Individualized Education Program (IEP) - TRANSITION State of Delaware School District 302-555-1212
Student Name: Student ID#: Address: City: Zip: Samuel Sample 5551212 5 Franklin Way Any town 19999 State: Delaware 11th D.O.B.: 8/31/1990
IEP Status
Meeting Date IEP Initiation Date IEP End Date Most Recent Evaluation Summary Report Date IEP Revision Date
10/1/2007 9/16/2008
9/17/2007
5/5/2005
Current Grade: Any district Franklin High Schol
District of residence: Attending Building: Disability Classification:
IEP Revision Date
Learning Disability Parent 1: Maria Sample P S
Unless revised, this IEP is in effect for the school year including those students eligible for longer school years because of disability classification.
G
Address (if different): Phone (H): Cell: 302-555-1234 (W): Email: ss@hotmail.com P S G
Temporary Placement
Agency Representative: Parent: Date:
302-555-3456 George Sample
Parent 2:
Address (if different): Phone (H): Cell: (W): Email:
Within 60 days, an IEP meeting must be held.
P S G – check if parent, surrogate, or guardian Meeting Participants
Role Parent 1 Parent 2 Student General Ed. Teacher Special Ed. Teacher Administrator / Designee Career Tech Rep Transition Counselor DVR Counselor Print Name Maria Sample George Sample Samuel Sample Jim Brown William White Judith Rich Susan Prince Michael King Harold Queen Signature
- Student Information Transition IEP 4/2008
Name:
Samuel Sample Data Considerations
Date:
9/17/2007
1. What are the student’s strengths? Samuel is very good in using accommodations in class to be successful. He works hard in his career pathway course and is doing well at his part-time job. He works well in groups and has a great sense of humor. He is also very good at fine motor skills. Employment Strengths: Samuel has received positive feedback from his employer. He is consistently on time and present. His employer states that he is willing to assist others when help is needed Post-Secondary Education/Training Strengths: Samuel is currently utilizing his accommodations on a consistent basis and asks for assistance when it is needed. He works well with others and is willing to assist when it is needed. Independent Living Strengths: Samuel is able to navigate public transportation to get to and from his job. His parents report that he assists them with various chores around the house (doing dishes, mowing, etc.) 2. What are the educational concerns of the parent (or student, if appropriate)? The Samules are concerned about his completing all graduation requirements and being able to be successful in a college program or employment. Samuel states that he is concerned about his organizational skills and completing assignments in classes that do not excite him. 3. What multiple data sources (including district or statewide assessments) are being used to create this IEP? Survey/Questionnaires Profiles/Portfolios Vocational Assessments Other: DSTP scores, local math and ELA assessments, career interest inventories, and vocational evaluation report information 4. How are extracurricular and non-academic areas affected by the student’s disability? Samuel participates with the drama program and is involved in the soccer program without any accommodations.
Other Factors to Consider: IEP team must consider each of the factors. If there is a need identified, check “yes” and address in the IEP. Y N Communication needs of the student Braille instruction for students who are blind or visually impaired Communication and language needs for students who are deaf/hard of hearing Language needs for students with limited English proficiency Positive behavior interventions, supports, and strategies for students whose behavior impedes learning Need for assistive technology devices or services - Data Considerations Transition IEP 4/2008
Name:
Samuel Sample
Date:
9/17/2007
Student’s Post-High School Goals: Post School Employment Goal Post Education/Training Independent Living (if needed) The student plans to exit school with: I will work full-time at an auto body shop while taking courses to become a certified auto repair technician I will attend a post-school training or education program for becoming an auto repair technician There are no identified needs at this time Diploma Certificate
Courses of Study: Grade Courses of Study (from student’s current year to year of graduation) 11th Required ELA, Math, Social Studies and Science courses. 12th Required ELA, Math, Social Studies and Science courses. Co-Op program. Activities and Services to reach goal: Employment Goal: I will work full-time at an auto body shop while taking courses to become a certified auto repair technician Activities/Services needed to reach Start Date Completion Date Responsible Party goal Referral to DVR for employment goals School 4/1/08 6/1/08 Obtain part-time summer employment School, Samuel and 3/1/08 6/1/08 in the automotive field Family
Post-Secondary Education/Training Goal: I will attend a post-school training or education program for becoming an auto repair technician Activities/Services needed to reach Responsible Party Start Date Completion Date goal Research community college and 9/1/07 3/1/08 other training programs through School, Samuel Career Cruising 9/1/07 6/1/08 Make site visits to at least 3 programs Samuel and Family Make application to program of Samuel, School and 11/08 2/09 choice Family Independent Living Goal (if needed): There are no identified needs at this time Activities/Services needed to reach goal Responsible Party Start Date Completion Date
In addition to School Supports, the Student Will Need the Assistance of: Agency Contact Person Phone Number Department of Vocational Rehab Joe to be Determined 302-333-3333 College Support Services Colleges of Choice 302-333-3331
- Transition Transition IEP 4/2008
Name:
Samuel Sample
Date:
9/17/2007
Is there a current Interagency Release of Information Form on file with the school? Yes No (If no, discuss form for transition planning with appropriate agencies)
- Transition Transition IEP 4/2008
Name:
Samuel Sample
Date:
9/17/2007
IEP team must consider each of the following when determining the needs to be addressed within this IEP: How is the student progressing in the general education curriculum (on grade-level)? How does the child’s disability affect progress in the general education curriculum? What are the child’s other educational needs that result from the child’s disability (e.g., organizational skills, self care, fine/gross motor)? A statement of the special education and related services and supplementary aids and services, based on peer-reviewed research to the extent practicable, to be provided to the child, or on behalf of the child, and a statement of the program modifications or supports for school personnel.
Sam will keep a daily agenda to record his homework assignments
Unique Educational Needs and Characteristics
In his English and Science class, Sam completes fewer than half of his homework assignments. Sam needs assistance with oral and written directions
Provide Sam with tape, tape recorder, headphones and instruct him in using the equipment in any classroom setting. Classroom teachers will condense lengthy directions into steps and write on chalkboard or handout
Services, Aids & Modifications
Review of daily agenda for current homework assignments Obtain class technology and other supplemental instructional material School mentor for checks on homework assignments (student input on selection)
Start Date
10/1/2007
Frequency
daily
Duration
5 minutes per class period, as needed beginning of every class, as needed 1 X daily
Location
General Education Classroom
10/01/07
daily
General Education Classroom
10/01/07
daily
guidance office
- Needs and Services Transition IEP 4/2008
Name:
Samuel Sample
Date:
9/17/2007
PLEP (Present Level of Educational Performance): Sam completes fewer than 50% of homework assignments in ELA and Science Benchmark #1
1st Marking Period Progress [m] 11 [y] 2007 M S N
6 out of 10 homework assignments per subject area judged satisfactory by rubric developed by his classroom teachers
Narrative (Benchmark #1):
[m] 2 [y] 2008 M S N
Benchmark #2
2nd Marking Period
Progress
7 out of 10 homework assignments judged satisfactory by rubric developed by his classroom teachers
Narrative (Benchmark #2):
[m] 4 [y] 2008 M S N
Benchmark #3
3rd Marking Period
Progress
9 out of 10 homework assignments judged satisfactory by rubric developed by his classroom teachers
Narrative (Benchmark #3):
[m] 6 [y] 2008 M S N
Benchmark #4
4th Marking Period
Progress
10 out of 10 homework assignments judged satisfactory by rubric developed by his classroom teachers
Narrative (Benchmark #4): Annual Goal:
Given homework assignments in ELA and Science, Sam will complete 10 out of 10 homework assignments per subject area at a satisfactory level as judged by rubric developed by his teachers.
M – mastered annual goal
S – sufficient progress to meet annual goal
N – not sufficient progress to meet annual goal (For Medicaid Cost Recovery)
Therapist Signature:
Date:
- Annual Goals Transition IEP 4/2008
Name:
Samuel Sample
Date:
9/17/2007
Transportation Special transportation needs? If yes, specify: It is necessary to place this student, who is transported from the school by bus into the charge of a parent or other authorized responsible person. Transportation Department will be notified by: YES NO
YES
NO
Participation in Statewide Assessment Student will participate in regular testing conditions without accommodations unless one of the below is checked. Student participates with accommodations as documented on the attached Student Accommodation Checklist. Student is included in Alternate Assessment. The Participation Guidelines form is attached and #64 is filled in on the Student Accommodation Checklist. Discipline The student will adhere to School Code of Conduct. (Check below if any of the following are needed): Interventions and supports are described under services/supports and/or in goals. Behavior intervention and support plan (see attached). Other: Consideration of Eligibility for Extended School Year Services (ESY) IEP team must consider each of the following factors: • Regression / Recoupment • Vocational Skills • Degree of Impairment • Breakthrough Skills • Extenuating Circumstances Is ESY needed? Yes No To Be Determined ESY offered, but declined by parent Rationale for decision:
Specify goals and services:
See attached page (if needed)
- Additional Considerations Transition IEP 4/2008
Name:
Samuel Sample
Date:
9/17/2007
Least Restrictive Environment/Placement Use the option below to determine the appropriate setting. Regular Setting Includes pull-out related services and team classrooms. Student served inside the A. regular classroom greater than or equal to 80% of the day. Services Provided Both in Separate Special Education Classes and Regular Setting Student B. served inside the regular classroom greater than or equal to 40% of the day and no more than 79% of the day. Separate Special Education in an Integrated Setting Student served inside the regular C. classroom less than 40% of the day. Separate School Student served in public or private separate day school facility for greater than D. 50% of the school day or a residential facility if student does not live at the facility. E. Residential Facility where student resides during the school week. F. G. Homebound or Hospital
Correctional Facilities (only used by DSCYF and Prison Education) Students placed in short-term detention or correctional facilities. Explain why the option selected is the most appropriate as the least restrictive environment. If a setting other than A is chosen, describe the other options considered and provide reasons these options were not selected.
Student Parent Signatures I acknowledge that I have received a copy of the Procedural Safeguards. My due process Yes No rights under those Procedural Safeguards have been explained to me. Yes No I agree with the program described in this document. Yes Yes No N/A I agree with the placement decision as noted above and discussed at this meeting. At least one year before the age of majority (18), student has been informed that rights will transfer to him/her unless a legal guardian has been appointed.
Parent/Guardian/Surrogate/Student Signature
Date
Parent/Guardian/Surrogate/Student Signature
Date
If Parent Does Not Attend Staff member below is responsible for forwarding a copy of the IEP and Procedural Safeguards and explaining content, if necessary to the Parent.
Name Transition IEP
Position - LRE -
Method of Contact 4/2008
Name:
Samuel Sample
Date:
9/17/2007
- LRE Transition IEP 4/2008