Mock Individualized Education Plan

Ryan Schulhauser

EDU 203 – Vicki Rieger

Mock Individualized Education Plan 2

I. Student Information and Instructional Profile

Student Joe N Jackson

Date of Birth 07-07-2007
Student Number 123-44-5678
Parent’s/Guardian’s Name Jim and Janice Jackson
Address 123 Sunrise Lane, Las Vegas, NV 89147
Parent’s/Guardian’s Phone No. 123-4444
Student’s Present School: No-name Elementary School
Grade: 5th
Date of IEP Meeting: 04-04-17
Date of Eligibility 04-04-13
IEP Review Date 10-4-17
Child’s Primary Language English

II. Present Levels of Academic Achievement and Functional Performance

Joe is a 5th grade student whose disability inhibits his capability to write and read on his grade
level. He is however able to perform on grade level in art, science and history when the material is read
to him aloud. No modifications are necessary for mathematics, and is favored subject. His vocabulary
for sight word reading is at a 2 nd grade level because of his difficulty reading. The most recent
standardized tests indicated that he continues to read below average and has difficulty decoding words
and reading comprehension.

Joe enjoys using the computer, and drawing. She repeats questions she is asked. Joe’s need for
individualized instruction impedes him from participating in most general education classes, He seems to
appreciate social interaction with adults over peers, and often needs frequent encouragement to
participate in regular activities in physical education.

III. Program Eligibility

Eligible Not Eligible _______

Area(s) of Disability Specific Learning Disability Speech-Language Impairments
PRIMARY SECONDARY
Rationale for Eligibility Joe meets eligibility criteria for Specific Learning Disability and Speech-
Language Impairment based on state guidelines.

Student: Joe N Jackson

Date of Birth 07-07-2007
Student Number 123-44-5678
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IV. Special Instructional Considerations

V. Measurable Annual Goals and Benchmarks

Goal

Performance Area Identified: Peer Interaction

Related Service: APE

Begin Date: April 2017

Goal to be achieved by: April 2018

Frequency: 2 times per week

Time: 30 minutes each time

He will play a multiplayer activity which reinforces socialization with his peers. Such as
4 square, or kickball. With the goal being that he doesn’t have to be persuaded to play
but is eager to on his own.

Goal

Performance Area Identified: Reading

Related Service: Resource

Begin Date: April 2017

Responsible Personnel: General Education Teacher & Resource Teacher

Goal to be achieved by: April 2018

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Frequency: 1-5 times per week

Time: 180 minutes per week

When given a selected Second grade narrative passage, he will distinguish the subject
of the passage, and supporting details about the subject in the passage with 75%. I
suggest starting with science or history as that holds his attention more. Look for
accuracy in 2 of 3 trials as measured and charted for with teacher data.

VI. Supplementary Aids and Related Services

Services/Related Services Provider Hours per Week Location

Adaptive Physical Education Mr. Franks 5 Gymnasium

Speech-Language Therapy_ Mrs. Blaze 1.5 Therapy room

Aids/equipment/program modifications needed to attain annual goals and progress in general

education curriculum:

Provide continued support and to help reduce anxiety and keep on task.

Frequency of use: As needed.

VII. Special Education Placement

Student to be placed in the following least restrictive environment:

Location of Services Duration Extent of Participation

(NO. OF HOURS IN LOCATION/

TOTAL NO. OF SCHOOL HOURS)

General Ed. classroom 2/6 Assistance provided by paraprofessional

Special Ed. environments:

Resource room 4/6 Assistance provided by paraprofessional

Self-contained class _______________________________________________________

Special day school _______________________________________________________

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Residential school _______________________________________________________

Hospital school _______________________________________________________

Homebound services _______________________________________________________

Other___________ _______________________________________________________

Rationale for placement in setting other than general education class _________________

VIII. Special Services

Physical Education: Regular______ Adaptive

Transportation: Regular______ Special Not Applicable_______

Student Joe N Jackson Date of Birth 07-07-2007 Student Number 123-44-5678

Is student provided an opportunity to participate in extracurricular and nonacademic activities

with nondisabled peers? yes

Are supports necessary? yes

Describe: Joe sees a psychologist.
Rationale for nonparticipation: _______________________________________________________

IX. Transition Services

Transition Service Needs Special Education Certificate

Focusing on Course of Study

Career Interest(s) Computers, math, drawing

Employment Outcome Joe will work in the community and function at a job with ongoing job coaching.

Community Living Outcome Joe will live in a supportive community living group home.
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Identify Needed Transition 1. Independent Living: Joe will be able to care for herself and her needs.

Services 2. Community Integration: Joe will be able to participate in the community with
the assistance of her caregiver.
3. Recreation and Leisure: Joe will identify and utilize community recreational
opportunities.
4. Transportation: Joe will utilize transit and para-transit transportation
opportunities.
5. Education: Joe will participate in a day treatment program focusing on
vocational and adaptive skills.

Identify Interagency A case manager will be identified for Joe from the Developmental Disabilities

Responsibilities Services (DDS) Office. Vocational rehabilitation will assist with vocational

evaluations.

Community Linkages DDS Office. Private Group Homes. Inc. Vocational Rehabilitation Services.

Community Recreation Centers, Community Transit and Para-Transit Systems.

X. Assessment Modifications

Is student able to participate in state- or district-wide assessments? no

Are modifications required? yes

Identify type of modifications:

Joe’s assessment needs will be met with an alternative assessment in the form of a competency
portfolio

Rationale for nonparticipation and alternative assessment plan: Joe does not have traditional test-taking skills.

A portfolio that demonstrates Joe’s competencies in the areas of her annual goals will be developed.

Student Joe N Jackson Date of Birth 07-07-2007 Student Number 123-44-5678

XI. Progress Report

Parents will be informed of child’s progress toward annual goals using same reporting methods used for
children without disabilities.

Method Frequency

Written Progress Report _Yes_ Every 9 weeks

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Yes/No

Parent Conference _Yes_ As requested

Yes/No

Other________________________________

Identify

Other________________________________

Identify

XII. Transferral of Rights

I understand that the rights under the Individuals with Disabilities Education Improvement Act will transfer
to me upon reaching my eighteenth birthday.

_____________________________________________ _____________
Student’s Signature Date

XIII. Recommended Instructional and/or Behavioral Interventions

Provide a rich reinforcement schedule following each activity. Use a timer to keep Morgan on
task during instructional and reinforcement activities. Block all attempts at injuring herself or others and
redirect to task at hand. Teachers working with Morgan should watch the tone of their voice and
vocabulary as she frequently becomes confused resulting in aggressive behavior. A behavior
management plan should be developed if self-injurious behaviors and/or aggression becomes a problem.

XIV. IEP Development Team

N Team Member’s
Position/Title
ame Signature
Mr. Jim Jackson Jim Jackson Parent/Guardian

Mrs. Janice Jackson Janice Jackson Parent/Guardian

Mrs. Rita 0’shea Rita O’shea LEA Representative

Mr. Ryan Schulhauser Ryan Schulhauser Special Education Teacher

Mr. Brett Clark Brett Clark General Education Teacher

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Mrs. Lynn Fiero Lynn Fiero SLP

Joe N Jackson Joe N Jackson Student

Mrs. Megan Harrison Megan Harrison Other __Social Worker__

Mock Individualized Education Plan 9

References

Last Name, F. M. (Year). Article Title. Journal Title, Pages From - To.

Last Name, F. M. (Year). Book Title. City Name: Publisher Name

Mock Individualized Education Plan 10

Footnotes

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Tables

Table 1

Table Title

Column Head Column Head Column Head Column Head Column Head
Row Head 123 123 123 123
Row Head 456 456 456 456
Row Head 789 789 789 789
Row Head 123 123 123 123
Row Head 456 456 456 456
Row Head 789 789 789 789

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Figures

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