UC - Denver 1380 Lawrence Street

Individualized Education Program Denver, CO 80204

(303) 555-1212

Helen Jackson 01/12/2005 November 30, 2016

Legal Name of Student DOB LASID SASID IEP Meeting Date

TYPE OF MEETING
Individualized Education Program
Initial IEP - School Age

DATES OF MEETINGS
Next eligibility meeting (on or before): 11/30/2016 Next review meeting (on or before): 11/29/2017
Initial eligibility: Initial consent for evaluation: 10/30/2016
Initial evaluation completed: 11/1/2016 Initial consent for service:

STUDENT AND FAMILY INFORMATION

Prior to Meeting After Meeting
Home District UC - Denver UC - Denver
Home School UCD - Elementary UCD - Elementary
Service District UC - Denver UC - Denver
Service School UCD - Elementary UCD - Elementary
Primary Disability
Secondary Disability
Least Restrictive General education class 40% to 79% of the
Environment time

Grade: 5th Age: 11y 10m Gender:

Race: Ethnicity: Not Hispanic/Latino

Primary Language Spoken in the Home: Students Primary Language:
Does the student have Limited English Proficiency? No

Parent Contact Information

Michael Jackson

Anna Jackson

Individualized Education Program UC - Denver Page 1 of 9

DRAFT
Helen Jackson 01/12/2005 November 30, 2016
Legal Name of Student DOB LASID SASID IEP Meeting Date

PROCEDURAL SAFEGUARDS
I have been provided the special education procedural safeguards in my native language or other mode of communication
on 11/23/2016.

Parent Signature IDEA 300.504(a) Date

Parent Signature IDEA 300.504(a) Date

IEP PARTICIPANTS

Student Parent 2nd Parent

IDEA 300.321(a)(7) and 300.321(b)(1) IDEA 300.321(a)(1) IDEA 300.321(a)(1)

Special Education Director or Designee General Education Teacher Special Education Teacher/Provider
IDEA 300.321(a)(4)(i)-(iii); ECEA 4.03(5)(a) IDEA 300.321(a)(2) IDEA 300.321(a)(3)

Individualized Education Program UC - Denver Page 2 of 9

Helen Jackson 01/12/2005 November 30, 2016
Legal Name of Student DOB LASID SASID IEP Meeting Date

PRESENT LEVELS OF ACADEMIC ACHIEVEMENT & FUNCTIONAL PERFORMANCE

INCLUDING INPUT FROM PARENT & STUDENT
Student Strengths, Preferences, Interests
What are the students education/developmental strengths, interest areas, significant personal attributes and personal
accomplishments as indicated by formal or informal assessment? Be sure to include specific feedback from the student.
IDEA 300.324(a)(i) strengths of child
IDEA 300.321(b)(2) preferences and interests
Helen's academic strengths include her listening comprehension, oral responses, and her determination. Helen has strong verbal skills
and cooperation skills. She is very social and aims to please adults and peers. Helen is especially thoughtful and considerate of
students with a variety of disabilities. She advocates for herself and others and works well in teams. Helen likes playing with friends
outside of school and is interested in studying to become a veterinarian. She loves animals and jumping on the trampoline. Helen
reports her favorite classes at school are math and writing.

Present Levels of Educational Performance Summary

Include results of initial or most recent evaluation, including, if appropriate, the results of any interventions, progress
monitoring and gap analyses.
IDEA 300.320(a)(1) present levels of academic achievement and functional performance
IDEA 300.324(a)(iii) Results of initial or most recent evaluation
KeyMath3
This test assesses three areas of math skills: basic concepts, operations, and applications. Each area is broken insubtests as shown in
the table below:

Helen scored in each subtest which leads to the following scores for each area: scaled score, grade equivalent, age equivalent, and
percentile rank. The standard score converts raw scores to a standard bell curve, with a median score. The grade and age equivalent
converts the raw score to the grade level and age level at which Helen is currently performing in each area. The percentile rank
indicates how well Helen performed on each test compared to 100 other nationally normed students her own age. The breakdown of
Helen's scores is shown below:

The results of the KeyMath3 assessment indicate that Helen is in the below average range of grade level expectations in math.
According to this assessment, she is not performing at or near grade level expectations.
STAR Math

Individualized Education Program UC - Denver Page 3 of 9

DRAFT
Helen Jackson 01/12/2005 November 30, 2016
Legal Name of Student DOB LASID SASID IEP Meeting Date

STAR Math is computer based progress monitoring tool that assesses students' math skills in the following areas: numeration
concepts, computation processes, word problems, estimation, data analysis and statistics, geometry, measurement, and algebra. The
assessment gives a norm-referenced score that relates to what students across the nation can actually do. This is in the form of a
percentile rank, as shown in the graph above.
According to Helen's last STAR Math assessment she is in the 16th percentile, meaning she performs as well or better than 16% of
students nationwide of the same grade. The benchmark for STAR Math is the 40th percentile, which puts Helen in the intervention
category according to the STAR Math assessment guide.
IXL

IXL is a computer based math program that students use to practice specific math skill fluency. Helen is currently working on passing
her subtracting 5's facts.

Student Needs and Impact of Disability

How does the students disability affect her involvement and progress in the general curriculum and participation in
appropriate activities?
IDEA 300.324(a)(ii) concerns of parent
IDEA 300.324(a)(iv) communication needs
IDEA 300.320(a)(1)(i) How the childs disability affects the childs involvement and progressin the general curriculum and participation
in appropriate activities

Individualized Education Program UC - Denver Page 4 of 9

DRAFT
Helen Jackson 01/12/2005 November 30, 2016
Legal Name of Student DOB LASID SASID IEP Meeting Date

Parent/Student Input
IDEA 300.324(a)(1)(ii) concerns of parent

CONSIDERATION OF SPECIAL FACTORS

The student does not exhibit behavior that requires a Behavior Intervention Plan. 300.324(1)(2)(i)
The student is not deaf-blind. 300.324(1)(2)(iii) & 300.324(a)(2)(iv)
The student is not deaf or hard of hearing. 300.324(a)(2)(iv)
The student is not blind or visually impaired. 300.324(1)(2)(iii)
The student does not require a Health Care Plan.
The student does not have Limited English Proficiency. 300.324(a)(2)(ii)
The student does not need Assistive Technology devices or services. 300.324(a)(2)(v)
The student does not require Special Transportation. 300.34 Related Services (a); 300.34 (c)(16); 300.107(b)

ANNUAL GOALS IDEA 300.320(a)(2)(i)

Progress Report (Describe how parents will be informed of Helens progress towards goals and how frequently
this will occur.) IDEA 300.321(a)(3)(iii)
Helen's parents will receive progress reports, in writing, correlating to the schools report card schedule.

Goal 1
Area of Need: Mathematics
Projected Achievement Date: 11/29/2017
ESY: No
Unit of Measurement: Percent correct
Baseline Data Point: 20% accuracy
Evaluation Method: Monitor and Chart Progress
Focused Assessments
Measurable Goal:
By November 2017, Helen will calculate with 80% accuracy, whole numbers, decimals and fractions in all four operations
(addition, subtraction, multiplication, division) as measured by a computer- or paper-based fact fluency program.

Standards:
1 Number Sense, Properties, and Operations // 2 Formulate, represent, and use algorithms with multi-
digit whole numbers and decimals with flexibility, accuracy, and efficiency // Evidence Outcomes // a Fluently
multiply multi-digit whole numbers using standard algorithms.

Individualized Education Program UC - Denver Page 5 of 9

DRAFT
Helen Jackson 01/12/2005 November 30, 2016
Legal Name of Student DOB LASID SASID IEP Meeting Date

ACCOMMODATIONS & MODIFICATIONS

Accommodations
What type(s) of accommodations(s) if any is (are) necessary for the student to access the general curriculum
and/or appropriate activities to make effective progress?

IDEA 300.320(a)(4)(i)-(iii)
IDEA 300.320(a)(6)(i)
Graph paper or graphic organizers/templates to line up numbers for computation; personal number line/hundreds chart; personal
multiplication/division chart; mnemonic devices, rhymes, songs to aid memory; manipulatives; reduce number of practice problems
assigned. Math instructions/directions and word problems need to be read aloud.

Modifications
No curricular modifications were identified by the team.

EXTENDED SCHOOL YEAR DETERMINATION IDEA 300.106

Summarized findings based on completion of the ESY Predictive Factors.
The student did not experience severe regression on her IEP goals and objectives.

The student did not require an unreasonably long period of time to relearn previously learned skills.

Predictive factors do not indicate the need for ESY services.

It has been determined that the student is not eligible for extended school year services.

Individualized Education Program UC - Denver Page 6 of 9

DRAFT
Helen Jackson 01/12/2005 November 30, 2016
Legal Name of Student DOB LASID SASID IEP Meeting Date

STATE AND DISTRICT ASSESSMENTS

Accommodations and modifications must reflect those used in daily classroom instruction

District Assessments
Test Participation Accommodations 300.320(a)(6)(i)
Reading Regular Teacher-Read Directions
Small Group
Read Aloud to Self
Writing Regular Teacher-Read Directions
Small Group
Read Aloud to Self
Oral Scripts
Math Regular Teacher-Read Directions
Small Group
Read Aloud to Self
Oral Scripts
Science Regular Teacher-Read Directions
Small Group
Read Aloud to Self
Oral Scripts
Social Studies Regular Teacher-Read Directions
Small Group
Read Aloud to Self
Oral Scripts
Other

State Assessments
Test Participation Accommodations 300.320(a)(6)(i)
CMAS PARCC: ELA State: Grade- Redirect Student to the Test
Level Extended Time (Time and a Half)
Small Group Testing
Unique: Text-to-Speech (Requires CO
UAR/Guidance)
CMAS PARCC: Math State: Grade- Redirect Student to the Test
Level Extended Time (Time and a Half)
Small Group Testing
Text-to-Speech
Student Reads Assessment Aloud to Self
Scratch Paper (graph, lined or unlined)
CMAS: S & SS State: Grade- Redirect Student to the Test
Level Small Group Testing
Extended Time (Double Time)
Text-to-Speech
Student Reads Assessment Aloud to Self
Scratch Paper (graph, lined or unlined)

Individualized Education Program UC - Denver Page 7 of 9

DRAFT
Helen Jackson 01/12/2005 November 30, 2016
Legal Name of Student DOB LASID SASID IEP Meeting Date

CoAlt: DLM: ELA & Math N/A

CoAlt: S & SS N/A

10th/11th Exam N/A

SAT/PSAT N/A

ACCESS for ELLs N/A

If the IEP Team has determined that the student qualifies for alternate assessments, parents have been informed
about the differences between regular and the alternate assessments (both state and district) and the effects of
these, if any (including that, for students taking alternate assessments, achievement will be measured based on
alternate achievement standards): Yes

SERVICE DELIVERY STATEMENT

Statement of types and anticipated location of services to be provided to and on behalf of the student:
Primary Service Provider:

Special
Specialized Instruction Education Service
Area and/or Related or Provider Role Start Date End Date
Services 300.320(a)(4) Related 300.18 & 300.320 300.320 Frequency of Special
Include ESY if applicable Location Services ECEA 3.04 (a)(7) (a)(7) Education/Related Services
Direct/
Minutes Frequency
Indirect

12/1/16 11/29/17

RECOMMENDED PLACEMENT IN THE LEAST RESTRICTIVE ENVIRONMENT (SPECIAL

EDUCATION SETTING) IDEA 300.320(a)(5)
Placement Options Considered
General education class 40% to 79% of the
time
Describe the possible advantages and
disadvantages of this placement option for the
Selected student and the modifications/supplementary
aids and services considered to reduce possible
disadvantages to the student.
This option was selected to best address Helen's needs in
both reading and math. Due to her needs in these areas,
Yes
Helen will best be served in a small group, pull out setting.

Individualized Education Program UC - Denver Page 8 of 9

DRAFT
Helen Jackson 01/12/2005 November 30, 2016
Legal Name of Student DOB LASID SASID IEP Meeting Date

Placement Date: 12/01/2016 Placement Type:Ages 6-21

LRE Setting: General education class 40% to 79% of the time
Time in general education environment: 100.0%
Time outside general education environment: 0.0%

PRIOR WRITTEN NOTICE IDEA 300.503

The IEP includes services to be provided to assist your child to make progress. The Present Level of Academic
Achievement and Functional Performance includes information about the data used as a basis for the decisions recorded
in the IEP.

Other options considered and reasons rejected:

Other factors considered:
Case Manager Contact Information

/
Name/Title Phone

Parents of a child with a disability have protection under the procedural safeguards. For a copy of the Procedural
Safeguards or assistance in understanding this information, please contact the person named above. IDEA
300.503(b)(4)

Individualized Education Program UC - Denver Page 9 of 9

DRAFT