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INDIVIDUALIZED EDUCATION PROGRAM

STUDENTS NAME:
DOB

4-20-2004

Carrie Smith
SCHOOL YEAR

IEP INITIATION/DURATION DATES

FROM

2014

12-1-2014

2015

GRADE
TO

12-1-2015

THIS IEP WILL BE IMPLEMENTED DURING THE REGULAR SCHOOL TERM UNLESS NOTED IN EXTENDED SCHOOL YEAR SERVICES.

STUDENT PROFILE WILL INCLUDE GENERAL STATEMENTS REGARDING:

Strengths of the student:


Carrie is a friendly, hard-working student who is in fourth grade at Samford Elementary School. She lives at home with
her mother, father, and younger brother. Carrie is sociable and polite, and she treats her classmates and teachers with
respect and kindness. Carrie works hard at school, especially when an assignment is interesting to her, and it is clear that
she desires to please her teachers.
Academic Strengths: Carrie displays a clear understanding of academic and conversational vocabulary, and she uses a
variety of words in her writing. She is also able to complete Cloze comprehension passages in which she must fill in
missing words that make sense to complete the passage. With prompting, she is able to answer WH questions about
characters, settings, and key events in stories that are read aloud her, as well as texts that she reads on her own. With adult
support, she is also able to compare and contrast two characters or settings from the same text.
Carrie is proficient in addition and subtraction that does not involve regrouping. She has also memorized some of her
multiplication facts, and she understands multiplication as repeated addition. Carrie has demonstrated an understanding of
place value in the base ten system, and she can compare decimal values using greater than, less than, and equal to. She is
able to represent parts of a whole using fractions, and she can match pictures with corresponding fractional values.
Carrie enjoys participating in science experiments and is able to connect science content knowledge to real-world
experiences. She particularly enjoyed the recent unit on the solar system, and she was able to explain which planets would
be most likely to support life based on a variety of factors.
Social/Emotional Strengths: Carrie is very cooperative and works well in group settings. She contributes to group
discussions but does not force her opinion on the group. She maintains healthy relationships with her classmates and has a
small group of friends she is especially close to. Carrie displays typical and healthy reactions to unexpected events in the
classroom, whether they be positive or negative. She has an even temper and pleasant disposition.
Behavioral Strengths: Carrie is able to follow clear directions and works hard to please her teachers. She is respectful to
adults and obeys them without complaining or arguing. Carrie does not blurt out in class or speak out of turn but is patient
and humble. She loves to volunteer to help her classmates with assignments and classroom tasks.
Communication Strengths: Ever since birth, Carrie has had typical development in the area of speech. She is able to
verbally communicate with her peers and with adults using basic conversational language. In writing, Carrie is able to
outline key ideas about a text, and she enjoys writing her own stories. According to her third and fourth grade teachers,
Carrie has no difficulty discussing academic and non-academic topics with her friends, who enjoy talking to her and
working with her.
Adaptive Strengths: Carrie practices basic self-help skills on a daily basis. Her parents report that she is able to get ready
independently, including zipping and buttoning clothes, gathering her school supplies and books, and being ready on time.
In the classroom, her teacher does not report any adaptive concerns. Carrie uses a typical tripod grip to write with her
right hand, and she is able to use classroom materials, such as scissors, rulers, and glue, without difficulty.

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Parental concerns:
Carries parents are most concerned about Carries poor report card grades. She is currently failing reading, language arts,
and social studies, with no grades higher than a C in any subject area. Her parents are also concerned with Carries
growing dislike of reading. They do not notice her reading at home, for school or for leisure, and they do not know how to
motivate her to read. They have also been contacted by Carries teacher because Carrie often turns in incomplete
assignments, and her parents are concerned about Carries lack of attention to her tasks.
Student Preferences and/or Interests:
Carrie enjoys taking lessons in dance and gymnastics, and she also participates in baton twirling camps when they are
offered. Her favorite subject is art, and she loves to be creative. She also enjoys science because she is able to observe and
participate in experiments. Her favorite vacation was when she traveled to visit family in New York City, and she is
fascinated by big cities. Carrie also enjoys playing with her little brother and her two golden retriever puppies.
Results of the most recent evaluations:
On 10/26/14, Carrie was evaluated using the Wechsler Intelligence Scale for Children- Third Edition (WISC-III), which
measures a childs overall intellectual functioning. Her full-scale IQ score of 96 falls within the average range of scores
for her age group. In the Verbal IQ subtest, her score of 89 indicates that Carrie scored slightly below average in the area
of verbal reasoning. Her Performance IQ score, however, was 102, which is within the average range for nonverbal
reasoning skills.
On 10/18/14, Carrie was evaluated using the Woodcock Johnson Tests of Achievement-Third Edition (WJ-III), which
assesses a students academic performance in a variety of skill areas. Carrie scored a composite value of 80, which is
below average for her age group. The subtest scores indicate that Carrie is performing in the average range in the areas of
Passage Comprehension, Understanding Directions, and Picture Vocabulary. The scores also indicate areas of need in
Letter-Word Identification, Word Attack skills, Math Calculation, Applied Math Problems, and Spelling, as Carries scores
are below average in these areas.
On 10/15/14, Carries fourth grade teacher completed documentation for Carries Response to Intervention sessions.
Despite small group instruction using evidence-based reading strategies, Carrie has not shown improvement in her
reading and English language arts skills.
On 10/1/14, Carries fourth grade teacher completed a behavior observation checklist. He reports that Carrie struggles
with task initiation and sustained attention while she works on an assignment. She often turns in incomplete work, which
has contributed to her poor report card grades.
The academic, developmental, and functional needs of the student:
Carries test scores and classroom performance indicate several areas of need:
Reading/Language Arts/Writing:
Carrie has difficulty using grade-level phonics skills to decode real and nonsense words [RF.4.3], which impacts her
fluency and comprehension of a text. She also struggles to spell grade-level words correctly and use appropriate
conventions of the English language in her writing [L.4.2].
Mathematics:
Carrie has difficulty with multi-digit addition and subtraction problems that require regrouping [4-NBT4], as well as
multi-digit multiplication and long division problems [4-NBT5], [4-NBT6]. She also struggles to apply math operations to
word problems [4-OA3].
Behavior/Self-Direction:
Carrie has difficulty with initiating and completing assignments in a reasonable amount of time [A:A2.1].
Other:

For the child transitioning from EI to Preschool, justify if IEP will not be implemented on the childs 3 rd birthday:
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INDIVIDUALIZED EDUCATION PROGRAM


STUDENTS NAME:

Carrie Smith

SPECIAL INSTRUCTIONAL FACTORS


Items checked YES will be addressed in this IEP:

Does the student have behavior which impedes his/her learning or the learning of others?
Does the student have limited English proficiency?
Does the student need instruction in Braille and the use of Braille?
Does the student have communication needs (deaf or hearing impaired only)?
Does the student need assistive technology devices and/or services?
Does the student require specially designed P.E.?
Is the student working toward alternate achievement standards and participating in the
Alabama Alternate Assessment?
Are transition services addressed in this IEP with an annual goal(s)?

YES
[X]
[ ]
[ ]
[ ]
[ ]
[ ]

NO
[ ]
[X]
[X]
[X]
[X]
[X]

[ ]
[ ]

[X]
[X]

TRANSPORTATION AS A RELATED SERVICE


Students mode of transportation:
[X] Regular bus
[ ] Bus for special needs
[ ] Parent contract
[ ] YES
Does the student require transportation as a related service?
If yes, check any transportation needs:
[
[
[
[
[

]
]
]
]
]

Bus assistance:
[ ] Adult support
Preferential seating
Behavioral Intervention Plan
Wheelchair lift and securement system
Restraint system
Specify type:

[ ] Other:

[X] NO

[ ] Medical support

[ ]

Other. Specify:

[ ]

Bus driver and support personnel are aware of the students behavioral and/or medical concerns.
NONACADEMIC and EXTRACURRICULAR ACTIVITIES

Will the student have the opportunity to participate in nonacademic/extracurricular activities with his/her nondisabled
peers?
[X] YES.
[ ] YES, with supports. Describe:
[ ]

NO. Explanation must be provided:


METHOD/FREQUENCY FOR REPORTING PROGRESS OF ATTAINING GOALS TO PARENTS

Annual Goal Progress reports will be sent to parents each time report cards are issued (every

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ALSDE Approved Feb. 2012

INDIVIDUALIZED EDUCATION PROGRAM


STUDENTS NAME:

CARRIE SMITH

[ ] This student is in a middle school course of study that will help prepare him/her for transition.
[X] This student was invited to the IEP Team meeting.
[ ] After prior consent of the parent or student (Age 19) was obtained, other agency representatives were invited to the
IEP Team meeting.
EXIT OPTIONS (Complete for students in Grades 9-12)

[ ]
[ ]
[ ]

Alabama High School Diploma


Alabama Occupational Diploma
Graduation Certificate

Anticipated Date of Exit:

Month:

Year :

PROGRAM CREDIT TO BE EARNED (Complete for students in grades 9-12)


For each course taken, indicate
program credit to be earned.

ENGLISH

MATH

SCIENCE

SOCIAL
STUDIES

Alabama High School Diploma


Alabama Occupational Diploma
Graduation Certificate
TRANSITION: (Beginning not later than the first IEP to be in effect when the student is 16, or earlier if appropriate, and
updated annually thereafter)
Transition Assessments (Check the assessment(s) used to determine the students measurable transition goals):
[ ]

Transition Planning Assessments

[ ] Interest Inventory

[ ]

Other

Goals for Postsecondary Transition:


Postsecondary Education/Training Goal
If Other is selected, specify
Employment/Occupation/Career Goal
If Other is selected, specify
Community/Independent Living Goal
If Other is selected, specify
Transition Services: Based on the students strengths, preferences, and interests, the following coordinated transition
services will reasonably enable the student to meet the postsecondary goals. Consider these service areas: Vocational
Evaluations (VE), Community Experiences (CE), Personal Management (PM), Transportation (T), Employment Development (ED),
Medical (M), Postsecondary Education (PE), Living Arrangements (LA), Linkages to Agencies (LTA), Advocacy/Guardianship (AG),
Financial Management (FM), and if appropriate Functional Vocational Evaluation (FVE).

Transition Strands
Academics/Post Secondary
Education/Training

Employment/Occupations
/
Careers

Personal/ Social

Daily Living

Service(s)
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INDIVIDUALIZED EDUCATION PROGRAM


STUDENTS NAME:

CARRIE SMITH

[ ] This goal is related to the students transition services needs.


AREA:

Reading/Language Arts

PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE:


Carrie is able to identify all of her letters by sight and sound [RF.4.3.2]. With considerable effort and support, she is able
to read texts silently and aloud and answer basic questions about the text [RL.1.4.3]. However, Carrie struggles with
reading fluently because she is unable to decode and blend grade-level words [RF.4.3]. Her recent Woodcock Johnson
Tests of Achievement III score of 76 in Letter-Word Identification indicates that Carrie has difficulty with basic decoding
skills, and her score of 82 in Word Attack Skills indicates that she struggles with phoneme-grapheme knowledge. Carries
inability to decode grade-level words impedes her learning in the general education classroom because it limits her
fluency and comprehension of grade-level texts.
MEASURABLE ANNUAL GOAL related to meeting the students needs:
DATE OF MASTERY:
By December 2015, Carrie will be able to decode and read grade-level words in the context of grade-level texts with at
least 80% accuracy in 4 out of 5 trials [RF.4.3].

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:


[ ] Curriculum Based Assessment [ ] Teacher/Text Test
[X]
[X] Data Collection
[ ] State Assessment(s) [X]

Teacher Observation
Work Samples

[ ] Other:

Other:

[ ]

BENCHMARKS:
1. By February 2015, Carrie will be able to sort words into categories based on
beginning, middle, and ending sounds, including vowel teams and consonant
patterns, with at least 80% accuracy in 4 out of 5 trials.
2. By April 2015, Carrie will be able to decode one- and two-syllable nonsense words
using common vowel teams and consonant patterns with at least 80% accuracy in 4
out of 5 trials.
3. By September 2015, Carrie will be able to recognize grade-level sight words and
read them in the context of sentences with at least 80% accuracy in 4 out of 5 trials.
4. By November 2015, Carrie will be able to decode grade-level words in isolated
grade-level sentences with at least 80% accuracy in 4 out of 5 trials.

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Grades

Date of Mastery:

Date of Mastery:
Date of Mastery:
Date of Mastery:

ALSDE Approved Feb. 2012

INDIVIDUALIZED EDUCATION PROGRAM


STUDENTS NAME:

CARRIE SMITH

[ ] This goal is related to the students transition services needs.


AREA:

Language Arts/Writing

PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE:


Carrie is able to spell most one-syllable words and use them correctly in context in a variety of forms of writing.
However, she has difficulty spelling multisyllabic grade-level words, especially those with vowel teams or silent final e
[L.4.2d]. Carrie consistently uses capital letters at the beginning of sentences and to designate proper nouns [L.4.2a], and
she is able to choose an appropriate punctuation mark for the end of a sentence [L.4.3b]. Carrie struggles to place commas
between clauses or in quotations [L.4.2b]. Her Woodcock Johnson Tests of Achievement III scores in Spelling (84) and
Writing (89) indicate that Carrie struggles to express words and ideas clearly in her writing. Carries inability to use
correct spellings and grammar conventions impede her performance in the general education classroom because she is
unable to effectively convey her content and creative knowledge in writing.
MEASURABLE ANNUAL GOAL related to meeting the students needs:
DATE OF MASTERY:
By December 2015, Carrie will be able to write paragraphs using correct grade-level spelling and grammar skills with at
least 80% accuracy in 4 out of 5 trials [L.4.2].

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:


[ ] Curriculum Based Assessment [ ] Teacher/Text Test
[X]
[X] Data Collection
[ ] State Assessment(s) [X]

Teacher Observation
Work Samples

[ ] Other:

Other:

[ ]

BENCHMARKS:
1. By February 2015, Carrie will be able to correctly place quotation marks in a given
sentence with at least 80% accuracy in 4 out of 5 trials.
2. By April 2015, Carrie will be able to correctly place commas in given a given
sentence with at least 80% accuracy in 4 out of 5 trials.
3. By September 2015, Carrie will be able to spell multi-syllable grade-level words
using vowel teams and consonant patterns with at least 80% accuracy in 4 out of 5
trials.
4. By November 2015, Carrie will be able to write a sentence using correct quotation
marks, commas, and grade-level spelling skills with at least 80% accuracy in 4 out of
5 trials.

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Date of Mastery:
Date of Mastery:

Date of Mastery:

Date of Mastery:

ALSDE Approved Feb. 2012

INDIVIDUALIZED EDUCATION PROGRAM


STUDENTS NAME:

CARRIE SMITH

[ ] This goal is related to the students transition services needs.


AREA:

Mathematics

PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE:


Carrie is proficient in adding and subtracting one-digit numbers that do not require regrouping using the standard
algorithm [3-NBT2]. She demonstrates a clear understanding of the concept of multiplication as repeated addition [3OA1], and she has memorized some, but not all, of her multiplication facts. However, Carrie is not able to use any of the
four operations in multi-digit problems that require regrouping [4-NBT4], [4-NBT5], [4-NBT6]. Her Woodcock Johnson
Tests of Achievement III score of 84 in Math Calculation reveals areas of need in basic uses of the four operations. The
examiner reports that Carrie did not even attempt the problems in this section that asked about multi-digit multiplication
and long division. Carries inability to use the four basic math operations with multi-digit numbers impedes her learning
in the general education classroom because she is unable to complete grade-level math work.
MEASURABLE ANNUAL GOAL related to meeting the students needs:
DATE OF MASTERY:
By December 2015, Carrie will be able to solve multi-digit math problems using each of the four operations (addition,
subtraction, multiplication, and division) with at least 80% accuracy in 4 out of 5 trials [4-NBT4-6].

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:


[ ] Curriculum Based Assessment [ ] Teacher/Text Test
[X]
[X] Data Collection
[ ] State Assessment(s) [X]

Teacher Observation
Work Samples

[ ] Other:

Other:

[ ]

BENCHMARKS:
1. By February 2015, Carrie will be able to fluently solve multi-digit addition problems
using regrouping with at least 80% accuracy in 4 out of 5 trials.
2. By April 2015, Carrie will be able to fluently solve multi-digit subtraction problems
using regrouping with at least 80% accuracy in 4 out of 5 trials.
3. By September 2015, Carrie will be able to fluently solve multi-digit multiplication
problems using regrouping, with the aid of a multiplication card, with at least 80%
accuracy in 4 out of 5 trials.
4. By November 2015, Carrie will be able to fluently solve multi-digit division
problems using her preferred long division strategy (Hangman or traditional) with
at least 80% accuracy in 4 out of 5 trials.

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Date of Mastery:
Date of Mastery:

Date of Mastery:

Date of Mastery:

ALSDE Approved Feb. 2012

INDIVIDUALIZED EDUCATION PROGRAM


STUDENTS NAME:

CARRIE SMITH________________________________

[ ] This goal is related to the students transition services needs.


AREA:

Mathematics

PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE:


Carrie is able to solve simple word problems that involve basic addition, subtraction, and multiplication without
regrouping [3-NBT2]. However, she has difficulty distinguishing between relevant and irrelevant information in a word
problem, and she often struggles to know which of the four operations to use to solve the problem [4-OA3]. Carries
Woodcock Johnson Tests of Achievement III score of 92 on the Applied Problems subtest falls within the very low range
for her age group. This score revealed that Carrie especially struggles on word problems that involve geometry skills,
particularly the fourth grade skill of measuring angles and using them in real-world examples [4-MD7]. Carries inability
to solve word problems using the four operations and geometry skills impedes her learning in the general education
classroom because she is unable to complete grade-level math work.
MEASURABLE ANNUAL GOAL related to meeting the students needs:
DATE OF MASTERY:
By December 2015, Carrie will be able to solve word problems using grade-level geometry skills with 80% accuracy in 4
out of 5 trials [4-MD7], [5-MD-5].

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:


[ ] Curriculum Based Assessment [ ] Teacher/Text Test
[X]
[X] Data Collection
[ ] State Assessment(s) [X]

Teacher Observation
Work Samples

[ ] Other:

Other:

[ ]

BENCHMARKS:
1. By February 2015, Carrie will be able to distinguish relevant information from
irrelevant information in word problems by crossing out unnecessary facts with at
least 80% accuracy in 4 out of 5 trials.
2. By April 2015, Carrie will be able to match key words in word problems to the
mathematical operations they indicate with at least 80% accuracy in 4 out of 5 trials.
3. By September 2015, Carrie will be able to correctly solve one- and two-step word
problems using the four mathematical operations with at least 80% accuracy in 4 out
of 5 trials.
4. By November 2015, Carrie will be able to solve one-step word problems involving
angle measurements and volume with at least 80% accuracy in 4 out of 5 trials.

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Date of Mastery:
Date of Mastery:

Date of Mastery:
Date of Mastery:

ALSDE Approved Feb. 2012

INDIVIDUALIZED EDUCATION PROGRAM


STUDENTS NAME:

CARRIE SMITH________________________________

[ ] This goal is related to the students transition services needs.


AREA:

Behavior/Self-Direction

PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE:


Carrie consistently displays positive attitudes toward school in general, as well as most subject areas [A:A1.2]. She is a
hard worker when she is interested in the task at hand, and she seeks to please her teachers and other adults. However,
Carrie struggles to initiate tasks that are difficult or unappealing, and she is often unable to manage her time wisely
[A:A2.1]. As a result, her third and fourth grade teachers note that Carrie often turns in incomplete work. Carries
inability to initiate tasks and manage her time impedes her success in the general education classroom because her
incomplete work contributes to her poor grades.
MEASURABLE ANNUAL GOAL related to meeting the students needs:
DATE OF MASTERY:
By December 2015, Carrie will independently initiate and complete quality classroom assignments with no more than one
adult prompt in 4 out of 5 trials [A:A2.1].

TYPE(S) OF EVALUATION FOR ANNUAL GOAL:


[ ] Curriculum Based Assessment [ ] Teacher/Text Test
[X]
[X] Data Collection
[ ] State Assessment(s) [X]

Teacher Observation
Work Samples

[ ] Other:

Other:

[ ]

BENCHMARKS:
1. By February 2015, Carrie will be able to initiate an assigned task within three
minutes of receiving instructions, as recorded on a self-monitoring behavior chart, in
at least 4 out of 5 observations.
2. By April 2015, Carrie will be able to complete an assigned task within the allotted
timeframe, as recorded on a self-monitoring behavior chart, in at least 4 out of 5
observations.
3. By September 2015, Carrie will be able to self-assess the quality of her work using a
checklist that covers task initiation, completion, and correctness in at least 4 out of 5
observations.
4. By November 2015, Carrie will be able to independently initiate tasks within three
minutes, complete tasks in the allotted timeframe, and assess the quality of her work
with no more than two adult prompts in 4 out of 5 observations.

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Date of Mastery:

Date of Mastery:

Date of Mastery:

Date of Mastery:

ALSDE Approved Feb. 2012

INDIVIDUALIZED EDUCATION PROGRAM


Students Name:

Carrie Smith

SPECIAL EDUCATION AND RELATED SERVICE(S): (Special Education, Supplementary Aids and Services,
Program Modifications, Accommodations Needed for Assessments, Related Services, Assistive Technology, and Support
for Personnel.)

Special Education
Service(s)

Direct instruction in reading/language


arts to improve decoding, fluency,
comprehension, and writing skills.
Direct instruction in mathematics to
improve calculation, problem-solving
skills, and geometry skills.
Inclusion support in reading/language
arts and mathematics

Related Services
Service(s)

Supplementary Aids and Services


Service(s)

Anticipated
Frequency of
Service(s)

Amount
of time

Beginning/Ending
Duration Dates

3 times per week

30 min.

December 1, 2014 to
November 30, 2015

Special education
classroom

2 times per week

30 min.

December 1, 2014 to
November 30, 2015

Special education
classroom

Daily

60 min.
total

December 1, 2014 to
November 30, 2015

General education
classroom

[ ] Needed

[X] Not Needed

Anticipated
Frequency of
Service(s)

Amount
of time

Beginning/Ending
Duration Dates

[X] Needed

[ ] Not Needed

Anticipated
Frequency of
Service(s)

Amount
of time

Beginning/Ending
Duration Dates

Self-monitoring behavior chart for task


initiation and completion
Self-assessment checklist to monitor
quality of work turned in
Sequential, one-step directions; check for
understanding

Daily

Program Modifications

[ ] Needed

[X] Not Needed

Anticipated
Frequency of
Service(s)

Amount
of time

Service(s)

December 1, 2014 to
November 30, 2015
December 1, 2014 to
November 30, 2015
December 1, 2014 to
November 30, 2015

Daily
Daily

Beginning/Ending
Duration Dates

Location of Service(s)

Location of Service(s)

Location of Service(s)

General education
classroom
General education
classroom
General education
classroom
Location of Service(s)

to

Accommodations Needed for


Assessments
Service(s)

[X] Needed

[ ] Not Needed

Anticipated
Frequency of
Service(s)

Amount
of time

Increased time for reading assessments

As necessary

Multiplication card for math assessments

As necessary

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Beginning/Ending
Duration Dates

December 1, 2014 to
November 30, 2015
December 1, 2014 to
November 30, 2015

Location of Service(s)

Special education
classroom
General education
classroom
ALSDE Approved Feb. 2012

Assistive Technology
Service(s)

[ ] Needed

[X] Not Needed

Anticipated
Frequency of
Service(s)

Amount
of time

Beginning/Ending
Duration Dates

Location of Service(s)

to
to

Support for Personnel


Service(s)

[ ] Needed

[X] Not Needed

Anticipated
Frequency of
Service(s)

Amount
of time

Beginning/Ending
Duration Dates

Location of Service(s)

to
to

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STUDENTS NAME:

CARRIE SMITH
TRANSFER OF RIGHTS

(Beginning not later than the IEP that will be in effect when the student reaches 18 years of age.)
Date student was informed that the rights under the IDEA will transfer to him/her at the age of 19
The IEP Team has considered the need for extended school year services.

[X] Yes

[ ] No

LEAST RESTRICTIVE ENVIRONMENT


Does this student attend the school (or for a preschool-age student, participate in the environment) he/she would attend if
nondisabled?
[X] Yes
[ ] No
If no, explain:
Does this student receive all special education services with nondisabled peers? [ ] Yes [X] No
If no, explain (explanation may not be solely because of needed modifications in the general curriculum):
Carrie receives one-on-one instruction in the special education classroom three days per week for reading and two days per
week for mathematics. This instruction will total less than 20% of the school day outside the general education classroom.
[X] 6-21 YEARS OF AGE

[ ] 3-5 YEARS OF AGE

Least Restricted Environment:

Carries least restricted environment places her in the general education classroom for more than 80% of each school day, with
no more than 20% of the day spent in the special education classroom for individualized instruction.

COPY OF IEP

COPY OF SPECIAL EDUCATION RIGHTS

Was a copy of the IEP given to parent/student (age 19) at


the IEP Team meeting?
[X] Yes
[ ] No

Was a copy of the Special Education Rights given to


parent/student (age 19) at the IEP Team meeting?
[X] Yes
[ ] No

If no, date sent:

If no, date sent:

Date copy of amended IEP provided/sent to parent/student (age 19)


THE FOLLOWING PEOPLE ATTENDED AND PARTICIPATED IN THE MEETING TO DEVELOP THIS IEP.

Position

Signature

Date

Parent
Parent
General Education Teacher
Special Education Teacher
LEA Representative
Someone Who Can Interpret The Instructional
Implications Of The Evaluation Results
Student
Career/Technical Education Representative
Other Agency Representative

Leslie Smith
Jackson Smith
Mark Brown
Sarah Jones
Emily Parker
Leah Green

11-30-2014
11-30-2014
11-30-2014
11-30-2014
11-30-2014
11-30-2014

Carrie Smith

11-30-2014

INFORMATION FROM PEOPLE NOT IN ATTENDANCE

Position

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Name

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