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IEP Template FORM Feature Revised 18052010

VIEWS: 0 PAGES: 4

									                                                                                                                             DATE:
                                                           STUDENT SUPPORT SERVICES
                                                              23000-116th Ave., Maple Ridge, BC                              SCHOOL:
                                                         Telephone: 604-467-1101 Fax: 604-467-7079



                                                            INDIVIDUAL EDUCATION PLAN

 Student:                                                                     Birth date:                                           Grade:


                                Ministry Designation:         Yes:    No:           Ministry Category:
 Individual Program:            Dogwood Certificate:          Yes:    No:
                                Evergreen Certificate:        Yes:    No:           Personal Development Hours: Yes:         No:



 ASSESSMENT/MEDICAL/DIAGNOSIS                                                                                     DATE(S)




 GLASSES: Yes:               No:                                                    HEARING AID: Yes:           No:
 Date of Last Vision Screening:                                                     Date of Last Hearing Screening:



 STRENGTHS/SPECIAL INTERESTS                                                        NEEDS (as they relate to the coding category)




IEP template revised: May 18, 2010                                                                                                           1
 SCHOOL-BASED SUPPORT SERVICES                                                             COMMUNITY AGENCIES/PROGRAMS
     Support Teacher                               District Support Teacher                   MCFD
     Special Education Assistant                   Child Care Worker                          Medical
     Speech & Language                             Hearing/Vision Teacher                     Counselling
     Counselor                                     Occupational/Physiotherapy                 Child Care Worker
     Other:                                        Other:                                     Other:


 IEP TEAM MEMBERS
 Case Manager:                                                                           Other:
 Classroom Teacher(s):                                                                   Other:
 Parent/Guardian:                                                                        Other:
 A Parent/Guardian was offered the opportunity to be consulted in the preparation of the IEP on date(s):

CONFIRMATION OF SERVICE AND DOCUMENTATION FOR MINISTRY IDENTIFIED STUDENTS ONLY: Category:
 TO BE ELIGIBLE FOR SUPPLEMENTAL FUNDING THE FOLLOWING                                     ADDITIONAL DOCUMENTATION FOR STUDENTS WITH INTENSIVE
 CONDITIONS MUST BE MET:                                                                   BEHAVIOUR NEEDS (CATEGORY H)

     A current IEP is in place.                                                                The student is receiving ongoing, coordinated, across-agency and community
                                                                                           (integrated case management/ wrap-around) planning that is reviewed yearly.
     The goals correspond to the category in which the student is identified.
    The student is receiving special education services to address the needs                  There is evidence that one or more of the following special education
 identified in the assessment documentation that are beyond those offered to the           services are provided:
 general student population and are proportionate to level of need.                                 direct intervention in the classroom to promote behavioural change
                                                                                                    or emotional support as per IEP; and/or
      The student is being offered learning activities in accordance with the IEP.

      The IEP outlines methods for measuring progress in relation to the IEP goals.                 placement in a program designed to promote behaviour
                                                                                                    change/implement IEP; and/or
      A parent/guardian was offered the opportunity to be consulted in preparation                   ongoing, individual social skills training and/or
 of the IEP.
                                                                                                     instruction in behaviour/learning strategies.



 Principal Signature:                                                                                                                      Date:

 Please send a copy of pages one and two to SSS by:

 cc: SSS (first two pages), School file, Parents                                                                                                         SD #42 IEP
IEP template revised: May 18, 2010                                                                                                                                          2
                                                                         Student Support Services
                                                                      School District #42 – Maple Ridge-Pitt Meadows


                                                            INDIVIDUAL EDUCATION PLAN

Student Name:                                                              School:                                      Date:
Case Manager:                                                              Grade:

Goal Area:                                          Position Responsible:
CURRENT LEVEL OF PERFORMANCE:
Goal #                                              Goal Statement:

                   Objectives                       Programs/Materials/Resources/Strategies                 Method of             Person/     Status
(What skills the student will achieve towards the     (The monitored plan-who will do what, when, how)      Evaluation            Position
 goal, where, when, or under what conditions &                                                            (How do know the      Responsible
         with what criteria for success.                                                                 objectives are met?)




Goal Area:                                          Position Responsible:
CURRENT LEVEL OF PERFORMANCE:
Goal #                                              Goal Statement:

                   Objectives                       Programs/Materials/Resources/Strategies                 Method of             Person/     Status
(What skills the student will achieve towards the     (The monitored plan-who will do what, when, how)      Evaluation            Position
 goal, where, when, or under what conditions &                                                            (How do know the      Responsible
         with what criteria for success.                                                                 objectives are met?)




IEP template revised: May 18, 2010                                                                                                                     3
Goal Area:                                          Position Responsible:
CURRENT LEVEL OF PERFORMANCE:
Goal #                                              Goal Statement:

                   Objectives                       Programs/Materials/Resources/Strategies                 Method of             Person/     Status
(What skills the student will achieve towards the     (The monitored plan-who will do what, when, how)      Evaluation            Position
 goal, where, when, or under what conditions &                                                            (How do know the      Responsible
         with what criteria for success.                                                                 objectives are met?)




IEP template revised: May 18, 2010                                                                                                                     4

								
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