INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student’s Name: Trevor Smith

INDIVIDUALIZED EDUCATION PROGRAM (IEP) School Age

Student’s Name: Trevor Smith

IEP Team Meeting Date (mm/dd/yy): 4/23/18

IEP Implementation Date (Projected Date when Services and Programs Will Begin): 4/30/18

Anticipated Duration of Services and Programs: 4/24/18 - 4/23/19

Date of Birth: 09/03/10

Age: 8

Grade: 2nd

Anticipated Year of Graduation: 2028

Local Education Agency (LEA): Steubenville City Schools

County of Residence: Jefferson County

Name and Address of Parent/Guardian/Surrogate: Phone (Home): 724-444-444

Rose Smith Phone (Work): 724-555-555

120 Orchard St.

Steubenville, OH 43952

Other Information:

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

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

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

N/A N/A N/A

N/A N/A N/A
N/A N/A N/A

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: Trevor Smith
II. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Trevor’s physical development had a raw score of 156 and a composite score of 91. This puts him in the 27th percentile. The age equivalent for
his scores is 6 years and 5 months old. This puts him almost 2 years behind age level. In gross motor skills, Trevor had a raw score of 63 and a
composite score of 101 which puts him in the 53rd percentile. He was able to stay on one foot, walk, skip, gallop, jump, hop, climb stairs, and
catch and throw a ball well. In fine motor skills, Trevor had a raw score of 93 and a composite score of 85 which puts him in the 16th percen-
tile. He struggled with building a tower with blocks and drawing a person with as many body parts as he could. He was able to write his name,
write numerals in sequence, print uppercase letters in sequence. However, his handwriting is often very large and letters are spaced very far
apart.

Trevor’s language development had a raw score of 230 and a composite score of 108. This puts him in the 60th percentile and gives him an age
equivalent of 7 years and 6 months. In receptive language, Trevor had a raw score of 102 and a composite score of 104 which puts him in the
60th percentile. In expressive language, Trevor had a raw score of 128 and a composite score of 109. He was able to understand verbal con-
cepts and directions, knew the uses of objects, could repeat sentences of twelve syllables, identified parts of the body and colors, used sen-
tences of at least eight words, and could tell a story with three elements. At least 90% of his speech is intelligible and he sometimes speaks
quickly and fuses words together.

Trevor’s academic skills/cognitive development had a raw score of 262 and a composite score of 94. This puts him in the 34th percentile. In
literacy, Trevor had a raw score of 165 and a composite score of 99 which puts him in the 48th percentile. He understood the layout of books
and texts, had experience with books and text, could recite the entire alphabet, could identify lowercase letters and words, could identify all
uppercase letters, had phonological awareness, knew the differences between word sounds, was familiar with different sounds, and could rec-
ognize words. He struggled reading longer words from common signs. In mathematics, Trevor received a raw score of 97 and a composite score
of 94 which puts him in the 34th percentile. He understood number concepts, could count to 30, could compare different amounts, could sort
objects by size, color, and shape, could match quantities to numerals, could reach numerals, and could subtract numbers. He had trouble add-
ing numbers together.

Trevor’s adaptive behavior had a raw score of 38 and a composite score of 75. This puts him in the 5th percentile. He had difficulty eating
correctly and often makes a mess while eating and does not use utensils properly. He also had trouble typing his shoes and fastening fasteners
Trevor had a lack of knowledge about his personal information. He was able to toilet himself and bathe himself.

Trevor’s social and emotional development had a raw score of 36 and a composite score of 98. This puts him in the 46th percentile.
He has good relationships with other students and enjoys talking and telling stories. He gets along well with other students, but did not seem to
have a best friend. He enjoyed talking to adults more than other students in the classroom. Trevor is not motived to begin assignments and
lacks the confidence to complete them. He gets off-task easily and wants someone else to do the assignments for him.

V. GOALS AND OBJECTIVES – Include, as appropriate, academic and functional goals. Use as many copies of this page as needed to plan appropriately. Spe-
cially designed instruction may be listed with each goal/objective or listed in Section VI.

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

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 stu-

Describe WHEN periodic re-
Include: Condition, Name, Behavior, and Criteria dent’s progress toward
ports 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

Trevor will be able to write entire sentences and The student’s daily work Reports will be given to par-
answers on the lines provided for him and will not and homework will be ents weekly and they will be
write in the margins of the page on homework and monitored and he will be asked to check his homework
daily assignments with 80% accuracy by the end of given smaller lines as he to make sure he is writing
this IEP. begins to write smaller. his sentences and answers on
the lines provided for him.
They will be asked to sign his
homework.

Trevor will be able to read a passage, when The student will be moni- Reports will be given to par-
prompted, with 75% word accuracy by the end of tored 3 times a week ents weekly and they will be
this IEP. through direct observation asked to read with the stu-
and progress monitoring. dent daily and sign off if he
The student will be is reading correctly.
prompted to read a pas-
sage.

Trevor will be able to read and identify words from The student will be moni- Reports will be given to par-
common signs found in the school and public set- tored 2 times a week ents every other week and
ting with 75% accuracy across 4 consecutive ses- through direct observation they will be asked to use the
sions. and progress monitoring. flashcards with the student
The student will be shown at home every week. They
flashcards with common will be asked to sign the stu-
words on signs and will be dent’s agenda each week
asked to read them and stating that they did this ac-
identify where the sign tivity.
may be found.

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INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: Trevor Smith
Trevor will be able to add two double-digit num- The student will be as- Reports will be given to the
bers together with 75% accuracy across 5 consecu- sessed daily through class parents weekly and they will
tive math classes. work. All problems done be asked to practice adding
will be checked and as- double-digit numbers at
sessed. home with the student.

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.

Modifications and SDI Location Frequency Projected Beginning Date Anticipated Duration

Trevor will be given lined handwriting paper to write Classroom Every day 4/30/18 Length of IEP
his answers and sentences on.

Trevor will be given longer lines to write answers and

sentences on. Lines will get smaller as handwriting de- Classroom Every day 4/30/18 Length of IEP
creases and he is writing on the lines that the rest of
the class use.

Trevor will be given longer periods of time to answer

Classroom and hallway Every day 4/30/18 Length of IEP
questions or read to ensure that he is reading each
word in entirety and correctly.

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

Trevor will be provided with visual aids of common

signs found in the school and public settings. He will Hallway 2 times per week 4/30/18 6 weeks
be asked to read words on the signs and identity where
the signs would be found

Trevor will work on math problems with an aid to en- Classroom Every math class 4/30/18 Length of IEP
sure that he is on task and understands the concepts.

Trevor will be provided with 2 minutes of affection be-

fore class begins and 2 minutes of affection after Classroom Every day 4/30/18 Length of IEP
lunch.

Trevor will be provided an aid to help him eat his

lunch and teach him to use his utensils correctly. The
Cafeteria Every day 4/30/18
aid will use most-to-least prompting when teaching 3 weeks
him how to use his utensils.

Trevor will be paired with a student of high ability who When working with
Classroom 4/30/18 Length of IEP
can help him when working with partners. partners

Trevor will be given an aid to keep him on-task and

prompt him to begin his work. Prompts will be faded Classroom Every day 4/30/18
6 weeks
as he begins his work on his own.

Trevor will be taken out of the classroom to work on

Hallway As needed 4/30/18 Length of IEP
individual assignments.

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

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

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