EDUC 521 IEP Project Final IEP A Isaacs

EDSP 521 Virginia Department of Education’s Sample IEP Form For Use with Students up to Age Thirteen, as Appropriate Adrienne Isaacs EDUC 521 Foundations of Exceptionality April 10, 2023 Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 1 of 27

EDSP 521 INDIVIDUALIZED EDUCATION PROGRAM PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE Student Name______Elli Smith ___________________________________ Date_4 _/10 __/_23 _ Page ___of___ Student ID Number_____________________________________________________ Demographic Information and Background: Elli Smith is an 8-year-old female currently entering the second grade. According to psychological evaluation, Elli demonstrates an overall ability in the average range. Elli was found eligible for special education services based on a diagnosis of specific learning disability. She has received PALS remediation and Title I supports for reading for six months and has made minimal progress despite supplemental instruction interventions targeting her identified deficit areas. Test Scores: Wechsler Individual Achievement Test – Third Edition (WIAT–III) Subtests with age-based scores: Listening Comprehension 90, Early Reading Skills 92, Reading Comprehension 79, Math Problem Solving 80, Alphabet Writing Fluency 96, Sentence Composition 90, Word Reading 72, Pseudoword Decoding 77, Numerical Operations 93, Oral Expression 95, Oral Reading Fluency 63, Spelling 80, Math Fluency – Addition 83, Math Fluency – Subtraction 89, Oral Reading Accuracy 61, Oral Reading Rate 78 Listening Comprehension Receptive Vocabulary 81 Below Average Oral Discourse Comprehension 103 Average Sentence Composition Sentence Combing 98 Average Sentence Building 84 Below Average Oral Expression Expressive Vocabulary 85 Average, Oral Word Fluency 107 Average Sentence Repetition 97 Average, Oral Language 91 Average Total Reading 69 Low, Basic Reading 75 Below Average Written Expression 85 Average Mathematics 85 Average, Math Fluency 86 Average Total Achievement 82 Below Average Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 2 of 27

EDSP 521 INDIVIDUALIZED EDUCATION PROGRAM (IEP) PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE, continued Student Name______Elli Smith ___________________________________ Date_4 _/10 __/_23 _ Page ___of___ Student ID Number__________________________________ PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE, continued. Effects of Disability on Academic Performance: Elli’s specific learning disability (SLD) affects writing by decreasing her ability to formulate sentences and communicate in writing on grade-level. Elli’s reading is affected because she is unable to decode accurately. She had poor word attack skills and has not been able to make progress in this area despite the intervention of Title and PALS remediation. Elli overall academic performance is affected because her SLD makes reading acquisition difficult, therefore she is unable to sufficiently comprehend written materials provided in class. Mathematics, science, and history/social sciences are not currently affected by Elli’s SLD. Effects of Disability on Functional Performance: Elli’s SLD does not appear to affect her functional performance. Based on teacher feedback, Elli’s social competence, communication, behavior, and personal management are within normal range. She gets along well with others and seems to love being around her peers at school. Elli also is reported to have positive interactions with her teachers. She is also reported to demonstrate eagerness and cheerfulness in school. Interests, Preferences and Strengths: Based on the above teacher feedback and achievement test scores, Elli demonstrates average oral language skills as evidenced by listening comprehension, oral discourse comprehension, and oral language scores. Teachers also report that Elli does well when comprehension is tested orally. Therefore, oral language skills appear to be an area of strength. Artistic expression is also an area of strength and interest for Elli. art. She loves art, and anything related to crafts. Connecting reading related activities to art activities may help to build upon Elli’s strengths and interests. Based on achievement scores and teacher feedback, mathematics skills also appear to be an area of strength for Elli. She had average mathematics scores on the WIAT- III and teachers report that she has been using the math strategies taught in class well. Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 4 of 27

EDSP 521 INDIVIDUALIZED EDUCATION PROGRAM (IEP) MEASURABLE ANNUAL GOALS, PROGRESS REPORT Student Name______Elli Smith ___________________________________ Date_4 _/10 __/_23 _ Page ___of___ Student ID Number________________________________ Area of Need____Receptive Vocabulary ___________________ # 1 MEASURABLE ANNUAL GOAL: By next annual review, when verbally given one new vocabulary within a sentence for context, Elli will correctly identify a picture depicting the vocabulary word by pointing and orally explaining her choice with an oral story of 8 or more words, in 4 out of 5 trials. The IEP team considered the need for short-term objectives/benchmarks.  Short-term objectives/benchmarks are included for this goal. (Required for students participating in the VAAP)  Short-term objectives/benchmarks are not included for this goal. SHORT-TERM OBJECTIVES: Objective/Benchmark #___ Objective/Benchmark #___ Objective/Benchmark #___ How will progress toward these annual goals be measured? (Check all that apply) ☐ Classroom Participation ☐ Checklist ☐ Classwork ☐ Homework ☐ Observation ☐ Special Projects ☐ Tests and Quizzes ☐ Written Reports ☐ Criterion-referenced test:_____________________ ☐ Norm-referenced test: _______________________ ☒ Other:_weekly receptive vocabulary probes_ _____ Progress on this goal will be reported to the parent or adult student using the following codes. Attach comments using progress report comment form located in section two. Anticipated Date of Progress Report* Actual Date of Progress Report Progress Code SP -The student is making S ufficient P rogress to achieve this annual goal within the duration of this IEP. IP - The student has demonstrated I nsufficient P rogress to meet this annual goal and may not achieve this goal within the duration of this IEP. ES - The student demonstrates E merging S kill but may not achieve this goal within the duration of this IEP. NI - The student has N ot been provided I nstruction on this goal. M -The student has M astered this annual goal. * Progress reports will be provided at least as often as parents are informed of the progress of children without disabilities. Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 5 of 27

EDSP 521 INDIVIDUALIZED EDUCATION PROGRAM (IEP) MEASURABLE ANNUAL GOALS, PROGRESS REPORT Student Name______Elli Smith ___________________________________ Date_4 _/10 __/_23 _ Page ___of___ Student ID Number________________________________ Area of Need____Writing______ ___________________ # 3 MEASURABLE ANNUAL GOAL: By the next annual review, given a picture prompt, Elli will compose and self-edit a sentence with correct spelling on her instructional level (first grade), correct capitalization and punctuation, and correct subject-verb agreement with 80 % accuracy over 4 out of 5 trials. The IEP team considered the need for short-term objectives/benchmarks.  Short-term objectives/benchmarks are included for this goal. (Required for students participating in the VAAP)  Short-term objectives/benchmarks are not included for this goal. SHORT-TERM OBJECTIVES: Objective/Benchmark #___ Objective/Benchmark #___ Objective/Benchmark #___ How will progress toward these annual goals be measured? (Check all that apply) ☐ Classroom Participation ☐ Checklist ☐ Classwork ☐ Homework ☐ Observation ☐ Special Projects ☐ Tests and Quizzes ☐ Written Reports ☐ Criterion-referenced test:_____________________ ☐ Norm-referenced test: _______________________ ☒ Other:_weekly writing progress monitoring probes _ Progress on this goal will be reported to the parent or adult student using the following codes. Attach comments using progress report comment form located in section two. Anticipated Date of Progress Report* Actual Date of Progress Report Progress Code SP -The student is making S ufficient P rogress to achieve this annual goal within the duration of this IEP. IP - The student has demonstrated I nsufficient P rogress to meet this annual goal and may not achieve this goal within the duration of this IEP. ES - The student demonstrates E merging S kill but may not achieve this goal within the duration of this IEP. NI - The student has N ot been provided I nstruction on this goal. M -The student has M astered this annual goal. * Progress reports will be provided at least as often as parents are informed of the progress of children without disabilities. Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 7 of 27

EDSP 521 INDIVIDUALIZED EDUCATION PROGRAM (IEP) SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT ACCOMMODATIONS/MODIFICATIONS Student Name______Elli Smith ___________________________________ Date_4 _/10 __/_23 _ Page ___of___ Student ID Number___________________________________ This student will be provided access to general education classes, special education classes, other school services and activities, including nonacademic activities, extracurricular activities, and education-related settings: ___ with no accommodations/modifications _X _ with the following accommodations/modifications Accommodations/modifications provided as part of the instructional and testing/assessment process will allow the student equal opportunity to access the curriculum and demonstrate achievement. Accommodations/modifications also provide access to nonacademic and extracurricular activities and educationally related settings. Accommodations/modifications based solely on the potential to enhance performance beyond providing equal access are inappropriate. Accommodations may be in, but not limited to, the areas of time, scheduling, setting, presentation and response including assistive technology and/or accessible materials. The impact of any modifications listed should be discussed. ACCOMMODATIONS/MODIFICATIONS (list, as appropriate) Accommodation(s)/Modification(s) Frequency Location (name of school *) Instructional Setting Duration m/d/y to m/d/y Audiobooks daily Elli’s Elementary School Reg Ed Classroom 4/10/23 to 6/30/23 (the remainder of the school year) C-Pen (text-to-speech pen reader) daily Elli’s Elementary School Reg Ed Classroom 4/10/23 to 6/30/23 (the remainder of the school year) Highlighted Class Notes daily Elli’s Elementary School Reg Ed Classroom 4/10/23 to 6/30/23 (the remainder of the school year) Graphic Organizers daily Elli’s Elementary School Reg Ed Classroom 4/10/23 to 6/30/23 (the remainder of the school year) * 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. 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. Supports for School Personnel: (Describe supports such as equipment, consultation, or training for school staff to meet the unique needs for the student) ___ The school will need to acquire audiobooks and a headset for Elli to use to listen to materials provided in text format for the other students. Elli will also need the books to read along with the audios. The teachers could use training in how to create graphic organizers and highlighted class notes that will assist Elli in better accessing the essential information in her lessons. The school will also need to purchase a C- Pen and headset that Elli can use to scan and read books that do not have audiobooks available . ______________ Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 8 of 27

EDSP 521 INDIVIDUALIZED EDUCATION PROGRAM (IEP) PARTICIPATION IN THE STATE AND DIVISIONWIDE ACCOUNTABILITY/ASSESSMENT SYSTEM (continued) Student Name______Elli Smith ___________________________________ Date_4 _/10 __/_23 _ Page ___of___ Student ID Number__________________________________ PARTICIPATION IN STATEWIDE ASSESSMENTS Test Assessment Type* (SOL, VSEP,VAAP) Accommodations** If yes, list accommodation(s) Reading  ____SOL _______________________________  Not Assessed at this Grade Level  Yes  No Reader for passages and questions, Additional Time Math  ___SOL ______________________________  Not Assessed at this Grade Level  Yes  No Reader (for word problems only) Science  ___SOL ______________________________  Not Assessed at this Grade Level  Yes  No Reader for passages and questions, Additional Time History/SS  ___SOL ______________________________  Not Assessed at this Grade Level  Yes  No Reader for passages and questions, Additional Time Writing  ___SOL ______________________________  Not Assessed at this Grade Level  Yes  No N/A * Students with disabilities are expected to participate in all content area assessments that are available to students without disabilities. The IEP Team determines how the student will participate in the accountability system. ** Accommodation(s) must be based upon those the student generally uses during classroom instruction and assessment, including assistive technology and/or accessible materials. For the accommodations that may be considered, refer to VDOE’s Students with Disabilities: Guidelines for Assessment Participation for guidance.  Division-wide Assessment (list): ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ___________________________________________________________________________________________________ EXPLANATION FOR NON-PARTICIPATION IN REGULAR STATE OR DIVISION-WIDE ASSESSMENTS If an IEP team determines that a student must take an alternate assessment instead of a regular state assessment, explain in the space below why the student cannot participate in this regular assessment; why the particular assessment selected is appropriate for the student, including that the student meets the criteria for the alternate assessment; and how the student’s nonparticipation in the regular assessment will impact the child’s promotion; or other matters. Refer to the VDOE’s Students with Disabilities: Guidelines for Assessment Participation for guidance.  Alternate/Alternative Assessments Participation Criteria is attached or maintained in the student’s educational record ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ ____________________________________________________________________________________________________ Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 10 of 27

EDSP 521 INDIVIDUALIZED EDUCATION PROGRAM (IEP) SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT, Continued Student Name______Elli Smith ___________________________________ Date_4 _/10 __/_23 _ 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.  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.  The student’s placement should be as close as possible to the child’s home and unless the IEP of the student with a disability requires some other arrangement, the student is educated in the school that he or she would attend if he or she did not have a disability.  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.  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. 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. 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. Address any needed transportation and physical education services including accommodations and/or modifications. * These services are listed on the “Accommodations/Modifications” page and “Extended School Year Services” page, as needed. Service(s) Frequency **School/location Instructional Setting (classroom) Duration m/d/y to m/d/y Orton Gillingham Tutoring Twice weekly Resource classroom 4/10/23 to 6/30/23 (the remainder of the school year) ** 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. 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. Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 11 of 27

EDSP 521 Student Name______Elli Smith ___________________________________ Date_4 _/10 __/_23 _ Page ___of___ Student ID Number___________________________________ PRIOR NOTICE The school division proposes to implement this IEP. This proposed IEP will allow the student to receive a free appropriate public education in the least restrictive environment. This decision is based upon a review of current records, current assessments and the student’s performance as documented in the Present Level of Academic Achievement and Functional Performance. 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. Additionally, other factors, if any that are relevant to this proposal are attached. Parent and adult student rights are explained in the Procedural Safeguards. If you, the parent(s) and adult student, need another copy of the Procedural Safeguards or need assistance in understanding this information please contact ________________________________ at (___) ____________ or e-mail ________________________________ or ________________________________ at (___) ____________ or e-mail ________________________________ . ____ Parent(s) initials here indicate that the parent(s) has read the above prior notice and attachments, if any, before giving permission to implement this IEP. PARENT/ADULT STUDENT CONSENT : Indicate your response by checking the appropriate space and sign below. ___ I give permission to implement this IEP. ___ I do not give permission to implement this IEP. ____________________________________________________ ____/____/____ Parent Signature Date Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 13 of 27

EDSP 521 TRANSITION INDIVIDUALIZED EDUCATION PROGRAM (IEP) PRIOR WRITTEN NOTICE Student Name__________________________________________________________ Date____/____/____ Page ___of___ Student ID Number___________________________________ Describe the action that the school division proposes or refuses to take: (Required upon graduation with a standard or advanced diploma) Explanation of why the school division is proposing or refusing to take action: Description of each evaluation procedure, assessment, record or report the school division used in deciding to propose or refuse the action: Description of any other choices that the Individualized Education Program (IEP) team considered and the reasons why those choices were rejected: Description of other reasons or other factors relevant as to why the school division proposed or refused the action: Resources for the parent to contact for help in understanding the Individuals with Disabilities Education Act (IDEA) and the related federal and Virginia Regulations: If this notice is not the initial referral for evaluation, document when the parent was provided a copy of the procedural safeguards and how a copy maybe obtained, if the parent requests an additional copy: Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 14 of 27

EDSP 521 ELEMENTARY INDIVIDUALIZED EDUCATION PROGRAM (IEP) PROCESS CHECKLIST  Meeting notices sent to parent and agency representatives, as appropriate  Acquire written consent from parent for an agency representative to attend the IEP meeting  Welcome and introductions of team members  Review purpose of meeting  Review meeting agenda  Review rights and procedural safeguards pertaining to special education and the IEP meeting  Review of special factors to be considered by the IEP team  Develop Present Level of Academic Achievement and Functional Performance  Develop measurable annual goals (Discuss progress report on previous annual goals, as needed.)  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 Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 16 of 27

EDSP 521 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. If you are unable to attend this meeting you may request participation through other means. If you are unable to attend this meeting, please contact: Special Education Staff Contact / IEP Case Manager Title Phone You and the school division may invite individuals to participate in the team meeting who have knowledge or expertise about the student’s educational needs. The determination of the knowledge or special expertise shall be made by the party who invited the individual. 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. 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. Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 17 of 27

EDSP 521 SAMPLE School Division Letterhead CONSENT TO INVITE AGENCY PERSONNEL Date: _____________ If the division intends to invite a representative of any agency that is likely to be responsible for providing or paying for transition services to the IEP meeting, written consent from the parent or adult student is required prior to the meeting date. _____ I give my consent for an agency representative(s) named on the meeting notice to be invited to the IEP meeting. _____ I do not give my consent for an agency representative(s) named on the meeting notice to be invited to the IEP meeting. Parent/Adult Student Signature Date ________________________________________ ______________________ Parent/Adult Student Signature Date **Please sign and return this page to your child’s IEP Case Manager. Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 19 of 27

EDSP 521 INDIVIDUALIZED EDUCATION PROGRAM (IEP) COVER PAGE – MEDICAID ELIGIBLE STUDENTS Student Name_________________________________________________________________________ Page ___ of ___ Student ID Number__________________________________ Medicaid/FAMIS # ____________________ Grade_______ DOB ____/____/____ Age* ________ Disability(ies) (if identified) ____________________________________________ Parent (s)Name_____________________________________________________Email ____________________________ Home Address_____________________________________________________ Primary (____)_____________________ _____________________________________________________ Secondary (____)___________________ Date of IEP meeting…………………...…………………….……………………… ..... ……..………….._____/_____/_____ Date parent notified of IEP meeting………………………………..……………………...………………_____/_____/_____ This IEP will be reviewed no later than ………..…………………….……………..……….……………_____/_____/_____ Most recent eligibility date…………………………….…………………………………….……………._____/_____/_____ Next re-evaluation, including eligibility, must occur before ………..……..…………..…..…………….._____/_____/_____ Copy of IEP given to parent (Name) _____________________________________________ On (Date)_____/_____/_____ IEP Teacher/Manager_________________________________________ Phone Number (____)______________________ PARTICIPANTS INVOLVED : The list below indicates that the individual participated in the development of this IEP and the placement decision; it does not authorize consent. Parent consent is indicated on the “Prior Notice” page. NAME OF PARTICIPANT POSITION _____________________________________________________ ____________________________________ _____________________________________________________ ____________________________________ _____________________________________________________ ____________________________________ _____________________________________________________ ____________________________________ _____________________________________________________ ____________________________________ Required for Billable Services ICD9 Code _________________________ Medicaid Discharge Plan/Disposition _______________________________ Virginia Department of Education -- Sample IEP Form—Revised August, 2015 Page 20 of 27 Summary of previous treatment if not addressed elsewhere: ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ________________________________________________________________________________________________ Intervention, treatment, and modalities if not addressed elsewhere: ___________________________________________________________________________________________________ ___________________________________________________________________________________________________ ________________________________________________________________________________________________