INDIVIDUALIZED EDUCATION PROGRAM STUDENTS NAME: DOB

John Jacobs
SC%OOL & E A R !$"' ( !$") GRADE ! ( '

Decembe !"# !$$!

IEP INITIATION*DURATION DATES

+ROM

NOVEMBER 22, 2013

TO

NOVEMBER 21, 2014

T%IS IEP ,ILL BE IMPLEMENTED DURING T%E REGULAR SC%OOL TERM UNLESS NOTED IN E-TENDED SC%OOL &EAR SERVICES. STUDENT PRO+ILE / ,ILL INCLUDE GENERAL STATEMENTS REGARDING: S0 en10hs o2 0he s034en0: John is able to sort and compare objects, co nt to 20, and identi!" basic shapes# John is able to acc ratel" ans$er % estions $hen intentionall" prompted b" the teacher# John ma&es !riends easil" and is sociall" $ell adapted# John is able to &eep his materials or'ani(ed# )e can print his name le'ibl"# )e can also color, c t, and trace sin' his !ine motor s&ills# )e is also able to e*press ideas orall"# Pa en0a5 conce ns: +he parents are concerned $ith the prescription stren'th o! John,s 'lasses# +he" are also concerned $ith the 'rades John is brin'in' home accordin' to his most recent report card# S034en0 P e2e ences an4*o In0e es0s: John lo-es sports and pla"in' $ith his peers on the pla"'ro nd# )e enjo"s -ideo 'ames and $ants to be a !ireman $hen he 'ets older, j st li&e his dad# Res350s o2 0he mos0 ecen0 e6a53a07ons: .ccordin' to the /tan!ord0Binet 1ntelli'ence /cale, John,s 12 is $ithin the a-era'e ran'e, $ith a score o! 30# )e also per!ormed in the a-era'e ran'e !or the O45/05istenin' 6omprehension and Oral E*pression assessment# John also per!ormed in the a-era'e ran'e !or the .dapti-e Beha-ior +est and the Beha-ior E-al ation /cale +hird Edition0/chool# John,s scores ran'e !rom 300 103 !or these assessments# 7or the 8o n' 6hildren,s .chie-ement +est, John per!ormed in the belo$ a-era'e ran'e# +he mean !or these assessments is 100 $ith a standard de-iation o! 19# Based on these test res lts, $e see a lar'e di!!erence bet$een John,s potential and his achie-ement# +his is ! rther s pported b" his 'rades in the classroom# The aca4em7c# 4e6e5o8men0a5# an4 23nc07ona5 nee4s o2 0he s034en0: Readin': John contin es to str ''le $ith correctl" !ormin' letters and the association o! so nds to letters# )e has di!!ic lties identi!"in' si'ht $ords# Math: John str ''les to reco'ni(e the n mbers 003, co nt bac&$ards !rom 10, and sol-e sin'le0di'it addition problems# 4ritin': John has di!!ic lt" $ritin' $ords $ith scrambled letters, $ritin' in a jo rnal, and correctl" !ormin' letters on lined paper# Beha-ior: +his st dent tends to str ''le $ith sta"in' on tas& d rin' learnin' acti-ities# 4hile bein' obser-ed, he $as tappin' his pen, loo&in' at his peer,s $or&sheet instead o! his o$n, and needed repeated instr ctions !or the tas& at hand# O0he : ;er parent in re!erral<4ears 'lasses to tr" to stren'then his e"es m scles# )is prescription chan'es !re% entl"# )e sees an e"e doctor e-er" 3 months# )e $as also 9 = $ee&s premat re and had ja ndice# Based on the E6E6 chec&list, one area o! concern that $as chec&ed $as his economic stat s# +o 0he ch754 0 ans707on7n1 2 om EI 0o P eschoo5# 93s072: 72 IEP ;755 no0 be 7m85emen0e4 on 0he ch754s ' 4 b7 0h4a::
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INDIVIDUALIZED EDUCATION PROGRAM STUDENTS NAME: John Jacobs

SPECIAL INSTRUCTIONAL +ACTORS I0ems chec<e4 =&ES> ;755 be a44 esse4 7n 0h7s IEP: >oes the st dent ha-e beha-ior $hich impedes his?her learnin' or the learnin' o! others@ >oes the st dent ha-e limited En'lish pro!icienc"@ >oes the st dent need instr ction in Braille and the se o! Braille@ >oes the st dent ha-e comm nication needs Cdea! or hearin' impaired onl"D@ >oes the st dent need assisti-e technolo'" de-ices and?or ser-ices@ >oes the st dent re% ire speciall" desi'ned ;#E#@ 1s the st dent $or&in' to$ard alternate achie-ement standards and participatin' in the Alabama Alternate Assessment@ .re transition ser-ices addressed in this 1E; $ith an ann al 'oalCsD@ TRANSPORTATION AS A RELATED SERVICE /t dent,s mode o! transportation: A * B Re' lar b s A B B s !or special needs A B ;arent contract >oes the st dent re% ire transportation as a related ser-ice@ A B 8E/ 1! "es, chec& an" transportation needs: A A A A A B B B B B B s assistance: A B .d lt s pport ;re!erential seatin' Beha-ioral 1nter-ention ;lan 4heelchair li!t and sec rement s"stem Restraint s"stem /peci!" t"pe: Other# /peci!": B s dri-er and s pport personnel are a$are o! the st dent,s beha-ioral and?or medical concerns# NONACADEMIC an4 E-TRACURRICULAR ACTIVITIES 4ill the st dent ha-e the opport nit" to participate in nonacademic?e*trac rric lar acti-ities $ith his?her nondisabled peers@ A * B 8E/# A B 8E/, $ith s pports# >escribe: A B NO# E*planation m st be pro-ided: A B Medical s pport &ES A*B A B A B A B A B A B A B A B NO A B A*B A*B A*B A *B A*B A*B A *B

A B Other: A * B NO

A B A B

MET%OD*+RE?UENC& +OR REPORTING PROGRESS O+ ATTAINING GOALS TO PARENTS .nn al Eoal ;ro'ress reports $ill be sent to parents each time report cards are iss ed Ce-er"
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INDIVIDUALIZED EDUCATION PROGRAM STUDENTS NAME: A B A B A B John Jacobs

+his st dent is in a middle school co3 se o2 s034: that $ill help prepare him?her !or transition# +his st dent $as in-ited to the 1E; +eam meetin'# .!ter prior consent o! the parent or st dent C.'e 13D $as obtained, other a'enc" representati-es $ere in-ited to the 1E; +eam meetin'# E-IT OPTIONS @Com85e0e 2o s034en0s 7n G a4es A("!B .labama )i'h /chool >iploma .labama Occ pational >iploma Erad ation 6erti!icate An07c78a0e4 Da0e o2 EC70: Mon0h: &ea :

A B A B A B

PROGRAM CREDIT TO BE EARNED @Com85e0e 2o s034en0s 7n 1 a4es A("!B +o each co3 se 0a<en# 7n47ca0e 8 o1 am c e470 0o be ea ne4. .labama )i'h /chool >iploma .labama Occ pational >iploma Erad ation 6erti!icate ENGLIS% MAT% SCIENCE SOCIAL STUDIES

TRANSITION: CBe'innin' not later than the !irst 1E; to be in e!!ect $hen the st dent is 1F, or earlier i! appropriate, and pdated ann all" therea!terD T ans707on Assessmen0s @Chec< 0he assessmen0@sB 3se4 0o 4e0e m7ne 0he s034en0s meas3 ab5e 0 ans707on 1oa5sB: A B +ransition ;lannin' .ssessments A B 1nterest 1n-entor" A B Other

Goa5s 2o Pos0secon4a : T ans707on: Pos0secon4a : E43ca07on*T a7n7n1 Goa5

1! O0he is selected, speci!"

Em85o:men0*Occ38a07on*Ca ee Goa5

1! O0he is selected, speci!"

Comm3n70:*In4e8en4en0 L767n1 Goa5

1! O0he is selected, speci!"

T ans707on Se 67ces: Base4 on 0he s034en0Ds s0 en10hs# 8 e2e ences# an4 7n0e es0s# 0he 2o55o;7n1 coo 47na0e4 0 ans707on se 67ces ;755 easonab5: enab5e 0he s034en0 0o mee0 0he 8os0secon4a : 1oa5s. Cons74e 0hese se 67ce a eas: Vocational E-al ations CVED, 6omm nit" E*periences C6ED, ;ersonal Mana'ement C;MD, +ransportation C+D, Emplo"ment >e-elopment CE>D, Medical CMD, ;ostsecondar" Ed cation C;ED, 5i-in' .rran'ements C5.D, 5in&a'es to .'encies C5+.D, .d-ocac"?E ardianship C.ED, 7inancial Mana'ement C7MD, and i! appropriate 7 nctional Vocational E-al ation C7VED# Aca4em7cs*Pos0 Secon4a : E43ca07on*T a7n7n1 Se 67ce@sB
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T ans707on S0 an4s Em85o:men0*Occ38a07ons* Pe sona5* Soc7a5 Ca ee s

Da75: L767n1

INDIVIDUALIZED EDUCATION PROGRAM STUDENTS NAME: E F John Jacobs

+his 'oal is related to the st dent,s transition ser-ices needs# Rea47n1

AREA:

PRESENT LEVEL O+ ACADEMIC AC%IEVEMENT AND +UNCTIONAL PER+ORMANCE: 66//#E5.05iterac"#R7#2#3, GHno$ and appl" 'rade0le-el phonics and anal"sis s&ills in decodin' $ords#I 1n the area o! readin', as described in 66//#E5.05iterac"#R7#2#3, John needs s pport identi!"in' rh"min' $ords and be'innin' so nds# John also has si'ni!icant di!!ic lt" reco'ni(in' letters, associatin' letters $ith their so nds, and identi!"in' si'ht $ords# Based on teacher obser-ations, he matches letters to so nds $ith 90J acc rac"# 6oncernin' his comprehension s&ills, he str ''les $ith retellin' stories and ans$erin' % estions on his readin' le-el# 4hen $ritin' jo rnal entries, $hich he has di!!ic lt" $ith, he inconsistentl" ses phoneticall" spelled $ords# )e is able to independentl" print his name and e*press ideas orall"# )is di!!ic lt" $ith phonolo'ical a$areness, comprehension, and si'ht $ord reco'nition ad-ersel" a!!ects his per!ormance in readin' and $ritin' in the 'eneral ed cation classroom and hinders his pro'ress to$ard brid'in' the 'ap to$ards 'rade le-el s&ills# MEASURABLE ANNUAL GOAL e5a0e4 0o mee07n1 0he s034en0s nee4s: DATE O+ MASTER&:

B" No-ember 2014, John $ill be able to identi!" letters, letter so nds, and second 'rade si'ht $ords $ith K0J acc rac" and 1 to 2 teacher prompts# A66//#E5.05iterac"#R7#2#3B T&PE@SB O+ EVALUATION +OR ANNUAL GOAL: A * B 6 rric l m Based .ssessment A B +eacher?+e*t +est A B +eacher Obser-ation A * B >ata 6ollection A B /tate .ssessmentCsD A * B 4or& /amples A B Other: A B Other: >ate o! Master": >ate o! Master": >ate o! Master": >ate o! Master":

A B

Erades

BENC%MARGS: ". B" 7ebr ar" 2014, John $ill be able to identi!" all letters o! the alphabet $ith K0J acc rac" and 1 to 2 teacher prompts# !. B" Ma" 2014, John $ill be able to associate so nds to each letter o! the alphabet $ith K0J acc rac" and 1 to 2 teacher prompts# '. B" . ' st 2014, John $ill be able to decode second 'rade si'ht $ords and phrases $ith at least K0J acc rac" $ith 1 to 2 teacher prompts# ). B" No-ember 2014, John $ill be able to incorporate si'ht $ords and letter so nd reco'nition s&ills to !l entl" read a passa'e $ith at least K0J acc rac" $ith 1 to 2 teacher prompts#

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INDIVIDUALIZED EDUCATION PROGRAM

STUDENTS NAME: E F

John Jacobs

+his 'oal is related to the st dent,s transition ser-ices needs# Ma0h

AREA:

PRESENT LEVEL O+ ACADEMIC AC%IEVEMENT AND +UNCTIONAL PER+ORMANCE: 66//#Mathematics#20O.2, G7l entl" add and s btract $ithin 20 sin' mental strate'ies# C/ee standard F, Erade 1, !or a list o! mental strate'ies#D B" end o! Erade 2, &no$ !rom memor" all s ms o! t$o one0di'it n mbers#I John is able to sort and compare objects, co nt to 20, and identi!" basic shapes# 1n the area o! mathematics as described in 66//#Mathmatics#20O.2, John needs assistance identi!"in' n mbers 1020 to &eep him ali'ned $ith 'rade le-el s&ills# John has di!!ic lt" completin' patterns, co ntin' bac&$ards !rom 10, and sol-in' sin'le0di'it addition problems# MEASURABLE ANNUAL GOAL e5a0e4 0o mee07n1 0he s034en0s nee4s: DATE O+ MASTER&: B" No-ember 2014, John $ill identi!" n mbers 1020 and sol-e simple one di'it addition problems $ith 102 teacher prompts !or K0J acc rac"# A66//#0Mathematics 20O.2B T&PE@SB O+ EVALUATION +OR ANNUAL GOAL: A * B 6 rric l m Based .ssessment A * B +eacher?+e*t +est A B A * B >ata 6ollection A B /tate .ssessmentCsD A B A B Other: A B

+eacher Obser-ation 4or& /amples Other:

A B

Erades

BENC%MARGS: ". B" 7ebr ar" 2014, John $ill reco'ni(e n mbers 1010 $ith 1 to 2 teacher prompts $ith at least K0J acc rac"# !. B" Ma" 2014, John $ill reco'ni(e n mbers 1020 $ith 1 to 2 teacher prompts $ith at least K0J acc rac"# '. B" . ' st 2014, John $ill appl" his reco'nition o! n mbers 1020 to add sin'le di'it n mbers 109 $ith 1 to 2 teacher prompts $ith at least K0J acc rac"# ). B" Ma" 2014, John $ill be able to sol-e sin'le0di'it problems 1010 $ith 1 to 2 teacher prompts $ith at least K0J acc rac"#

>ate o! Master": >ate o! Master": >ate o! Master": >ate o! Master":

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INDIVIDUALIZED EDUCATION PROGRAM

STUDENTS NAME: E F

John Jacobs

+his 'oal is related to the st dent,s transition ser-ices needs# Beha67o

AREA:

PRESENT LEVEL O+ ACADEMIC AC%IEVEMENT AND +UNCTIONAL PER+ORMANCE: > rin' independent $or& time, John !re% entl" en'a'es in o!!0tas& beha-ior# 4hen obser-ed, he re% ired se-eral teacher prompts and appeared to be -er" distracted# .ltho 'h he str ''les $ith sta"in' on tas& !or an e*tended period o! time, John scored $ithin the G.-era'eI ran'e on both the .dapti-e Beha-ior E-al ation /cale0Re-ised 2 nd Edition and the Beha-ior E-al ation /cale, 3rd Edition CBE/03D# DATE O+ MASTER&: MEASURABLE ANNUAL GOAL e5a0e4 0o mee07n1 0he s034en0s nee4s: B" No-ember 2014, John $ill sta" on tas& !or 20 min tes $ith 1 or 2 teacher prompts on 4 o! 9 consec ti-e da"s# T&PE@SB O+ EVALUATION +OR ANNUAL GOAL: A B 6 rric l m Based .ssessment A B +eacher?+e*t +est A B A * B >ata 6ollection A B /tate .ssessmentCsD A B A B Other: A B

+eacher Obser-ation 4or& /amples Other:

A B

Erades

BENC%MARGS: ". B" 7ebr ar" 2014, John $ill sta" on tas& !or 9 min tes $ith 1 or 2 teacher prompts on 4 o! 9 consec ti-e da"s# !. B" Ma" 2014, John $ill sta" on tas& !or 10 min tes $ith 1 or 2 teacher prompts on 4 o! 9 consec ti-e da"s# '. B" . ' st 2014, John $ill sta" on tas& !or 19 min tes $ith 1 or 2 teacher prompts on 4 o! 9 consec ti-e da"s# ). B" No-ember 2014, John $ill sta" on tas& !or 20 min tes $ith 1 or 2 teacher prompts on 4 o! 9 consec ti-e da"s#

>ate o! Master": >ate o! Master": >ate o! Master": >ate o! Master":

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INDIVIDUALIZED EDUCATION PROGRAM S034en0s Name: John Jacobs

SPECIAL EDUCATION AND RELATED SERVICE@SB: C/pecial Ed cation, / pplementar" .ids and /er-ices, ;ro'ram Modi!ications, .ccommodations Needed !or .ssessments, Related /er-ices, .ssisti-e +echnolo'", and / pport !or ;ersonnel#D S8ec7a5 E43ca07on Se 67ce@sB Readin' reso rce teacher Math reso rce teacher Re5a0e4 Se 67ces Se 67ce@sB An07c78a0e4 + eH3enc: o2 Se 67ce@sB E-er" da" E-er" da" A B Needed An07c78a0e4 + eH3enc: o2 Se 67ce@sB Amo3n0 o2 07me 30 mins 30 mins A * B Not Needed Amo3n0 o2 07me Be17nn7n1*En47n1 D3 a07on Da0es to to S3885emen0a : A74s an4 Se 67ces Se 67ce@sB Beha-ior ;lan A * B Needed An07c78a0e4 + eH3enc: o2 Se 67ce@sB E-er" da" A B Not Needed Amo3n0 o2 Be17nn7n1*En47n1 07me D3 a07on Da0es entire school da" 11?22?2013 to 11?21?2014 Loca07on o2 Se 67ce@sB Be17nn7n1*En47n1 D3 a07on Da0es 11?22?2013 to 11?21?2014 11?22?2013 to 11?21?2014 Loca07on o2 Se 67ce@sB Reso rce room Reso rce room

Loca07on o2 Se 67ce@sB consistent thro 'ho t the school

P o1 am Mo4727ca07ons Se 67ce@sB

A B Needed An07c78a0e4 + eH3enc: o2 Se 67ce@sB

A * B Not Needed Amo3n0 Be17nn7n1*En47n1 o2 07me D3 a07on Da0es to to

Loca07on o2 Se 67ce@sB

Accommo4a07ons Nee4e4 2o Assessmen0s Se 67ce@sB +estin' in small 'ro p settin' +est read alo d Ass7s076e Techno5o1: Se 67ce@sB

A * B Needed An07c78a0e4 + eH3enc: o2 Se 67ce@sB as needed as needed A B Needed An07c78a0e4 + eH3enc: o2 Se 67ce@sB

A B Not Needed Amo3n0 Be17nn7n1*En47n1 o2 07me D3 a07on Da0es as needed as needed 11?22?2013 to 11?21?2014 11?22?2013 to 11?21?2014

Loca07on o2 Se 67ce@sB Reso rce room Reso rce room

A * B Not Needed Amo3n0 o2 07me Be17nn7n1*En47n1 D3 a07on Da0es to to Loca07on o2 Se 67ce@sB

S388o 0 2o Pe sonne5 Se 67ce@sB

A B Needed An07c78a0e4 + eH3enc: o2 Se 67ce@sB

A * B Not Needed Amo3n0 o2 07me Be17nn7n1*En47n1 D3 a07on Da0es to Loca07on o2 Se 67ce@sB

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INDIVIDUALIZED EDUCATION PROGRAM

STUDENTS NAME: John Jacobs TRANS+ER O+ RIG%TS CBe'innin' not later than the 1E; that $ill be in e!!ect $hen the st dent reaches 1K "ears o! a'e#D >ate st dent $as in!ormed that the ri'hts nder the 1>E. $ill trans!er to him?her at the a'e o! 13 +he 1E; +eam has considered the need !or e*tended school "ear ser-ices# A B 8es A * B No

LEAST RESTRICTIVE ENVIRONMENT >oes this st dent attend the school Cor !or a preschool0a'e st dent, participate in the en-ironmentD he?she $o ld attend i! nondisabled@ A * B 8es A B No 1! no, e*plain:

>oes this st dent recei-e all special ed cation ser-ices $ith nondisabled peers@ A B 8es A * B No 1! no, e*plain Ce*planation ma" not be solel" beca se o! needed modi!ications in the 'eneral c rric l mD: John is si'ni!icantl" belo$ a-era'e in Readin' and Math and is p lled to the reso rce room !or e*tra help in these areas# E F I(!" &EARS O+ AGE 5east Restricted En-ironment: Eeneral Ed cation 6lassroom $ith p llo t to reso rce room !or Readin' and Math COP& O+ IEP 4as a cop" o! the 1E; 'i-en to parent?st dent Ca'e 13D at the 1E; +eam meetin'@ A B 8es A B No 1! no, date sent: COP& O+ SPECIAL EDUCATION RIGHTS 4as a cop" o! the Special Education Rights 'i-en to parent?st dent Ca'e 13D at the 1E; +eam meetin'@ A B 8es A B No 1! no, date sent: E F '(J &EARS O+ AGE

>ate cop" o! amen4e4 1E; pro-ided?sent to parent?st dent Ca'e 13D T%E +OLLO,ING PEOPLE ATTENDED AND PARTICIPATED IN T%E MEETING TO DEVELOP T%IS IEP. Pos707on ;arent ;arent Eeneral Ed cation +eacher /pecial Ed cation +eacher 5E. Representati-e /omeone 4ho 6an 1nterpret +he 1nstr ctional 1mplications O! +he E-al ation Res lts /t dent 6areer?+echnical Ed cation Representati-e Other .'enc" Representati-e S71na03 e Da0e

IN+ORMATION +ROM PEOPLE NOT IN ATTENDANCE Pos707on Name Da0e

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