Individualized Education Program (IEP)

Individualized Education Program (IEP) For Students in Need of Postsecondary Transition Services School District/Public Agency PART I: Development & Review of IEP Name of Child WISER ID DOB Grade School Year Date Name(s) of Parent or Guardian Name(s) of Parent or Guardian Address (City, State & Zip) Address (City, State & Zip) Phone H: C: W: Email Phone H: C: W: Email Indicate whether parent listed above is an appointed surrogate parent yes no Date of Last IEP Meeting Date of Last Evaluation Transition Services Transition Services means a coordinated set of activities for a student with a disability that is designed to be within a results-oriented process, that is focused on improving the academic and functional achievement of the student with a disability to facilitate the student’s movement from school to postschool activities, including postsecondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation. Transition services are based on the individual student’s needs, taking into account the child’s strengths, preferences, and interests; and includes instruction; related services; community services; the development of employment and other post-school adult living objectives; and If appropriate, acquisition of daily living skills and provision of a functional vocational evaluation. Section I: Student Preferences & Interests Student’s Preferences & Interests that Relate to Postsecondary Transition The student attended this IEP Meeting The student did not attend this IEP Meeting. (check one) Provide a statement of the student’s preferences & interests. If the student did not attend this IEP Meeting specify how the student’s preferences & interests were obtained. Name of Student DOB Grade School Year Date of IEP Meeting Section II: IEP Development, Review or Revision A. Results of Initial Evaluation or Summary of Progress or Results of Reevaluation and Summary of Progress Provide information about the results of the initial evaluation or for students continuing to need special education, the results of the reevaluation and the summary of progress toward the annual goals on the student’s most recent IEP. (Include data from current classroom based local and State assessments and as appropriate, include areas of socialization, independent living or orientation and mobility). B. Strengths of the Student Provide information about the strengths of the student. C. Concerns of Parents Provide information about the concerns of the parents for enhancing the education of their child. D. Extended School Year (ESY) ESY are services provided beyond the school district’s or public agency’s normal school year. Did any IEP team member indicate a need for the IEP team to determine whether ESY is necessary to provide the student with a free appropriate public education (FAPE)? No Yes (If yes, complete the Consideration for ESY Worksheet to determine the need for ESY). Name of Student DOB Grade School Year Date of IEP Meeting Section III: Consideration of Special Factors Consideration of Special Factors Identify the student’s special factors. The student’s behavior impedes the student’s learning or that of others: Yes No (If yes is checked provide a description of positive behavioral interventions and supports, and other strategies that will be used to address that behavior in the present level of academic and functional performance (PLAAFP). Develop measurable annual goal if appropriate and/or designate services to address the behavior that impedes the student’s learning or that of others). The student has limited English proficiency: Yes No (If yes is checked provide a description of the student’s language needs in the present level of academic and functional performance (PLAAFP). Develop measurable annual goal if appropriate and/or designate services to address the student’s limited English proficiency). The student is blind or visually impaired: Yes No Braille Instruction: Yes, the student needs Braille instruction No (See most recent, “Evaluation Report for IEP Team to Consider Need for Braille Instruction or Use of Braille.”) The student is deaf or hearing impaired or has communication needs: Yes No (If yes is checked and in the case of a student who is deaf or hearing impaired the IEP Team must consider and provide a description of the student’s language and communication needs, opportunities for direct communications with peers and professional personnel in the student’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 as applicable in the present level of academic and functional performance (PLAAFP). Develop measurable annual goal if appropriate and/or designate services to address the student’s communication needs). Assistive Technology: Yes No (If yes is checked provide a description of the student’s need for assistive technology devices and services in the present level of academic and functional performance (PLAAFP). Develop measurable annual goal if appropriate and/or designate services to address the student’s need for assistive technology). Section IV: Present Levels of Academic Achievement & Functional Performance Present Levels of Academic Achievement & Functional Performance General: Identify how the student’s disability affects the student’s involvement and progress in the general education curriculum (i.e., the same curriculum as for nondisabled students) that provides information to develop appropriate measurable annual goals for the student. Name of Student DOB Grade School Year Date of IEP Meeting Section V: State & District-wide Assessments Participation in State and District-wide Assessments Determine how the student will participate in State and district-wide assessments. Review the following options. Select the appropriate option by checking the box. Complete information required as appropriate. Child is in a grade where state and district-wide tests are not given. Participation without Accommodations The IEP Team has determined that the student will participate in the following assessments without test accommodations(check all that are applicable) Statewide assessment PAWS ACT WorkKeys District-wide assessment/s Name/s of district-wide assessment/s_______________________________ Participation with Accommodations The IEP Team has determined that the student will participate in the following assessments with test accommodations. Selection of test accommodations for the student must be made in accordance with the allowable accommodations for each assessment given. (check all that are applicable) Statewide assessment PAWS ACT WorkKeys District-wide assessment/s Name/s of district-wide assessment/s_______________________________ (check one) See attached test accommodation checklist/s of the allowable test accommodations that are necessary to measure the academic achievement and functional performance of the student on the State and district-wide assessments the student will take. Provide a statement of the allowable test accommodations that are necessary to measure the academic achievement and functional performance of the student on the State and district-wide assessments the student will take. If student is participating in more than one assessment indicate the accommodations for each assessment if the allowable accommodations are different for each assessment. (List accommodations below for each assessment). Participation in Alternate Assessment The IEP team has determined that the student must take an alternate assessment instead of the regular State or district-wide assessment of student achievement. The student will participate in the PAWS Alternate Statewide Assessment Alternate District-wide Assessment.________________________________________________ (name of district-wide assessment) Explain why the student cannot participate in the regular assessment Describe why the particular alternate assessment selected is appropriate for the student Name of Student DOB Grade School Year Date of IEP Meeting Section VI: Measurable Postsecondary Goals & Measurable Annual Goal Training/Education Training Means: A program leading to a high school completion document or certificate (e.g., GED); short term employment training (Workforce Investment Act, Job Corps; Pre or Vocational School program less than two years). Education Means: Community/Technical Colleges (2 year programs) College/University (4 year programs). Results of Age Appropriate Transition Assessments - Training/Education Measurable Postsecondary Goal - Based on age appropriate transition assessments. Measurable Annual Goal - That enables the student to meet the measurable postsecondary training/education goal. How the student’s progress towards meeting this annual goal will be measured? Evidence of student’s performance: Written Performance Oral Performance Demonstration Other:________________________________________________________________________ Documentation of student’s performance: Observation Data Log Content Classroom-Based Assessments Curriculum-Based Measurement Other:___________________ Periodic Reports of Progress Towards Meeting the Annual Goals Will be Provided: For school districts in concurrence with the issuance of report cards. For other public agencies in concurrence with the agency’s regular reporting periods. Key for Measuring Progress: E=Emerging A= Attained NI=Not Introduced M=Maintained NP=No Progress DATE PROGRESS INITIALS IS PROGRESS SUFFICIENT TO REACH ANNUAL GOAL? Lack of progress to enable the student to achieve the goal by the end of the IEP year requires an IEP team to review the annual goal and provide an explanation below. Yes No Yes No Yes No Yes No Narrative reports of progress towards meeting the annual goal: Date: Date: Date: Date: Benchmarks or short-term objectives: necessary to describe the steps to progress towards meeting the annual goal are required only for students that the IEP Team has determined will take alternate State or district-wide assessment(s). 1. 2. 3. Name of Student DOB Grade School Year Date of IEP Meeting Section VI: Measurable Postsecondary Goals & Measurable Annual Goal Employment Employment Means: A service performed for wages; work; occupation; profession; job; military service. Results of Age Appropriate Transition Assessments - Employment Measurable Postsecondary Goal - Based on age appropriate transition assessments. Measurable Annual Goal - That enables the student to meet the measurable postsecondary employment goal. How the student’s progress towards meeting this annual goal will be measured? Evidence of student’s performance: Written Performance Oral Performance Demonstration Other:________________________________________________________________________ Documentation of student’s performance: Observation Data Log Content Classroom-Based Assessments Curriculum-Based Measurement Other:___________________ Periodic Reports of Progress Towards Meeting the Annual Goals Will be Provided: For school districts in concurrence with the issuance of report cards. For other public agencies in concurrence with the agency’s regular reporting periods. Key for Measuring Progress: E=Emerging A= Attained NI=Not Introduced M=Maintained NP=No Progress DATE PROGRESS INITIALS IS PROGRESS SUFFICIENT TO REACH ANNUAL GOAL? Lack of progress to enable the student to achieve the goal by the end of the IEP year requires an IEP team to review the annual goal and provide an explanation below. Yes No Yes No Yes No Yes No Narrative reports of progress towards meeting the annual goal: Date: Date: Date: Date: Benchmarks or short-term objectives: necessary to describe the steps to progress towards meeting the annual goal are required only for students that the IEP Team has determined will take alternate State or district-wide assessment(s). 1. 2. 3. Name of Student DOB Grade School Year Date of IEP Meeting Section VI: Measurable Postsecondary Goals & Measurable Annual Goal Independent Living (Check the one that applies) The IEP Team determined that postsecondary goals for independent living are not appropriate for the student. The IEP Team determined that postsecondary goals for independent living are appropriate for the student. Independent Living Means: Control over one's life based on the choice of acceptable options that minimize reliance on others in making decisions and in performing everyday activities. This includes managing one's affairs, participating in day to day activities in the community, fulfilling a range of social roles, and making decisions that lead to self-determination and the minimization of physical and psychological dependence upon others. Results of Age Appropriate Transition Assessments – Independent Living Measurable Postsecondary Goal - Based on age appropriate transition assessments. Measurable Annual Goal - That enables the student to meet the measurable postsecondary independent living goal. How the student’s progress towards meeting this annual goal will be measured? Evidence of student’s performance: Written Performance Oral Performance Demonstration Other:________________________________________________________________________ Documentation of student’s performance: Observation Data Log Content Classroom-Based Assessments Curriculum-Based Measurement Other:___________________ Periodic Reports of Progress Towards Meeting the Annual Goals Will be Provided: For school districts in concurrence with the issuance of report cards. For other public agencies in concurrence with the agency’s regular reporting periods. Key for Measuring Progress: E=Emerging A= Attained NI=Not Introduced M=Maintained NP=No Progress DATE PROGRESS INITIALS IS PROGRESS SUFFICIENT TO REACH ANNUAL GOAL? Lack of progress to enable the student to achieve the goal by the end of the IEP year requires an IEP team to review the annual goal and provide explanation below. Yes No Yes No Yes No Yes No Narrative reports of progress towards meeting the annual goal: Date: Date: Date: Date: Benchmarks or short-term objectives: necessary to describe the steps to progress towards meeting the annual goal are required only for students that the IEP Team has determined will take alternate State or district-wide assessment(s). 1. 2. 3. Name of Student DOB Grade School Year Date of IEP Meeting Section VII: Measurable Annual Goal Measurable Annual Goal: How the student’s progress towards meeting this annual goal will be measured? Evidence of student’s performance: Written Performance Oral Performance Demonstration Other:_____________________________________________________________________ Documentation of student’s performance: Observation Data Log Content Classroom-Based Assessments Curriculum-Based Measurement Other:___________________ Periodic Reports of Progress Towards Meeting the Annual Goals Will be Provided: For school districts in concurrence with the issuance of report cards. For other public agencies in concurrence with the agency’s regular reporting periods. Key for Measuring Progress: E=Emerging A= Attained NI=Not Introduced M=Maintained NP=No Progress DATE PROGRESS INITIALS IS PROGRESS SUFFICIENT TO REACH ANNUAL GOAL? Lack of progress to enable the student to achieve the goal by the end of the IEP year requires an IEP team to review the annual goal and provide an explanation below. Yes No Yes No Yes No Yes No Narrative reports of progress towards meeting the annual goal: Date: Date: Date: Date: Benchmarks or short-term objectives: necessary to describe the steps to progress towards meeting the annual goal are required only for students that the IEP Team has determined will take alternate State and districtwide assessment(s). 1. 2. 3. 4. Individualized Education Program (IEP) For Students in Need of Postsecondary Transition Services PART II: Services Name of Student DOB Grade School Year Date Special Education, Related Services, Supplementary Aids & Services, Program Modifications or Supports for School Personnel A statement of the special education, related services, supplementary aids and services, based on peer-reviewed research to the extent practicable, to be provided to the student, or on behalf of the student, and a statement of the program modifications or supports for school personnel that will be provided to enable the student:  To advance appropriately toward attaining the annual goals.  To be involved in and make progress in the general education curriculum and to participate in extracurricular and other nonacademic activities.  To be educated and participate with other students with disabilities and nondisabled students in extracurricular and other nonacademic activities. The projected date for the beginning of the services and modifications and the anticipated frequency, location, and duration of special education and related services, supplementary aids and services and program modifications and supports for school personnel. Section I: Special Education & Related Services A. Special Education (specially designed instruction) Special Education Amount Frequency Projected Start Date Location Duration Physical Education: The development of physical and motor fitness; fundamental motor skills and patterns; and skills in aquatics, dance, and individual and group games and sports (including intramural and lifetime sports); and includes special physical education, adapted physical education, movement education, and motor development. Please check one below NA Regular Specially Designed (if specially designed specify services above) Name of Student DOB Grade School Year Date of IEP Meeting B. Related Services Related Service Assistive Technology Services None needed to benefit from special education. Amount (needed to benefit from special education.) (Check those that apply below). Frequency Projected Start Date Location Duration Devices Audiology Counseling Educational Interpreting Medical Services for Diagnosis and Evaluation Occupational Therapy Orientation and Mobility (VI only) Physical Therapy Psychological Services Recreation Rehabilitation Counseling Services School Health Services School Nurse Services School Social Work Services Speech / Language Hearing Aid (checks) External Components of Surgically Implanted Medical Devices (checks) Transportation Other: specify Name of Student DOB Grade School Year Date of IEP Meeting Section II: Supplementary Aids & Program Modifications & Supports A. Supplementary Aids & Services (accommodations, aids, services, and other supports that are provided in regular education classes, other educationrelated settings and in extracurricular and non academic settings). Supplementary Aids & Services Amount Frequency Projected Start Date Location Duration B. Program Modifications or Supports for School Personnel (a statement of program modifications and supports for school personnel that will be provided to enable the student to advance appropriately towards attaining the annual goals and be involved in and make progress in the general education curriculum and participate in extra curricular and nonacademic activities) Modifications or Supports Amount Frequency Projected Start Date Location Duration Section III: Courses of Study Proposed Courses of study needed to assist the student in reaching the measurable postsecondary goals School year: School year: School year: School year: Name of Student DOB Grade School Year Date of IEP Meeting Section IV: Least Restrictive Environment A. Participation with Nondisabled Students in the Regular Classroom The student will participate in the regular classroom with nondisabled students. The student will be removed from the regular classroom (Provide an explanation of the extent,that removal from the regular educational environment occurs because the nature and severity of the student’s disability is such that education in regular classes even with the use of supplementary aids and services cannot be achieved). B. Participation with Nondisabled Students in Extracurricular & Nonacademic Activities The student is able and has the opportunity to participate in the extracurricular & nonacademic activities with nondisabled students. The student is unable to participate in the extracurricular and nonacademic activities with nondisabled students (Provide an explanation of the extent, to which the student will not participate with nondisabled students in extracurricular and other nonacademic activities even with the use of supplementary aids and services). Section V: Age of Majority A. Guardianship Guardianship was granted under Wyoming State Law (complete the following information). NA Yes Date guardianship was granted. Name of guardian (s). B. Transfer of Rights At least one year prior to the student reaching the age of majority (18 years of age) the IEP must include a statement that the student has been informed of the his/her rights under Part B of IDEA that will transfer to the student on reaching the age of majority. NA th The student will reach his/her 17 birthday during the timeframe of the IEP. Date Date the student was informed of the transfer of rights. ______Initials Individualized Education Program (IEP) For Students in Need of Postsecondary Transition Services PART III: Educational Placement Name of Student DOB Grade School Year Date of IEP Meeting Section I: Placement Decision A. Placement: In determining the educational placement of a student with a disability the school district or public agency must ensure that: the student’s placement is made by a group of persons, including the parents, and other persons knowledgeable about the child and must be made in conformity with the LRE provisions. Placement for a student with a disability must be determined at least annually; is based on the student’s IEP; and is as close as possible to the student’s home. Will the student attend the school he or she would attend if non-disabled? Yes No (If No, provide an explanation that in selecting the LRE placement, consideration was given to any potential harmful effect on the student or on the quality of services that he or she needs; and that the student is not removed from education in age appropriate regular classrooms solely because of needed modifications in the general education curriculum. The school district or public agency where the student’s IEP will be implemented: DURATION OF IEP SERVICES: Projected beginning and ending dates of IEP services (Includes only scheduled school days during the regular school year unless otherwise specified.) Beginning Date: Ending Date: B. Other Options Considered: List other options considered, if any, related to the placement site, frequency, duration and location of the special education and related services, supplementary aides and services, program modifications and supports, including potential harmful effect on the student or the quality of services needed and any other factors relevant to the purposed action. None Explanation of other options considered is provided in the space below. Name of Student DOB Grade School Year Date of IEP Meeting C. Special Education Rights for Parents and Children: You have protection under the procedural safeguards (rights) of special education law. The school district or public agency must provide you with a copy of your procedural safeguards once a year. That document provides information on sources for parents to contact to obtain assistance in understanding the rules. In addition to those sources you may contact the individual listed below to provide you with information or answer your questions . Previously you received a copy of your procedural safeguards rights in a brochure about Special Education Rights for Parents and Children. If you would like another copy of this information, please refer to the contact information provided below. __________(initials) A copy of the procedural safeguards notice is enclosed. __________(initials) A copy of the procedural safeguards notice is available at www.k12.wy.us If you do not have access to the internet or would like the school district or public agency to provide you with a copy of the procedural safeguards notice please contact the person listed below. Name & Title of Contact Person Address Phone Email You previously received a copy of the evaluation & eligibility report and a copy of the IEP is enclosed or attached. __________(initials) Copy of the evaluation report and the IEP are enclosed or attached. __________(initials) Section II: Documentation of IEP Team Members A. IEP Team Members Excusal Agreement The IEP team members and the parent(s) agree to excuse an IEP team member from the IEP meeting in whole or in part because the IEP team members input or curricular area is not being or no longer being discussed. Parents, or adult student agree to excusal Parents do not agree to excusal Parent Signature: Name & Title of IEP Team Members Excused B. IEP Team Members Present List IEP Team Members Attending or Participating by Alternate Means in the IEP Meeting Agency representative authorized to provide resources An individual who can interpret the instructional implications of evaluation results. (Note: One of the individuals identified may also be appointed to meet the requirement). Special education teacher of the child: Regular education teacher if child will be in regular education Parent: Student: Other: Other: Other: Other: If the parent did not attend or participate in the meeting by other means and did not agree to the time and place of the IEP team meeting, document 3 efforts to involve the parents. Date of Contact: Date of Contact: Date of Contact: Method: Method: Method: C. IEP Document I. Copy of IEP Provided to Parent Copy of this IEP was provided to parents Method provided Date Provided: email child (check applicable box or boxes and initial) Staff Initials: Parent Initials: US mail given to parent sent home with 2. Copy of IEP Provided to Staff The IEP was provided to the teachers and services provider. Each teacher and service provider was informed of their specific responsibilities for the implementation of this IEP. Name of staff person Title Date informed & IEP provided: