Virginia Department of Education – July 28, 2011 Sample: Measurable English Standards Based IEP Goals for K Kindergarten Goals Strand/Standard Current (2003) Strand/Standard New (2010) Strategies/Ideas for Instruction By the annual review of the IEP, the student will be able to use words to describe or name people, places, feelings, and things during group activities and … I c a n a t t e n d o n F O R M T E X T a t F O R M T E X T ( d a t e ) ( t i m e a n d p l a c e ) P l e a s e c o n t a c t m e a t F O R M T E X T t o d e t e r m i n e a m u t u a l l y a g r e e a b l e d a t e , t i m e , a n d p l a c e f o r t h i s I E P m e e t i n g . M -The student has Mastered this annual goal. A listing of more than one anticipated location is permissible, if the parents do not indicate that they will object to any particular school or state that the team should identify a single school. IP -The student has demonstrated Insufficient Progress to meet this annual goal and may not achieve this goal within the duration of this IEP.ES - The student demonstrates Emerging Skill but may not achieve this goal within the duration of this IEP.NI -The student has Not been provided Instruction on this goal. " Y o u m a y h o l d this meeting in my absence. Virginia Department of Education’s Sample IEP Form TABLE OF CONTENTS The Virginia Department of Education does not require that schools use this sample IEP format; it is offered as a best practice example. Fill in the necessary fields (these are marked in yellow). NAME OF PARTICIPANT POSITION _____________________________________________________ ____________________________________ _____________________________________________________ ____________________________________ _____________________________________________________ ____________________________________ _____________________________________________________ ____________________________________ _____________________________________________________ ____________________________________ Required for Billable Services ICD9 Code _________________________ Medicaid Discharge Plan/Disposition _______________________________ PARENTAL CONSENT FOR BILLING PUBLIC INSURANCE LANGUAGE FOR THE IEP or IEP AMENDMENT One-Time Consent (This document is optional and is not a necessary component of the IEP annual review) For Medicaid or FAMIS (Family Access to Medical Insurance Securities) Insured Only If your child is now or later becomes eligible for Medicaid or FAMIS and he or she receives health-related services written in an Individual Education Program (IEP), the federal government can help the public school division pay for these health-related services, such as, but not limited to physical, occupational or speech therapy; audiology, nursing, psychological or personal care services and health screening associated with Early Periodic Screening Diagnosis and Treatment (EPSDT). IEP-Sample … The academic, developmental, and functional needs of the student; ______________________________________________________________________________________________________________ 4. She categorizes familiar … The team may consider placement options in conjunction with discussing any needed supplementary aids and services, accommodations/modifications, assistive technology and/or accessible materials, and supports for school personnel. (for example: see Present Level of Academic Achievement and Functiona. Keeping up with grade level reading assignments : so he will extra time for assignments, and to have someone read directions to him, and to explain things to him orally. The SB IEP PLoP of Jordan, a rising fourth grader, example from the Virginia Department of Education (VDOE) SB IEP website, contains wording that may lead to consideration of the VMAST: “The IEP team has considered the use of goals and objectives in his current IEP and feels that a combination of both best meets his academic needs. In selecting the LRE, consideration is given to any potential harmful effect on the student or on the quality of services that he/she needs. We make that achievable through giving you access to our feature-rich editor effective at changing/correcting a document?s initial text, inserting unique boxes, and e-signing. Parents, school personnel, and often the student receiving special education services develop the IEP jointly. In considering the placement continuum options, check those the team discussed. by Eileen Bailey Health Writer. SERVICES – Preschool (ages 0-5): LEAST RESTRICTIVE ENVIRONMENT–PLACEMENT, Continued Student Name_________________________________________________ Date____/____/____ Page ___of___ Student ID Number ___________________________________ Extended School Year Services (ESY): (see attached summary sheet as a means to document discussion) The IEP team determined that the student needs ESY services. When considering that Braille is not appropriate for the child the IEP team may use the Functional Vision and Learning Media Assessment for Students who are Pre-Academic or Academic and Visually Impaired in Grades K-12 (FVLMA) or similar instrument; and ___________________________________________________________________________________________________ 11. Forms 10/10, Features Set 10/10, Ease of Use 10/10, Customer Service 10/10. Other options considered, if any, and the reason(s) for rejection are attached, or can be found in the Placement Decision section of this IEP. (check all that apply)____ Classroom Participation ____ Checklist ____ Class work ____ Homework ____ Observation ____ Special Projects ____ Tests and Quizzes ____ Written Reports ____ Criterion-referenced test:_________________________ ____ Norm-referenced test: ___________________________ ____ Other: ________________________________________ Progress on this goal will be reported to the parent or adult student using the following codes. TopTenReviews wrote "there is such an extensive range of documents covering so many topics that it is unlikely you would need to look anywhere else". Sample ipad, sample epic scrum, sample epmd da joint, 25+ Best Ideas About Autism Checklist On Pinterest Source: www.pinterest.com Writing A Measureable Iep - Behavioral Directions, Llc In Source: www.pinterest.com Iep Instructions For Students Identified As Gifted - Ppt Source: slideplayer.com Fulfilling The Purpose Of Idea Through Academic And … P l e a s e r e s c h e d u l e t h i s m e e t i n g . The highest level of recognition among eCommerce customers. The sample IEP form is divided into two sections. 1$ 7$ 8$ H$ gd{}Ù Æ h„h„˜ş1$ 7$ 8$ H$ ^„h`„˜şgd{}Ù In this example, the student’s teacher-adviser serves as the leader of the transition-planning team. Determine progress report schedule Document that the IEP team considered the need for short-term objectives or benchmarks for students other than those who take alternate assessments aligned to alternate achievement standards Develop short-term objectives or benchmarks for the annual goals, as needed Determine any needed accommodations and/or modifications in instruction and assessment Determine participation in state and divisionwide assessments Determine services and placement Determine if student needs ESY services Review any requests proposed and/or refused Provide prior written notice and obtain parental consent Identify how staff will be informed of their responsibilities for implementation of the IEP Special Education Meeting Notice (School Division Letterhead) Date: To:____________________________________and______________________________________ Parent(s)/Adult Student Student (if appropriate or if transition will be discussed) You are invited to attend a meeting regarding ____________________________________________ Student’s Name PURPOSE OF MEETING (check all that apply): IEP Development or Annual Review IEP Amendment Team Review of Referral Team Review of Existing Data Transition: PartC to Part B Eligibility Determination Team Determination of Needed Data Transition: Postsecondary Goals, Transition Services Manifestation Determination Other: ____________________________ The meeting has been scheduled for: Date Time Location Meetings are scheduled at a mutually agreed upon place and time by you and the school division. # Vermont Department of Education Form 5: VT DOE EEE IEP July 1, 2012 Individualized Education Program (IEP) School District: Some School District Annual Meeting Date: 05/19/2012 IEP Case Manager: Casey Manager Next Annual Review Date: 05/19/2013 Next 3-year Re-evaluation Date: 02-10-2014 Effective date of Revision : 09/01/2012 If yes, complete the “VSEP Participation Criteria” for each content area considered. The student needs to state what the text literally says — plus what it might really mean.Two times out of three, the student must back up those inferences with evidence, with at least 80 percent accuracy. Then, describe the placement selected in the PLACEMENT DECISION section below. Services may be provided as itinerant services in a community setting where the child is already attending. Jot these down on a piece of scrap paper first. View IEP_Template_VDOE.doc from EDUC 525 at Colorado Technical University. Fax (956) 984-7655. facebook twitter youtube instagram pinterest linked in flickr vimeo. ( Alternate/Alternative Assessments Participation Criteria is attached or maintained in the student’s educational record ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ INDIVIDUALIZED EDUCATION PROGRAM (IEP) SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT, Continued Student Name________________________________________________________ Date____/____/____ Page ___of___ Student ID Number ___________________________________ Least Restrictive Environment (LRE) When discussing the least restrictive environment and placement options, the following must be considered: To the maximum extent appropriate, the student is educated with children without disabilities. Addressed by date:______________ Explain: INSTRUCTIONAL SETTING/Placement No single model for the delivery of services to any population or category of children with disabilities is acceptable for meeting the requirement for a continuum of alternative placements. M -The student has Mastered this annual goal. Refer to the VDOE’s Students with Disabilities: Guidelines for Assessment Participation for guidance. 7. It would be irresponsible of me not to tell you this: Some schools view a Records Request as a hostile act. The IEP team should revise and update the transition form every year. • IEP Membership and Responsibilities 8 • Suggested Agenda for an IEP Meeting 10 Foundation of the IEP 11 • Present Level of Educational Performance (PLEP) 12 • Measurable Annual Goals with Objectives/Benchmarks 16 • Transition 24 Assessment and Supports 28 • Participation in Assessments 29 • Special Education Services and Supports 31 Appendices 36 • Appendix A: … The Virginia Department of Education does not require that schools use this sample IEP format; it is offered as a best practice example. Follow the simple instructions below: Feel all the benefits of completing and submitting legal documents online. School Finance; ESSA; WV School Counselors; W. Clayton Burch State Superintendent of Schools Miller L. Hall President, West Virginia Board of … Virginia Department of Education’s Sample IEP Form For Use with Students up … process, procedural safeguards or implementation of the IEP. 2 Virginia Department of Education July 28, 2011 Sample: Measurable English Standards Based IEP Goals for K Kindergarten Goals. ( A n I E P w o r k s h e e t i s e n c l o s e d . NOTE: As the IEP Team discusses how each weakness gets in the way, the IEP Team may list several ways. For example: Struggling with knowing his sounds and letters gets in the way of Learning and mastering grade level reading skills: so he will need a goal to improve basic reading skills. (page 3) Factors for IEP Team Considerations: This form may be used to document the team’s consideration of the matters that the applicable regulations require the team to consider during the process of developing the IEP, along with any decisions made by the team regarding these matters. Additionally, summarize the discussions and decision around LRE and instructional setting. Do you wonder what type of information should be included in an IEP? (Yes (No If “yes” to any of the above, check the assessment(s) chosen and attach (or maintain in student’s educational record) the assessment page(s), which will document how the student will participate in Virginia’s accountability system and any needed accommodations and/or modifications. Without the alphabet strip on her desk, Candace produces the letters but looks about the room for letter examples (80% upper and lower case). ___ I give permission to implement this IEP. Enjoy smart fillable fields and interactivity. Skip to search results. Sample Special classes, separate schooling or other removal of the student from the regular educational environment occurs only when the nature or severity of the disability is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily. (Yes (NoBased on the Present Level of Academic Achievement and Functional Performance, is this student being considered for participation in the Virginia Standards of Learning (SOL)Assessments (select appropriate content area) ( Reading ( Math ( Science ( History/Social Science ( Grade 8 Writing(Yes (NoBased on the Present Level of Academic Achievement and Functional Performance, is this student being considered for participation in the Special Permission Request Virginia Substitute Evaluation Program (VSEP)? All placement decisions shall be based on the individual needs of each student. The sample IEP form is divided into two sections. How to Ask for a No Meet Addendum to the IEP; Sample Gebser letters (Bullying, Sexual Harassment) Read more on Bullying and Harrassment first! But knowing what goes in an IEP can help you make sense of it. No two teams are alike and each team will arrive at different answers, ideas and supports and services to address the student’s unique needs. The factors are addressed in other sections of the IEP if not documented on this page. Results of the initial or most recent evaluation of the student; ______________________________________________________________________________________________________________ 2. In the case of a student who is blind or is visually impaired, provide for instruction in Braille and the use of Braille unless the IEP team determines after an evaluation of the student’s reading and writing skills, needs, and appropriate reading and writing media, including an evaluation of the student’s future needs for instruction in Braille or the use of Braille, that instruction in Braille or the use of Braille is not appropriate for the student. In selecting the LRE, consideration is given to any potential harmful effect on the student or on the quality of services that he/she needs. INDIVIDUALIZED EDUCATION PROGRAM (IEP) PARTICIPATION IN THE STATE AND DIVISIONWIDE ACCOUNTABILITY/ASSESSMENT SYSTEM (continued) Student Name________________________________________________________ Date ____/____/____ Page ___of___ Student ID Number__________________________________ PARTICIPATION IN STATEWIDE ASSESSMENTS TestAssessment Type* (SOL, VSEP,VAAP) Accommodations** If yes, list accommodation(s)Reading ( _______________________________________ ( Not Assessed at this Grade Level(Yes (NoMath ( _______________________________________ ( Not Assessed at this Grade Level(Yes (NoScience ( _______________________________________ ( Not Assessed at this Grade Level(Yes (NoHistory/SS ( _______________________________________ ( Not Assessed at this Grade Level(Yes (NoWriting ( _______________________________________ ( Not Assessed at this Grade Level(Yes (No * Students with disabilities are expected to participate in all content area assessments that are available to students without disabilities. Choose the template you require in the collection of legal forms. Sample Gebser Letter; Sample Letters Requesting FERPA Records . 6. Taking tests … PRESCHOOL INSTRUCTIONAL SETTING OPTIONS CONSIDERED: (check all that have been considered):*general education class(es) – public or private special class(es) *separate special day school *residential facility *home *service provider location Other *Can be considered itinerant service setting Based upon identified services and the consideration of least restrictive environment (LRE) and instructional setting options, describe in the space below the service(s) setting(s). The documentation of these considerations, while not required, is best practice. It should be noted that in a standards-based IEP, the PLOP and some or all of the annual goals are connected to the specific grade-level SOL. Test scores, if included, should be self-explanatory or an explanation should be included, and the Present Level of Academic Achievement and Functional Performance should be written in objective measurable terms, to the extent possible. In the case of a student who is deaf or hard of hearing, consider the student’s language and communication needs, opportunities for direct communications with peers and professional personnel in the student’s language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the student’s language and communication mode. Anticipated Date of Progress Report*Actual Date of Progress ReportProgress Code SP -The student is making Sufficient Progress to achieve this annual goal within the duration of this IEP. TABLE OF CONTENTS. An IEP … Service(s)Frequency**School/location Instructional Setting (classroom)Duration m/d/y to m/d/y ** IEP teams are required to identify the specific school site (public or private) when the parent expresses concerns about the location of the services or refuses the proposed site. The second section includes those pages that will be added to the IEP as needed and sample … But you’ll be part of the IEP team creating and overseeing your child’s IEP. 1. The Virginia Department of Education does not require that schools use this sample IEP format; it is offered as a best practice example. Anticipated Date of Progress Report*Actual Date of Progress ReportProgress Code SP -The student is making Sufficient Progress to achieve this annual goal within the duration of this IEP. For IEP Meetings, if the division intends to invite a representative of an agency that is likely to be responsible for providing or paying for transition services to the IEP meeting, written consent of the parent or adult student is required. ! INDIVIDUALIZED EDUCATION PROGRAM (IEP) MEASURABLE ANNUAL GOALS, PROGRESS REPORT, continued Student Name_______________________________________________________ Date____/____/____ Page ___of___ Student ID Number________________________________ Area of Need________________________________________ # _____ MEASURABLE ANNUAL GOAL: The IEP team considered the need for short-term objectives/benchmarks. Standards-Based IEPs Standards-Based IEP Guidance Resources. The sample IEP form is divided into two sections. The annual review date is listed on the cover page of the IEP document. Special Education Meeting Notice Parent/Student Response Form To the Parent(s) / Guardian(s) / Student: Student: FORMTEXT D a t e o f M e e t i n g : F O R M T E X T P l e a s e c h e c k y o u r c h o i c e a n d r e t u r n t h i s p a g e t o : F O R M T E X T a t F O R M T E X T I t h e F O R M C H E C K B O X p a r e n t F O R M C H E C K B O X s t u d e n t w i l l a t t e n d t h e m e e t i n g a s s c h e d u l e d . If yes, determine for specific content area. - The Individualized Education Program (IEP) describes the special education and related services designed to meet the unique needs of a child with disabilities. They should be completed no later than when a student turns sixteen or earlier. Resources. (check all that apply)____ Classroom Participation ____ Checklist ____ Class work ____ Homework ____ Observation ____ Special Projects ____ Tests and Quizzes ____ Written Reports ____ Criterion-referenced test:_________________________ ____ Norm-referenced test: ___________________________ ____ Other: ________________________________________ Progress on this goal will be reported to the parent or adult student using the following codes. Your data is well-protected, since we adhere to the latest security requirements. ACCOMMODATIONS/MODIFICATIONS (list, as appropriate) Accommodation(s)/Modification(s)FrequencyLocation (name of school *)Instructional SettingDuration m/d/y to m/d/y * IEP teams are required to identify the specific school site (public or private) when the parent expresses concerns about the location of the services or refuses the proposed site. TABLE OF CONTENTS. " Useful Links. ___ I do not give permission to implement this IEP. These services are the special education services and as necessary, the related services, supplementary aids and services based on peer-reviewed research to the extent practicable, assistive technology and/or accessible materials, supports for personnel*, accommodations and/or modifications* and extended school year services* the student will receive that will address area(s) of need as identified by the IEP team. She repeats questions she is asked. (Grades 3-8 only) ( Reading ( Math ( Science ( History/Social Science ( Grade 8 Writing(Yes (NoDoes the student meet the VSEP participation criteria? Access the most extensive library … Explanation of Placement Decision: SERVICES –Preschool (ages 0 – 5): LEAST RESTRICTIVE ENVIRONMENT–PLACEMENT Student Name_________________________________________________ Date____/____/____ Page ___of___ Student ID Number ___________________________________ Least Restrictive Environment (LRE) When discussing the least restrictive environment and placement options, the following must be considered: To the maximum extent appropriate, the student is educated with children without disabilities. No. Then, describe the setting and the reason for provision of services in that setting in the INSTRUCTIONAL SETTING DECISION section below. T Name Susan Knowles Date 6 / 15 / 11 Page 2 of Student ID Number 434809801 During the IEP meeting, the following factors must be considered by the IEP team. Í E O v ~ € ¥ ñâÙĞÙÇÁ»ÇÙÇÙ´£™´�‚wpfpfpfpfpf^pf h°|¥ h{}Ù \�h°|¥ h{}Ù 5�\� h°|¥ h{}Ù h°|¥ hˆB� CJ aJ h°|¥ h¿3ø CJ aJ h°|¥ h¿3ø >*CJ aJ h°|¥ hˆB� 5�\� h°|¥ h¿3ø 5�\� h°|¥ hˆB� h°|¥ h¿3ø This page is part of the school board’s IEP form. The communication needs of the student; ______________________________________________________________________________________________________________ 6. ( Short-term objectives/benchmarks are included for this goal. Describe. The sample IEP form is divided into two sections. The second section includes those pages that will be added to the IEP as needed and sample formats for other purposes. IP -The student has demonstrated Insufficient Progress to meet this annual goal and may not achieve this goal within the duration of this IEP.ES -The student demonstrates Emerging Skill but may not achieve this goal within the duration of this IEP.NI -The student has Not been provided Instruction on this goal. ^J h°|¥ hÇkì ^J h°|¥ hæK� ^J h°|¥ h¯7% ^J h°|¥ hˆB� CJ OJ QJ aJ h°|¥ h¿3ø CJ OJ QJ aJ # 3 l n € � ÿ This must include an explanation of why the student will not be participating with students without disabilities in the general education class(es), programs, and activities. Don’t start writing the actual ways into the PLAAFP until the IEP Team discusses which ones are top priorities for this student. _____ I give my consent for an agency representative(s) named on the meeting notice to be invited to the IEP meeting. (Required for students participating in the VAAP) ( Short-term objectives/benchmarks are not included for this goal. Free Appropriate Public Education (FAPE) When discussing FAPE for this student, it is important for the IEP team to remember that FAPE may include, as appropriate: Educational Programs and Services Proper Functioning of Hearing Aids Assistive Technology and/or accessible materials Transportation Nonacademic and Extracurricular Services and Activities Physical Education Extended School Year Services (ESY) Length of School Day SERVICES: Identify the service(s), including frequency, duration and location that will be provided to or on behalf of the student in order for the student to receive a free appropriate public education. Use this handy visual aid to see what’s in an IEP, and what the different parts of an IEP mean. È Below is a list of the participants (by name or position) the division will be inviting to attend the meeting: Please review and return the following page to assist the school staff in preparing for the meeting. Sample IEP Goal: By the end of the IEP period, when given a list of 40 multisyllabic words containing closed, open, consonant-vowel-e, and vowel team syllable types, the student will be able to decode 36/40 words correctly as measured by teacher records. Sample IEP Form (Word) Sample Transition IEP Form (Word) Calculation Tool for Least Restrictive Environment (LRE) Extended School Year Services (PDF) Your Family's Special Education Rights – Virginia Procedural Safeguards Notice (PDF) How will progress toward this annual goal be measured? Experience a faster way to fill out and sign forms on the web. The student with a disability shall be served in a program with age-appropriate peers unless it can be shown that for a particular student with a disability, the alternative placement is appropriate as documented by the IEP. The following provides a basic IEP, filled out for you to review. The first section includes those pages that are the foundation of all IEPs. Ensures that a website is free of malware attacks. * Progress reports will be provided at least as often as parents are informed of the progress of children without disabilities. Sample 2 Sample Plan for a Student With Low to Moderate Needs (e.g., a student with a learning disability who is seeking admission to a college or university). _____ I do not give my consent for an agency representative(s) named on the meeting notice to be invited to the IEP meeting. If prior consent has been given, no further action is required. # hr ^J National Association of Special Education Teachers NASET | Completed Sample IEP 4 2-Social Development: Describe the quality of the student's relationships with peers and adults, feelings about self, social adjustment to school and community environment and behaviors that may impede Concerns shared with the team discussed up to Age Thirteen, as needed sections of the IEP team document outlines... 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