IEP Project: Final IEP Assignment Instructions Overview Special education teachers are responsible for developing and implementing Individualized Education Programs (IEPs) for students with exceptiona

EDSP 521

For Use with Students up to Age Thirteen, as Appropriate

COMPLETE ALL COMPONENTS HIGHLIGHTED IN YELLOW

Teacher Candidate Name:

Course:

Date:

INDIVIDUALIZED EDUCATION PROGRAM

Student Name__________________________________________________________ Date____/____/____ Page ___of___

Student ID Number_____________________________________________________

The Present Level of Academic Achievement and Functional Performance summarize the results of assessments that identify the student’s interests, preferences, strengths and areas of need, including assistive technology and/or accessible materials. It also describes the effect of the student’s disability on his or her involvement and progress in the general education curriculum, and for preschool children, as appropriate, how the disability affects the student’s participation in appropriate activities. This includes the student’s performance and achievement in academic areas such as writing, reading, mathematics, science, and history/social sciences. It also includes the student’s performance in functional areas, such as self-determination, social competence, communication, behavior and personal management. 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. There should be a direct relationship among the desired goals, the Present Level of Academic Achievement and Functional Performance, and all other components of the IEP.

_______________________________________________________________________________________________

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student Name________________________________________________________ Date ____/____/____ Page ___of___

Student ID Number__________________________________

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

MEASURABLE ANNUAL GOALS, PROGRESS REPORT

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.

 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 #___

* Progress reports will be provided at least as often as parents are informed of the progress of children without disabilities.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

MEASURABLE ANNUAL GOALS, PROGRESS REPORT

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.

 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 #___

* Progress reports will be provided at least as often as parents are informed of the progress of children without disabilities.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

MEASURABLE ANNUAL GOALS, PROGRESS REPORT

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.

 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 #___

* Progress reports will be provided at least as often as parents are informed of the progress of children without disabilities.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT

Student Name_________________________________________________________ Date____/____/____ 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

___ 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)

* 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.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

SERVICES – LEAST RESTRICTIVE ENVIRONMENT – PLACEMENT, Continued

PARTICIPATION IN THE STATE AND DIVISIONWIDE ACCOUNTABILITY/ASSESSMENT SYSTEM

Student Name________________________________________________________ Date ____/____/____ Page ___of___

Student ID Number__________________________________

This student’s participation in state and division-wide assessments must be discussed annually. During the duration of this IEP:

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.

 State Assessments:*

___ SOL Assessments  Reading  Math  Science  History/Social Science  Grade 8 Writing

___ Virginia Substitute Evaluation Program (VSEP)  Reading  Math  Science  History/Social Science  Grade 8 Writing

___ Virginia Alternate Assessment Program (VAAP)

 Division-wide Assessment (list):

____________________________________________________________________________________________________________________________________________________________________________________________________________________

*Refer to Students with Disabilities: Guidelines for Assessment Participation for additional guidance on the assessment programs.

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

* 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

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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.

• 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:

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.

** 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.

SERVICES – 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.

• The IEP team determined that the student does not need ESY services. Describe.

• The IEP team will determine and/or address ESY services at a later date. Addressed by date:______________

Explain:

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. All placement decisions shall be based on the individual needs of each student. 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. In considering the placement continuum options, check those the team discussed. Then, describe the placement selected in the PLACEMENT DECISION section below. Determination of the Least Restrictive Environment (LRE) and placement may be one or a combination of options along the continuum.

Based upon identified services and the consideration of least restrictive environment (LRE) and placement continuum options, describe in the space below the placement. Additionally, summarize the discussions and decision around LRE and placement. 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. Attach additional pages as needed.

Explanation of Placement Decision:

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

PRIOR NOTICE AND PARENT CONSENT

Student Name__________________________________________________________ Date____/____/____ Page ___of___

Student ID Number___________________________________

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

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:

SECTION 2

Additional Forms

To Be Used

As Needed

ELEMENTARY INDIVIDUALIZED EDUCATION PROGRAM (IEP)

• 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

Special Education Meeting Notice

(School Division Letterhead)

Parent(s)/Adult Student Student (if appropriate or if transition will be discussed)

You are invited to attend a meeting regarding ____________________________________________

Student’s Name

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:

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.

Special Education Meeting Notice Parent/Student Response Form

To the Parent(s) / Guardian(s) / Student:

(date) (time and place)

to determine a mutually agreeable date, time, and place for this IEP meeting.

 An IEP worksheet is enclosed.

 I will need the following accommodations for this IEP meeting:

 I plan to bring _______ individuals that I believe have knowledge or expertise regarding my child.

______________________________________ ___________________________________

Parent Signature Date

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.

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 (____)______________________

Summary of previous treatment if not addressed elsewhere: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Intervention, treatment, and modalities if not addressed elsewhere: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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

_____________________________________________________ ____________________________________

_____________________________________________________ ____________________________________

_____________________________________________________ ____________________________________

_____________________________________________________ ____________________________________

_____________________________________________________ ____________________________________

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). Parent/Guardian consent is required before the public school system can bill Medicaid or FAMIS.

Additional information about the one-time parental consent, the parental consent form and the procedural safeguards can be found at http://www.doe.virginia.gov/support/health_medical/medicaid/index.shtml.

If prior consent has been given, no further action 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.

 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.

* Progress reports will be provided at least as often as parents are informed of the progress of their children without disabilities.

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

SHORT TERM OBJECTIVES OR BENCHMARKS, as determined by IEP Team

(Required for students participating in the VAAP)

Student Name__________________________________________________________ Date____/____/____ Page ___of___

Student ID Number________________________________ Goal # _____ Area of Need: ___________________________

Short Term Objectives or Benchmarks, as needed

Objective/Benchmark #___

Objective/Benchmark #___

Objective/Benchmark #___

Objective/Benchmark #___

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

PROGRESS REPORT COMMENTS, Continued

(This document is optional)

Student Name__________________________________________________________ Date____/____/____ Page ___of___

Student ID Number________________________________

Goal #___ Progress Report Code ___

Goal #___ Progress Report Code ___

Goal #___ Progress Report Code ___

Goal #___ Progress Report Code ___

Goal #___ Progress Report Code ___

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

EXTENDED SCHOOL YEAR SERVICES (ESY)

(Optional)

Student Name_________________________________________________________ Date____/____/____ Page ___of___

Student ID Number___________________________________

Identify the Extended School Year services needed to meet these goals:

** 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.