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 ___F Home 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:

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

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

___________________________________________________________________________________________________________________________________________________________

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 Assessment Alternate 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 Assessment Alternate Assessment

* 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:______________________

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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:

Criteria Evaluation Procedures Student’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 Annual Goals/Objectives: (Objectives required 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:

Criteria Evaluation

Procedures

Student’s Progress Toward Goal

Measurable Short-Term Objectives

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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 Location

Starting Date

Ending Date

Provider e.g. LEA, ESD, Regional

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