SPD 510 T 4 Mock IEP
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School
Grand Canyon University *
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Course
510
Subject
Health Science
Date
Feb 20, 2024
Type
docx
Pages
12
Uploaded by MateAntelopeMaster289
1
Special Education Department
Individualized Education Program (IEP)
Student Name:
Student Data/Cover Sheet (Form A-1)
IEP Meeting Date:
Student ID:
DOB:
Demographic Information
Student Number:
Student Name:
Birthdate:
Gender:
Grade:
Student Address:
Home Phone:
City, State, Zip:
Parent 1 Name:
Parent 1 Relationship:
Parent 1 Address:
Home Phone:
City, State, Zip:
Work Phone:
Parent 1 Email:
Parent 2 Name:
Parent 2 Relationship:
Parent 2 Address:
Home Phone:
City, State, Zip:
Work Phone:
Parent 2 Email:
Primary Language of Home:
Primary Language Survey Date:
Primary Language Survey Results:
Language of Instruction:
Home District:
Attendance District:
Service Coordinator:
Home School:
Attending School:
Vision Screened On:
Results:
Hearing Screened On:
Results:
Meeting Date:
Anticipated Duration of IEP:
To
Re-evaluation Due:
Current Evaluation:
Special Education Primary Category #1:
Special Education Eligibility Category #2:
Special Education Eligibility Category #3:
For Students with SLD only, the following area(s) of eligibility was/were previously determined:
Level of Services: (A)
Type: of Meeting:
Date Meeting Notice Sent to the Parent(s):
Date Procedural Safeguards given to the Parent(s):
2
Special Education Department
Individualized Education Program (IEP)
The following persons participated
in the conference and/or the development of the IEP. Additionally, parents have
been given a copy of their rights regarding the student’s placement in special education and understand that they have the right to request a review of their child’s IEP at any time.
Position/Relation to Student
Participant
Date (MM/DD/YY)
*If during the IEP year the student turns 16, if the student is not present at the IEP meeting, the service coordinator must review the IEP with the student and obtain the student’s signature and the date of this review.
3
Special Education Department
Individualized Education Program (IEP)
PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Section 1: Current IEP Information
Goal Number Written:
Summarize special education services the student is receiving:
Section 2: Evaluation Information
Areas of Eligibility
Special Education Primary Category:
Special Education Eligibility Category #2:
Special Education Eligibility Category #3:
For students with SLD only, the following area(s) of eligibility was previously determined:
Section 3: Present Level of Academic Achievement
READING
WRITING
MATH
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4
Parent’s Input on Student’s Current Academic Achievement:
Current Classroom-Based Data:
State and District Assessments:
Section 4: Functional Performance
Social Emotional and Behavior:
Parent’s Input and Student’s Current Functional Achievement:
Summary of Work Habits:
Section 5: Summary of Educational Needs
5
Special Education Department
Individualized Education Program (IEP)
ADDITIONAL DOCUMENTATION/CONSIDERATION OF SPECIAL FACTORS
Considered Not
Included
Needed
Individual Transition Plan
Statement of Transfer of Parental Rights at Age of Majority
For a student whose behavior impedes his/her learning, or that of
others, positive behavior interventions, strategies, and supports have
been considered.
Statement of Language Needs in the Case of a Child with Limited English
Proficiency
Statement of Provisions of Instruction in Braille & User of Braille for a
Visually Impaired Child
Statement of the Language of Needs, Opportunities for Direct Communication
with Peers in the Child’s Language and Communication Mode
Statement of Required Assistive Technology Devices and Services
Statement of Communication Needs for a Child with a Disability
Statement of Health Concerns
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6
Special Education Department
Individualized Education Program (IEP)
Skill Area:
Written Expression
Standard:
Demonstrate mastery of their own writing process with clear, coherent, and error-free polished products
Annual Goal: By August 26, 2024 Lesley will work on completing written assignments using complete sentences in 4 out of 5 trials.
Baseline Level of Mastery: Lesley completes written assignments with complete sentences 1 out of 5 trials.
Service Provider(s) for this goal: Special Education Case Manager
Skill Area:
Social Emotional Behavior
Standard:
Utilize knowledge and skills to enhance mental, emotional, and social well-being.
Annual Goal: Lesley will work on controlling her anger and remain focused during classroom instruction. She will do this with no more than one prompt from the teacher.
Baseline Level of Mastery: Lesley receives 3 or more prompts from teachers to remain focused or to calm down.
Service Provider(s) for this goal: Special Education Case Manager
Skill Area:
Communication
Standard: Deliver effective oral presentations for varied audiences and varied purposes.
Annual Goal: Lesley will continue to work on communication skills in small group and whole group settings. She will calmly and effectively present the information she has learned to others in 3 out of 5 trials.
Baseline Level of Mastery: Lesley is currently able to present information 1 out of 5 trials
Service Provider(s) for this goal: Special Education Case Manager
Skill Area:
Standard:
Annual Goal:
Baseline Level of Mastery:
Service Provider(s) for this goal:
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7
Special Education Department
Individualized Education Program (IEP)
ACCOMODATIONS
Date given to Genera Ed. Teacher:
Service Coordinator:
Accommodations do not change now much of the curriculum the student is expected to learn. It only changes how students access and express knowledge on a daily basis. Accommodations are changes in how a student accesses information and demonstrates learning. Accommodations do not substantially change the instructional level, content, or performance criteria. The changes are made in order to provide a student with equal access to learning and equal opportunity to show what he or she knows and can do. Students with disabilities who qualify in one academic area are eligible for accommodations in other areas to the extent that their disability would affect performance in those areas.
Accommodations
Type
Location
Use of a Calculator
3
A
Extra Time
3
A
Breaks As needed per BIP
3
A
Legend for Type and Location Fields
Type:
1 = Class work / assignments 2 = Assessments / tests 3 = Both class work / assignments / assessments.
Location:
A = All Subjects
B = Language Arts / English
C = Reading
D = Spelling
E = Math
F = Science
G = Social Studies
H = Health
I = Electives
J = Physical Ed.
K = Lunch
L = Transition / Vocation
M = Library
N = Title 1
Special / Exploratory
Parental Communication
How will the parent be informed of their child’s academic progress and the extent to which that profess is sufficient to enable the child to achieve annual goals by the end of the year?
IEP Team Consideration for Extended School Year
Consideration for eligibility: IEP team considered ESY eligibility in the areas of regression and recoupment factors and essential skills at a critical stage of development.
8
Eligible for ESY:
Written explanation as to why ESY is or is not needed:
9
Special Education Department
Individualized Education Program (IEP)
ASSESSMENT
Rationale: Students with disabilities will participate in usual district assessments unless indicated by this form. Only those accommodations that are provided for instruction and are required by the IEP should be provided for assessment. All students will be assessed at grade level, other than the few who must be provided alternative assessments. State Assessments
Standard Accommodation(s):
District Assessments
Standard Accommodation(s):
CURRENT STATE STANDARDIZED TEST (i.e., AIMS, PSSA) RESULTS
Testing Area
Test Results
Grade
Semester
Year
Reading
Writing
Math
Science
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10
Special Education Department
Individualized Education Program (IEP)
SPECIAL EDUCATION SERVICES TO BE PROVIDED
Special Education Program(s) Necessary to Meet Special Education Goals and Objectives during the school calendar year.
**The child is in need of specially designed instruction in the following areas:
Special Education Services
Instructional Setting / Location
Start Date
Frequency
Provider
Duration / End Date
ESS
General Ed
08/27/2023
100 Min/wk
ESS Staff
8/27/2024
ESS
Resource
08/27/2023
225 Min/Wk
ESS Teacher
8/27/2024
RELATED SERVICES
Educationally Relevant Related Services Are Listed Below
Special Education Services
Instructional Setting / Location
Start Date
Frequency
Provider
Duration / End Date
Clarification:
SUPPLEMENTARY AIDS / ASSISTIVE TECHNOLOGY AND SERVICE FOR STUDENTS
Educationally Relevant Supplementary Aides / Assistive Technology and Services Are Listed Below.
SUPPORTS FOR SCHOOL PERSONNEL
Supports For School Personnel Are Listed Below
Clarification:
LEAST RESTRICTIVE ENVIRONMENT
Provide an explanation of the extent, if any, to which the student will NOT
participate with non-disabled students in the general curricular, extracurricular and nonacademic activities, and program options. §300.347(a)(4):
Lesley will benefit from being in the general education class with her peers for the majority of the day. She will spend at least 80% of her day taking general education courses. This is most beneficial for her because she will receive instruction for her grade-level curriculum first hand from her teachers. Lesley will have access to the resource room on a daily basis to help provide additional support for her general academic courses and additional individualized instruction she may need in the areas of math computation, math problem solving as well as written expression. Lesley will also have the ability to work with an ESS staff member in her Algebra class as well as during English. This placement will be the best fit for Lesley, due to her current success with her academics.
Consider any potential harmful effects of this placement for the child or on the quality of services that he or she needs §300.552 (a-b):
Reason for Different Services School:
11
Rationale
Based on the information provided Lesley seems to have made a lot of progress in basic math computation and in the specific area of algebra. Her area of struggle is in geometry which she has completed this class as of the end of the last school year. She still struggles in this area and will need to have assistance and extra time as well as instructional support when working on this area. However, as a
team we have decided that Lesley is not in need of a math goal at this time and if she begins to have any
struggles with her algebra class, we will consider amending the IEP at that time. Lesley will continue to work towards improving her writing skills and using complete sentences in all written responses. Lesley will also continue working on controlling her anger and maintaining focus during instruction of the general education curriculum. With that she will also continue to work on advocating for breaks as needed to help maintain the focus and calm demeanor in class. Lesley will also continue to work in the transition area during her resource class by looking into careers that interest as well as continuing to work in the preschool as an assistant teacher to help her find what she is good at and what she enjoys. Also, this is part of her transition as she is of high school age. Lesley will have mostly general education classes other than the resource class with support from the ESS staff in the resource room and frequent check in while in her ELA class by an ESS staff member. With Lesley’s disability of specific learning disability, it is best that she is in all general education classes receiving instruction first hand from the course teachers. She does have a behavior intervention plan set in place and that will continue to be followed throughout each day as needed. Lesley will also benefit from having extra time for her assignments and assessments especially in the ELA classroom.
12
References:
Colorado Department of Education. (2023). Colorado academic standards online.
Retrieved on August 27, 2023 from https://www.cde.state.co.us/apps/standards/3,15,0
Mock IEP. https://halo.gcu.edu/resource/13a2a5d3-3d5e-4f40-a00f-7ce73cba35b2?
nestedResourceId=317a67f1-5507-4bfc-a81c-8835d4a4c92b
Center For parents information and resources. (April, 2022). Retrieved on August 27, 2023 from https://www.parentcenterhub.org/iep/
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