James will work in a booklet where he


in the classroom every morning 4/16/18 6 weeks
traces on these shapes every morning for 5 minutes

(Goal #3) James will be allowed time to “play” with whenever the
In the classroom,
the Ipad on an app the helps him practice tracing schedule allows for 4/11/18 6 weeks
during free play time
shapes free play

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: James

Page 6 of 6 April 2014

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