Fillable Printable What Is An Individual Education Plan
Fillable Printable What Is An Individual Education Plan
What Is An Individual Education Plan
Oregon Department of Education Office of Student Learning & Partnerships
Public Service Building
255 Capitol Street NE
Salem, OR 97310-0203
OREGON STANDARD INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Oregon Standard INDIVIDUALIZED EDUCATION PROGRAM
For students age 15 and younger when IEP is in effect
To be used in conjunction with Individualized Education Program, Part A: IEP Guidelines for Completion
Student’s Name: District: Annual IEP Meeting Date:
__M ___FHome School: Revision date(s) to annual IEP (if needed):
Date of Birth (mm/dd/yy): Attending School/District:Reevaluation Due:
Grade: Case Manager:
Secure Student Identifier (SSID):
Disability Code:
IEP Meeting Participants:
Parent(s):
Special Education Teacher / Provider:
District Representative
Student:
Regular Education Teacher:
Individual Interpreting Evaluations:
Other:
Other:
Other:
Form 581-5138a-P Page 1 of 7
1/2011: Oregon Standard IEP for students age 15 and younger when IEP is in effect
If a required participant participates through written input or is excused from all or part of the IEP meeting, attach documentation of
parents’ and district agreement to participation by written input or excuse.
Student’s Name: Date: School District:
The IEP team must consider these factors as part of IEP development:
A. Does the student need assistive technology devices or services?
__ Yes, services/devices addressed in IEP __ No
B. Does the student have communication needs?
__ Yes, addressed in IEP __ No
C. Does the student exhibit behavior that impedes his/her learning or the learning of others?
__ Yes__ No
(if yes, the IEP Team must consider the use of strategies, positive behavioral interventions, and supports to address the behavior(s)
D. Does the student have limited English proficiency?
__ Yes__ No
(If yes, the IEP Team must consider the language needs of the student as those needs relate to the IEP)
E. Is the student blind or visually impaired?
__ Yes__ No
(if yes, Braille needs are addressed in the IEP, or evaluation of reading/writing needs is completed and a determination is made that Braille
is
not appropriate)
F. Is the student deaf or hard of hearing?
__ Yes__ No
(if yes, the IEP addresses the student’s language and communication needs, opportunities for direct communication with peers and
professional personnel in the child’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).
Present Levels of Academic Achievement and Functional Performance
The Present Levels of Academic Achievement and Functional Performance must include specific information addressing:
The strengths of the student;
The concerns of the parents for enhancing the education of their child;
The present level of academic performance, including the student’s most recent performance on State or district-wide assessments;
The present level of developmental and functional performance (including the results of the initial or most recent evaluation); and,
How the student’s disability affects involvement and progress in the general education curriculum.
___________________________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________________________________
Form 581-5138a-P Page 2 of 7
1/2011: Oregon Standard IEP for students age 15 and younger when IEP is in effect
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Student’s Name: Date: School District:
Statewide Assessment
Will the student participate in any Statewide Assessment during this IEP period?
No, Statewide Assessment not conducted at student’s grade level (at time of testing)
Yes (student’s grade level at time of testing __________). If yes, describe participation decisions below:
Regular AssessmentAlternate Assessment
* Explanation
State why student cannot participate in regular assessment
and why particular alternate assessment selected is
appropriate for student.
Accommodations
Reading/Literature:
3, 4, 5, 6, 7, 8, and HS/11
Standard (may include
accommodations)
* Extended Assessment
* Standard Administration
* Scaffold Administration
Mathematics:
3, 4, 5, 6, 7, 8, and HS/11
Standard (may include
accommodations)
* Extended Assessment
* Standard Administration
* Scaffold Administration
Writing:
4,7 and HS/11
Standard (may include
accommodations)
* Extended Assessment
* Standard Administration
* Scaffold Administration
Science:
5, 8 and HS/11
Standard (may include
* Extended Assessment
* Standard Administration
* Scaffold Administration
Form 581-5138a-P Page 3 of 7
1/2011: Oregon Standard IEP for students age 15 and younger when IEP is in effect
accommodations)
Student’s Name: Date: School District:
Districtwide Assessment
Will the student participate in any Districtwide assessment during this IEP period?
No, Districtwide Assessment not conducted at student’s grade level (at time of testing)
Yes, student’s grade level at time of testing _________. If yes, describe participation decisions below:
Regular AssessmentAlternateAssessment
* Explanation:
State why student cannot participate in regular assessment
and why particular alternate assessment selected is
appropriate for student.
Accommodations
Assessment:
__________________
Grades administered:_______
Standard administration
* District Alternate Assessment
*Other:______________________
Assessment:
__________________
Grades administered:_______
Standard administration
* District Alternate Assessment
*Other:______________________
Assessment:
__________________
Grades administered:_______
Standard administration
* District Alternate Assessment
*Other:______________________
Form 581-5138a-P Page 4 of 7
1/2011: Oregon Standard IEP for students age 15 and younger when IEP is in effect
Assessment:
__________________
Grades administered:_______
Standard administration
* District Alternate Assessment
*Other:______________________
Student’s Name: Date: School District:
Measurable annual goals page:
Measurable Annual Goals:
How progress will be measured:How progress will be
reported to parents:
When progress will be
reported to parents:
CriteriaEvaluation ProceduresStudent’s Progress Toward Goal
.
Form 581-5138a-P Page 5 of 7
1/2011: Oregon Standard IEP for students age 15 and younger when IEP is in effect
Student’s Name: Date: School District:
Measurable AnnualGoals/Objectives: (Objectivesrequired for students taking alternate assessments aligned to alternate achievement standards).
Measurable Annual Goal:
Progress will be measured as indicated
below:
How progress will be
reported to parents:
When progress will be
reported to parents:
CriteriaEvaluation
Procedures
Student’s Progress Toward Goal
Measurable Short-Term Objectives
Form 581-5138a-P Page 6 of 7
1/2011: Oregon Standard IEP for students age 15 and younger when IEP is in effect
Student’s Name: Date: School District:
Service Summary (this section may be continued on additional page(s), if necessary)
Specially Designed Instruction
Related Services
Supplementary Aids/Services; Modifications;
Accommodations
_______________________________
_______________________________________
Supports for School Personnel
___________________________
Anticipated Amount/Frequency
Anticipated Amount/Frequency
Anticipated Amount/Frequency
Anticipated Amount/Frequency
Anticipated Location
Anticipated Location
Anticipated Location
Anticipated Location
Starting Date
Starting Date
Starting Date
Starting Date
Ending Date
Ending Date
Ending Date
Ending Date
Provider e.g. LEA, ESD, Regional
Provider
Provider
Provider
Nonparticipation Justification
Does the student need to be removed from participating with nondisabled students in the regular classroom, extracurricular, or nonacademic activities for the
provision of special education services, related services, or supplementary aids and services?
Yes_________ No___________
If yes, document the amount/ extent of the removal:__________________________________________
If yes, provide explanation justifying the removal:
Extended School Year (ESY) Services
ESY services will be provided for this student:
__ Yes: ESY services to be provided are described on Services Summary Page __ No __ To be considered: Will meet to consider ESY by (date)
Form 581-5138a-P Page 7 of 7
1/2011: Oregon Standard IEP for students age 15 and younger when IEP is in effect
