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

INDIVIDUALIZED EDUCATION PROGRAM (IEP) School Age

Student’s Name: Student IEP Team Meeting Date (mm/dd/yy): 02/13/12IEP Implementation Date (Projected Date when Services and Programs Will Begin): 02/15/12Anticipated Duration of Services and Programs: 12/14/13Date of Birth: 07/31/99Age: 12y 7mGrade: 07Anticipated Year of Graduation: 2017Local Education Agency (LEA): Muhlenberg School DistrictCounty of Residence: Berks

Name and Address of Parent/Guardian/Surrogate: Phone (Home): (610) xxx- xxxx

Mother Phone (Work): (484) xxx- xxxx (Cell)xxx Acacia AveReading, PA 19605

Other Information: Neighborhood School: Muhlenberg Middle School

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

of 33 June 2010 Revisions

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

of 33 June 2010 Revisions

IEP TEAM/SIGNATURES

The Individualized Education Program team makes the decisions about the student’s program and placement. The student’s parent(s), the student’s special education teacher, and a representative from the Local Education Agency are required members of this team. Signature on this IEP documents attendance, not agreement.

Role Printed Name SignatureParent/Guardian/Surrogate Mother

Student* StudentRegular Education Teacher** Kelly Molinari

Special Education TeacherLearning/Autistic/Emotional Support Teacher Sue Raynes

Principal/LEA Donna Albright/Travis Bloom

* The IEP team must invite the student if transition services are being planned or if the parents choose to have the student participate.** If the student is, or may be, participating in the regular education environment*** As determined by the LEA as needed for transition services and other community services**** A teacher of the gifted is required when writing an IEP for a student with a disability who also is gifted.One individual listed above must be able to interpret the instructional implications of any evaluation results.

Written input received from the following members:

Transfer of Rights at Age of Majority

For purposes of education, the age of majority is reached in Pennsylvania when the individual reaches 21 years of age. Likewise, for purposes of the Individuals with Disabilities Education Act, the age of majority is reached for students with disabilities when they reach 21 years of age.

PROCEDURAL SAFEGUARDS NOTICE

I have received a copy of the Procedural Safeguards Notice during this school year. The Procedural Safeguards Notice provides information about my rights, including the process for disagreeing with the IEP. The school has informed me whom I may contact if I need more information.

Signature of Parent/Guardian/Surrogate:

I. SPECIAL CONSIDERATIONS THE IEP TEAM MUST CONSIDER BEFORE DEVELOPING THE IEP. ANY FACTORS CHECKED AS “YES” MUST BE ADDRESSED IN THE IEP.

Is the student blind or visually impaired?Yes The IEP must include a description of the instruction in Braille and the use of Braille unless the IEP team

determines, after an evaluation of the student’s reading and writing skills, needs, and appropriate reading and writing media (including an evaluation of the student’s future needs for instruction in Braille or the use of Braille), that instruction in Braille or the use of Braille is not appropriate for the student.

X No

Is the student deaf or hard of hearing?Yes The IEP must include a communication plan to address the following: language and communication needs;

opportunities for direct communications with peers and professional personnel in the student’s language and communication mode; academic level; full range of needs, including opportunities for direct instruction in the student’s language and communication mode; and assistive technology devices and services. Indicate in which section of the IEP these considerations are addressed. The Communication Plan must be completed and is available at www.pattan.net

X No

Does the student have communication needs?Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual

goals, etc.)X No

Does the student need assistive technology devices and/or services?Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction, annual goals,

etc.)X No

Does the student have limited English proficiency? Yes The IEP team must address the student’s language needs and how those needs relate to the IEP.

X No

Does the student exhibit behaviors that impede his/her learning or that of others?Yes The IEP team must develop a Positive Behavior Support Plan that is based on a functional assessment of behavior

and that utilizes positive behavior techniques. Results of the functional assessment of behavior may be listed in the Present Levels section of the IEP with a clear measurable plan to address the behavior in the Goals and Specially Designed Instruction sections of the IEP or in the Positive Behavior Support Plan if this is a separate document that is attached to the IEP. A Positive Behavior Support Plan and a Functional Behavioral Assessment form are available at www.pattan.net

http://www.pattan.net/


X No

Other (specify):

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)Phonemic Awareness:

Student does demonstrate prerequisite phonemic awareness skills, which is the abilitiy to apply the principles of sound production, blending and segmenting words.

Decoding:

Given grade level word lists from the Qualitative Reading Inventory (QRI) student was bale to produce the following results:

Phonemic Awareness:

Studnet does demonstrate prerequisite phonemic awareness skills, which is the ability to apply the principles of sound production, blending and segmenting words.

Decoding:

Given grade level word lists from the Qualitative Reading Inventory (QRI) student was able to produce the following results:

Grade Identified Correctly Accuracy Current LevelPrimer 20/20 100% Independent1 17/20 85% Instructional2 19/20 95% Independent3 13/20 65% Frustration

Based on these results, student is at the independent level (90-100% accuracy rate) up through the 2nd grade level. When assessed at the 3rd grade level, student was at the frustration level.

Currently in reading instruction from the her current 3rd grade level text, student read 95% of the words correctly within a 3 second time limit.

Student is able to demonstrate effective decoding skills through the 2nd grade level, yet is instructional at the 3rd grade level.

Fluency:

Given grade level passages from the Qualitative Reading Inventory (QRI) student was able to produce the following results:

Grade Number of words read per

minute

Number of errors

Accuracy Words read correctly per minute

Suitable number of

wcpm for grade level(s) assessed

1st 99 2 98% 97 532nd 106 0 100% 106 893rd 68 4 94% 67 1074th 75 2 97% 73 123

Currently in reading class, when given a passage from the 6-minute Solution at a 2nd grade level, student read 92 words correctly per minute with 3errors which corresponds to decoding the passage with 97% accuracy. In her current reading text at a 3rd grade level, she read 126 words per minute with 0 errors.

According to the Hasbrouck and Tindal Oral Reading Fluency Data (2005) the results indicate that student is reading fluently at a 2nd grade level.

Vocabulary Comprehension:

When presented with grade level word lists from the (QRI) student was able to demonstrate the following knowledge base by using the words correctly in a sentence or stating an acceptable definition, understanding their meaning

Grade Identified Correctly Accuracy Level1 10/10 100% Independent2 9/10 90% Independent3 9/10 90% Independent4 7/10 70% Instructional5 5/10 50% Frustration

This assessment indicates that student is instructional up to a 4th grade vocabulary comprehension level.

Text Comprehension:Grade Explicit Implicit Total Questions Overall

AccuracyLevel

1 4/4 (100%) 2/2 (100%) 6/6 100% Independent

2 2/4 (50%) 4/4 (100%) 6/8 75% Instructional

3 3/4 (75%) 3/4 (75%) 6/8 75% Instructional

4 0/4 (0%) 4/4 (100%) 4/8 50% Frustration

In her current reading instruction at a 3rd grade level, she averages a 100% on oral comprehension and an 85% on written comprehension.

These results indicate that student is instructional in comprehension skills at 3rd grade level.

Written Language

Spelling: Given graded word lists from the Qualitative Reading Inventory student was able to spell with the following accuracies.

Grade Spelled Correctly Accuracy Level2 5/5 100% Independent3 3/5 60% Instructional 4 2/5 40% Frustration

Currently in spelling at a 3rd grade level, student is earning a 65% on her spelling tests. She ranges from 40-80%.

Student is instructional in spelling up through a 3rd grade level. Paragraph Writing: Student scored the following scores on a writing assessment written about a summer activity as assessed using the Exeter Writing Rubric. These scores are on a writing assignment that was completed independently.

Spelling Grammar/Sentence Structure Sequence & Organization9 Spells 90% of words

correctlyUses 3 of the following: complex sentences, compound sentences, quotations, adverbial phrases

Essay has four or more logically/sequentially connected paragraphs

8 Spells 75% of words correctly

Uses 2 of the following: complex sentences, compound sentences, quotations, adverbial phrases

Essay has at least three logically/sequentially connected paragraphs

7 Spells 50% of words correctly

Uses 1 of the following: complex sentences, compound sentences, quotations, adverbial phrases

Essay has at least two logically/sequentially connected paragraphs

6 Spells 25% of words Writes complete sentences using Essay has at least 2 paragraphs

correctly correct and consistent tenses, agreement, & person

using indentation

5 Uses logical phonetic spelling

Writes complete sentences, no run-ons or sentence fragments

Paragraph has concluding sentence

4 Uses vowels Writes a complete sentence with subject/predicate agreement

Paragraph has a topic sentence

3 Uses beginning/ending sounds

Uses a prepositional phrase in a sentence

Paragraph has at least 3 related sentences

2 Uses some letters to match sounds

Uses a complete sentence to convey thought

Paragraph has at least 2 related sentences

1 Prints own name & occasional known words. Uses letters to represent words

Uses a string of words to convey thought

Paragraph has un-related sentences

0score 8 4 4

Word Choice/ Vocabulary Capitalization Punctuation9 Uses precise descriptors,

synonyms and vocabulary to create consistent writer’s voice/tone (personality)

Capitalizes correctly (names, etc.) and differentiates when to use capitals 90% of the time

Correctly uses commas, quotations, hyphens, colons, semicolons 90% of the time

8 Uses complex descriptors, synonyms, and varied vocabulary


Correctly uses commas, quotations, hyphens, colons, semicolons 50% of the time

7 Uses simple descriptors, synonyms and varied vocabulary


Correctly uses commas, quotations, & apostrophes 90% of the time

6 Uses at least 3 synonyms to replace repeated words

Capitalizes correctly (names, places, titles, proper nouns, and first words of quotes) and differentiates when to use capitals 25% of the time

Correctly uses commas, quotations, & apostrophes 50% of the time

5 Uses 1 or 2 synonyms to replace repeated words

Capitalizes only words that require capitalization

Uses other forms of ending punctuation & commas 90% correct

4 Uses at least 3 simple descriptors (color, size, shape)

Capitalizes beginning of sentences 90% of the time

Uses other forms of ending punctuation and commas 50% correct

3 Uses 1 or 2 simple descriptors (color, size, shape)

Capitalizes beginning of sentences 50% of the time

Uses periods correctly at the end of a sentence 90% of the time

2 Adequately conveys meaning using basic word

Differentiates use of upper and lower case within individual

Uses periods correctly at the end of a sentence 50% of the time

choices words1 Uses words to label pictures

(e.g. cat, table)Differentiates use of upper and lower case within own name

Uses some form of punctuation regardless of placement

0score 4 3 2

Writing Rubric:Created by Exeter Township School District Special Education Department and BCIU CSPD/TaCTOTAL SCORE: 25 out of a possible 54 points.

Listening Comprehension:Given graded reading passages from the Brigance Battery of Assessments, student was able to answer questions about stories read to him with the following accuracies.

Grade Total Questions Accuracy Level2 5/5 100% Independent3 4/5 80% Instructional4 4/5 80% Instructional5 3/5 60% Instructional6 2/5 40% Frustration

These results indicate that in reference to listening comprehension student is instructional up to a 5th grade level.

Basic Math CalculationsGiven the Bader Math Calculations assessment student was able to complete, 8 out of the 30 of the problems with 100% accuracy within five minutes. This is equivalent to a 4.3 grade level.

Skill Area Answered Correctly

Strength Need

Simple Addition 3/3 Strength

Addition of Fractions 0/4 Adding like fractions

Addition of Decimals 0/1 Adding decimals

Simple Subtraction 4/4 Strength

Subtraction of Fractions 1/2 Subtracting like fractions

Simple Multiplication 0/4 Did not attempt 1 by 1 digit Up to 3x1

Multiplication of Fractions 0/2 Multiplication of fractions

Multiplication of Decimals 0/2

Simple Division 0/4 Division without remainders

Division of Fractions 0/1

Division of Decimals 0/2

Decimal Conversion 0/1

Student is currently being instructed in the Connecting Math Concepts, Level C book, which corresponds to a 3rd grade level.

The assessment shows that student is instructional up to a 4th grade level.

Math Fact Fluency

Given timed math calculations for one minute each student was able to demonstrate the following abilities:

Operation Total CorrectAddition 9Subtraction 11Multiplication 12Division 9

Students who are able to compute 40 to 60 calculations in one minute are considered fluent in math fact fluency.

Student is significantly below average in math fact fluency.

Math Problem Solving

Given graded word problems involving addition and subtraction, student answered and labeled the problems with 25% accuarcy. Within her current direction instruction math program at a 3rd grade level, she is completing word problems using number families with 64% average.

Counting coins NeedCounting bills and coins NeedTelling time to the minute NeedTelling time to the five-minute StrengthMeasuring inch, ½ inch, ¼ inch Need

Based on these results student demonstrates math calculation below her grade level peers. This curriculum based – assessment and math assessment indicates that student is instructional at the end of 3rd – beginning of 4th grade level. However, there are functional math skills that are below this level which need to be taught/practiced/maintained in addition to instruction at a 3rd-4th grade level.

FUNCTIONAL PERFORMANCE:

Behavior: Student follows rules and directions set in all environments of the school. Her behaviors are appear sometime to be hyper (example: calling out, giggling, talking loudly, fidgeting, rushing to complete tasks, interrupting others when they talk). Her behaviors are corrected through classroom behavior/management systems. Student exhibits age appropriate behaviors in the areas of the school environment.

Fine Motor Skills: Student exhibits age-appropriate fine motor skills

Gross Motor Skills: Student displays age-appropriate gross-motor skills.

Organization: Student keeps her schoolwork, planner and folders organized. There are times when she needs reminders to find the materials in the correct binder or section of her binder.

Self Help: Student exhibits self-help and self-care skills that are age-appropriate.

Social: Student has a small group of friends. Her social skills are age-appropriate and are corrected with modeling and correction during instruction.

EXPLANATION OF HOW DISABILITY AFFECTS THE CHILD’S INVOLVEMENT & PROGRESS IN THE GENERAL EDUCATION CURRICULUM.

It is recommended that student continue to qualify for special education services as a student with an Other Health Impairment. Student requires direct instruction in reading, basic math skills and written expression that are not part of her current grade level that is taught in the general curriculum. Given the level of repetition and practice required for student to master the learning outcomes of the social studies and science general curriculum, she will require modifications of the curriculum to eliminate outcomes that are less relevant to her and at a slower pace. Because student exhibits weakness in the areas of reading fluency, text comprehension, vocabulary comprehension, fact fluency, math calculation/problem solving, listening comprehension, and written expression it may be necessary for her skeletal outlines when taking notes. She will need extended time on tests

and quizzes and have tests and quizzes read aloud; along with the ability to takes adapted and modified tests and quizzes in a small group setting where she may receive support. She will need repetition of directions and instruction in order to be successful.

STRENGTH:Phonemic AwarenessHandwriting/Printing LegibilityOrganization SkillsAge-Appropriate Fine Motor SkillsAge Appropriate Gross Motor SkillsAge Appropriate Self-Help Age Appropriate Social Skills

NEEDS:Reading FluencyText ComprehensionVocabulary ComprehensionFact FluencyMath Calculation/Problem SolvingListening ComprehensionWritten Expression

Transition Outcome: Student is not of transition ageTransition not applicable

III. TRANSITION SERVICES – This is required for students age 14 or younger if determined appropriate by the IEP team. If the student does not attend the IEP meeting, the school must take other steps to ensure that the student’s preferences and interests are considered. Transition services are a coordinated set of activities for a student with a disability that is designed to be within a results oriented process, that is focused on improving the academic and functional achievement of the student with a disability to facilitate the student’s movement from school to post school activities, including postsecondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation that is based on the individual student’s needs taking into account the student’s strengths, preferences, and interests.

POST SCHOOL GOALS – Based on age appropriate assessment, define and project the appropriate measurable postsecondary goals that address education and training, employment, and as needed, independent living. Under each area, list the services/activities and courses of study that support that goal. Include for each service/activity the location, frequency, projected beginning date, anticipated duration, and person/agency responsible.

For students in Career and Technology Centers, CIP Code:

Postsecondary Education and Training Goal: Measurable Annual Goal

Yes/No

X

(Document in Section Courses of Study:

Service/Activity Location Frequency Projected Beginning Date

Anticipated Duration

Person(s)/Agency Responsible

Employment Goal: Measurable Annual Goal

Yes/No(Document in Section

V)Courses of Study:




Independent Living Goal, if appropriate: Measurable Annual Goal

Yes/No(Document in Section

V)Courses of Study:




IV. PARTICIPATION IN STATE AND LOCAL ASSESSMENTSInstructions for IEP Teams: Please check the appropriate assessments. If the student will be assessed using the PSSA or the PSSA-Modified, the IEP Team must choose which assessment will be administered for each content area (Reading, Mathematics, and Science). For example, a student may take the PSSA-Modified for Reading and the PSSA for Mathematics and Science. If the student will be assessed using the PASA, the IEP Team need not select content areas because ALL content areas will be assessed using the PASA.

PSSA (Please choose the appropriate option and content areas for the student. A student may be eligible to be assessed using the PSSA-Modified assessment for one or more content areas and be assessed using the PSSA for other content areas.)

PSSA-Modified (Please choose the appropriate option and content areas for the student. A student may be eligible to be assessed using the PSSA-Modified assessment for one or more content areas and be assessed using the PSSA for other content areas.)

Allowable accommodations may be found in the PSSA Accommodations Guidelines at: www.portal.state.pa.us/portal/server.pt/community/testing_accommodations__security/7448Criteria regarding PSSA-Modified eligibility may be found in Guidelines for IEP Teams: Assigning Students with IEPs to State Tests (ASIST) at: www.education.state.pa.us/portal/server.pt/community/special_education/7465/assessment/607491Criteria regarding PASA eligibility may be found in Guidelines for IEP Teams: Assigning Students with IEPs to State Tests (ASIST) at: www.education.state.pa.us/portal/server.pt/community/special_education/7465/assessment/607491

Not Assessed (Please select if student is not being assessed by a state assessment this year)Assessment is not administered at this student’s grade level

Reading (PSSA grades 3-8, 11; PSSA-M grades 4-8, 11)Student will participate in the PSSA without accommodationsStudent will participate in the PSSA with the following appropriate accommodations:Student will participate in the PSSA-Modified without accommodations

X Student will participate in the PSSA-Modified with the following appropriate accommodations: Allowable portions fo the test read aloud, Paper, templates and highlighters, Scheduled breaks, Scheduled extended time, Simplifying directions, Small Group Testing, Tesing in a separate room.

Math (PSSA grades 3-8, 11; PSSA-M grades 4-8, 11)Student will participate in the PSSA without accommodationsStudent will participate in the PSSA with the following appropriate accommodations:Student will participate in the PSSA-Modified without accommodations

X Student will participate in the PSSA-Modified with the following appropriate accommodations: Allowable portions fo the test read aloud, Paper, templates and highlighters, Scheduled breaks, Scheduled extended time, Simplifying directions, Small Group Testing, Tesing in a separate room.

http://www.education.state.pa.us/portal/server.pt/community/special_education/7465/assessment/607491

http://www.education.state.pa.us/portal/server.pt/community/special_education/7465/assessment/607491

http://www.portal.state.pa.us/portal/server.pt/community/testing_accommodations__security/7448

Science (PSSA grades 4, 8, 11; PSSA-M grades 8, 11)Student will participate in the PSSA without accommodationsStudent will participate in the PSSA with the following appropriate accommodations:Student will participate in the PSSA-Modified without accommodationsStudent will participate in the PSSA-Modified with the following appropriate accommodations:

Writing (PSSA grades 5, 8, 11)Student will participate in the PSSA without accommodationsStudent will participate in the PSSA with the following appropriate accommodations:

PASA (PASA grades 3-8, 11 for Reading and Math; Grades 4, 8, 11 for Science)Student will participate in the PASA

Explain why the student cannot participate in the PSSA or the PSSA-M for Reading, Math, or Science:

Explain why the PASA is appropriate:

Choose how the student’s performance on the PASA will be documented.Videotape (will be kept confidential as all other school records)

Written narrative (will be kept confidential as all other school records)

Local Assessments

Local assessment is not administered at this student’s grade level; OR

Student will participate in local assessments without accommodations; OR

X Student will participate in local assessments with the following accommodations Allowable portions fo the test read aloud, Paper, templates and highlighters, Scheduled breaks, Scheduled extended time, Simplifying directions, Small Group Testing, Tesing in a separate room. OR

The student will take an alternate local assessment.

Explain why the student cannot participate in the regular assessment:

Explain why the alternate assessment is appropriate:

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.

Instructional Area: Reading

MEASURABLE ANNUAL GOALInclude: Condition, Name, Behavior, and

Criteria(Refer to Annotated IEP for description

of these components)

Describe HOW the student’s progress

toward meeting this goal will be measured

Describe WHEN periodic reports on

progress will be provided to parents

Given fiction and non-fiction passages at the 3rd and 4th grade level, student will apply learned decoding and word analysis strategies to read 110 words per minute at the 3rd grade level and 125 words per minute at the 4th grade level orally with 98% accuracy as assessed weekly on 4 consecutive probes.

Curriculum-based Assessment

Quarterly on Annual Goal Progress

SHORT TERM OBJECTIVES – Required for students with disabilities who take alternate assessments aligned to alternate achievement standards (PASA).

Not Applicable

Short term objectives / Benchmarks


Criteria(Refer to Annotated IEP for description of these

components)



Describe WHEN periodic reports on progress will be

provided to parents

Given a passage at theh 3rd grade and 4th grade level, student will apply pre-reading, reading and post reading strategies to answer oral and written comprehension questions with an average of 95% accuracy as assessed through curriculum-based assessment on 3 consecutive probes.

Curriculum-based Assessment

Quarterly on Annual Goal Progress


Not Applicable




components)




provided to parents

Given a list of word parts (affixes) and their definitions, student will use the word parts to identify the meaning of a word and use the words correctly in a sentence with 90% accuracy on a 3 consecutive assessments and earn a 90% accuracy on an end of the quarter assessment of all word parts learned throughout the quarter. (R8.A.1.2.1)

Tests/Quizzes Quarterly on Annual Goal Progress

Instructional Area: Math


Not Applicable



Not Applicable




components)




provided to parents

Given math fact probes, student will complete 20 addition, 20 subtraction, 20 multiplication and 10 division facts in one minute with 100% accuracy on 3 consecutive probes.

Timed Math Probes Quarterly on Annual Goal Progress



components)




provided to parents

Given a worksheet, quiz, test of no more than 20 problems including one of the following skills: subtracting with regrouping, measuring to the nearest ¼ inch, area and perimeter, solving word problems (up to a 3rd grade level), multiple digit multiplication (up to 3 by 1 digit), division with no remainders, fractions (adding and subtracting unlike fractions and multiplying and dividing fractions) and decimal operations involving addition and subtraction of money amounts, counting coins and dollar bills up to $10, telling time to the minute, student will write correct answers with an average of 90% accuracy on 3 consecutive classroom assessments and show progress towards the goals by earning at least a 90% accuracy on tests and quizzes of the mixed skills listed above

Tests/Quizzes,Math Probes Quarterly on Annual Goal Progress

PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION (SDI)

Addressed in Section VI of IEP

Instructional Area: Written Expression


Not Applicable



Not Applicable




components)




provided to parents

In response to verbal/written prompts, modeling faded to elimination, and given a graphic organizer, Kiara will follow a learned writing process to produce narrative, informational, and persuasive pieces that score a level 9 in Spelling, a level 5 in Grammar/Sentence Structure, a level 5 in Sequence and Organization, a level 5 in Word Choice/Vocabulary, a level 5 in Capitalization and a level 4 in Punctuation, as measured by the Exeter Writing Rubric, on 3 of 3 consecutive probes. (1.5.9.A-F)

Rubrics Quarterly on Annual Goal Progress



components)




provided to parents

Given a list of no more than 10 high frequency words at a 3rd-4th grade level, student will apply spelling rules to spell words correctly with a 90% accuracy on 3 consecutive weekly tests per quarter.

Tests/Quizzes Quarterly on Annual Goal Progress

Instructional Area: Written Expression


Not Applicable




Instructional Area: Listening Comprehension


Not Applicable




components)




provided to parents

When given a 4 step oral directions, student will follow all four steps without repetition of directions in 3 consecutive observations per quarter.

Data Collection Quarterly on Annual Goal Progress


Not Applicable



Not Applicable




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.



components)




provided to parents

Given up to a 4 sentences story read orally to student, she will answer who, what, where, how and why questions with a 90% accuracy or higher on 3 consecutive bi-weekly trials per quarter.

Data Collection Quarterly on Annual Goal Progress

Modifications and SDI Location Frequency Projected Beginning Date Anticipated Duration

Reading: *direct instruction*small group instruction at student’s level*firming before moving on *frequent oral responses*vocabulary instruction*structured reading program*repetition of material

MMS, integrated in Resource Room

2-40 minutes periods per day (unless building-wide schedule is changed)1-40 minute periods are designated for direct instruction and 1-40 minute periods are designated for vocabulary, spelling and application of reading comprehension strategies.

2/15/12 2/14/13

Mathematics:*direct instruction*small group instruction at student’s level*Structured, sequential math program*repetition of material*drill and practice


1-40 minute periods per day (unless building-wide schedule is changed).

2/15/12 2/14/13

Writing: *Small Group instruction at student’s level*structured writing program*repetition of materials*assistance in the writing/editing process*use of graphic organizers to help organize thoughts in pre-writing process


1-40 minute periods per day (unless building-wide schedule is changed).

2/15/12 2/14/12

Spelling:*practice spelling high frequency, irregularly spelled words*Immediate corrections


During Reading/English period at least 20 minutes per week.

2/15/12 2/14/13

*Repetition of material*Drill and practiceModified science and social studies curriculum taught in small group with opportunities for hands on activities, modified pacing, and reduction of concepts taught.


1-40 minute period of science per day and 1-40 minut periods of social studies per day unless school-wide schedule changes.

2/15/12 2/14/13

Listening Comprehension:*Repetition of directions*Rephrase directions*Ask Kiara to repeat directions*Model Visualization practices to improve comprehension of oral directions an reading of stories*Immediate correction

MMS, Integrated in the Resource Room

As directions are given to the class.

2/15/12 2/14/13

General Education Supports:*Assistance privided to complete long-term projects*Assistance to study concepts which will be assessed

MMS, Integrated in the Resource/Regular Room

At least 30-40 minute periods per cycle (Tutorials- unless building-wide schedule is changed).

2/15/12 2/14/13

Assessments:*Small Group Setting*Tests read orally by staff*Provide sentence starters for essays*Do not take points off for misspelling*Extended time*Reduce a multiple choice on tests longer than 20 questions

MMS All assessments 2/15/12 2/14/13

*Highlight keywords*Allow Kiara to respond orally on essay questions if she asks to do so.

B. RELATED SERVICES – List the services that the student needs in order to benefit from his/her special education program.X- Related Services Not Applicable at this time.

Service Location Frequency Projected Beginning Date Anticipated Duration

C. SUPPORTS FOR SCHOOL PERSONNEL – List the staff to receive the supports and the supports needed to implement the student’s IEP.

School Personnel to Receive Support Support Location Frequency Projected Beginning

Date Anticipated Duration

Regular Education Teacher

All staff who work with student will receive copies of

her IEP and all revisions

MMS Annual IEP and all revisions

02/15/12 02/14/13

D. GIFTED SUPPORT SERVICES FOR A STUDENT IDENTIFIED AS GIFTED WHO ALSO IS IDENTIFIED AS A STUDENT WITH A DISABILITY – Support services are required to assist a gifted student to benefit from gifted education (e.g., psychological services, parent counseling and education, counseling services, transportation to and from gifted programs to classrooms in buildings operated by the school district). X- Gifted Support Services not applicable at this time.

E. EXTENDED SCHOOL YEAR (ESY) – The IEP team has considered and discussed ESY services, and determined that:

Student IS eligible for ESY based on the following information or data reviewed by the IEP team:

OR

Support Service

X As of the date of this IEP, student is NOT eligible for ESY based on the following information or data reviewed by the IEP team:

After reviewing the seven factors outlined in Chapter 14.132(2), Kiara Gomez does not qualify for ESY services for this summer.

The Annual Goals and, when appropriate, Short Term Objectives from this IEP that are to be addressed in the student’s ESY Program are:

If the IEP team has determined ESY is appropriate, complete the following:

ESY Service to be Provided Location Frequency Projected Beginning

Date Anticipated Duration

VII. EDUCATIONAL PLACEMENTPrimary Disability: Other Health ImpairmentsSecondary Disability:Tertiary Disability:

A. QUESTIONS FOR IEP TEAM – The following questions must be reviewed and discussed by the IEP team prior to providing the explanations regarding participation with students without disabilities.

It is the responsibility of each public agency to ensure that, to the maximum extent appropriate, students with disabilities, including those in public or private institutions or other care facilities, are educated with students who are not disabled. Special classes, separate schooling or other removal of students with disabilities from the general educational environment occurs only when the nature or severity of the disability is such that education in general education classes, EVEN WITH the use of supplementary aids and services, cannot be achieved satisfactorily.

What supplementary aids and services were considered? What supplementary aids and services were rejected? Explain why the supplementary aids and services will or will not enable the student to make progress on the goals and objectives (if applicable) in this IEP in the general education class.

What benefits are provided in the general education class with supplementary aids and services versus the benefits provided in the special education class?

What potentially beneficial effects and/or harmful effects might be expected on the student with disabilities or the other students in the class, even with supplementary aids and services?

To what extent, if any, will the student participate with nondisabled peers in extracurricular activities or other nonacademic activities?

Explanation of the extent, if any, to which the student will not participate with students without disabilities in the regular education class:Kiara will not participate with non-disable peers in the regular education class for isntruction in Mathematics, Reading, Writing, Spelling, Science, and Social Studies.

Explanation of the extent, if any, to which the student will not participate with students without disabilities in the general education curriculum:Kiara will not participate with non-disable peers in the regular education class for isntruction in Mathematics, Reading, Writing, Spelling, Science, and Social Studies.

B. Type of Support

1. Amount of special education supports

Itinerant: Special education supports and services provided by special education personnel for 20% or less of the school day

X Supplemental: Special education supports and services provided by special education personnel for more than 20% of the day but less than 80% of the school day

Full-Time: Special education supports and services provided by special education personnel for 80% or more of the school day

2. Type of special education supports

Autistic SupportBlind-Visually Impaired SupportDeaf and Hard of Hearing SupportEmotional Support

X Learning SupportLife Skills SupportMultiple Disabilities SupportPhysical Support

Speech and Language Support

C. Location of student’s programName of School District where the IEP will be implemented: Muhlenberg SD

Name of School Building where the IEP will be implemented: Muhlenberg MS

Is this school the student’s neighborhood school (i.e., the school the student would attend if he/she did not have an IEP)?X Yes

No. If the answer is “no,” select the reason why not.

Special education supports and services required in the student’s IEP cannot be provided in the neighborhood schoolOther. Please explain:

VIII. PENNDATA REPORTING: Educational Environment (Complete either Section A or B; Select only one Educational Environment)To calculate the percentage of time inside the regular classroom, divide the number of hours the student spends inside the regular classroom by the total number of hours in the school day (including lunch, recess, study periods). The result is then multiplied by 100.

SECTION A: For Students Educated in Regular School Buildings with Nondisabled Peers – Indicate the percentage of time INSIDE the regular classroom for this student:

Time spent outside the regular classroom receiving services unrelated to the student’s disability (e.g., time receiving ESL services) should be considered time inside the regular classroom. Educational time spent in age-appropriate community-based settings that include individuals with and without disabilities, such as college campuses or vocational sites, should be counted as time spent inside the regular classroom.

Calculation for this Student:Column 1 Column 2 Calculation Indicate Percentage Percentage Category

Total hours the student spends in the regular

classroom per day

Total hours in a typical school day

(including lunch, recess & study periods)

(Hours inside regular classroom ÷ hours in

school day) x 100 = %(Column 1 ÷ Column 2)

x 100 = %

Section A: The percentage of time student spends

inside the regular classroom:

Using the calculation result – select the appropriate percentage category

2.50 7.15% of the day

INSIDE the Regular Classroom 80% or More of the Day35 INSIDE the Regular Classroom 79-40% of the Day

X INSIDE the Regular Classroom Less Than 40% of the Day

SECTION B: This section required only for Students Educated OUTSIDE Regular School Buildings for more than 50% of the day – select and indicate the Name of School or Facility on the line corresponding with the appropriate selection: (If a student spends less than 50% of the day in one of these locations, the IEP team must do the calculation in Section A)

Approved Private School (Non Residential)

Other Public Facility (Non Residential)

Approved Private School (Residential) Hospital/Homebound1

Other Private Facility (Non Residential) Correctional FacilityOther Private Facility (Residential) Out of State FacilityOther Public Facility (Residential) Instruction Conducted in the Home

EXAMPLES for Section A: How to Calculate PennData – Educational Environment Percentages

Column 1 Column 2 Calculation Indicate Percentage

Total hours the student spends in the regular classroom – per day

Total hours in a typical school day (including lunch, recess & study

periods)

(Hours inside regular classroom ÷ hours in school day) x 100 = %

(Column 1 ÷ Column 2) x 100 = %

Section A: The percentage of time student spends inside the regular

classroom:Example 1 5.5 6.5 (5.5 ÷ 6.5) x 100 = 85% 85% of the day (Inside 80% or More of

Day)Example 2 3 5 (3 ÷ 5) x 100 = 60% 60% of the day (Inside 79-40% of Day)

Example 3 1 5 (1 ÷ 5) x 100 = 20% 20% of the day (Inside less than 40% of Day)

For help in understanding this form, an annotated IEP is available on the PaTTAN website at www.pattan.net Type “Annotated Forms” in the Search feature on the website. If you do not have access to the Internet, you can request the annotated form by calling PaTTAN at 800-441-3215


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