jane doe sample iep
TRANSCRIPT
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STUDENT NAME:Jane DoeDATE OF BIRTH:7/7/2000 LOCAL ID #:5555555
DISABILITY CLASSIFICATION:Learning Disability
PROJECTED DATE IEP IS TO BEIMPLEMENTED:02/13/2015
PROJECTED DATE OF ANNUAL REVIEW:05/19/2016
STUDENT NAME:Jane Doe NYC ID:5555555
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS
DOCUMEN!"ON O# $UDEN%$ CU&&EN 'EO&M!NCE !ND !C!DEM"C( DE)ELO'MEN!L !ND #UNC"ON!L NEED$
EVALUATION RESULTS (INCLUDING FOR SCHOOL-AGE STUDENTS, PERFORMANCE ON STATE AND DISTRICT-WIDE ASSESSMENTS)ELA Stat E!a" $%&'resent Le*el 2'ro+i,ien,y &ating- 2.90rot &ate- 77
$,ale $,ore 300
MATHEMATICS Stat E!a" $%&'resent Le*el- 2'ro+i,ien,y &ating- 2.57rot &ate- 2$,ale $,ore- 32
ACADEMIC ACHIEVEMENT, FUNCTIONAL PERFORMANCE AND LEARNING CHARACTERISTICSLE)EL$ O# 4NOLEDE !ND DE)ELO'MEN "N $UJEC !ND $4"LL !&E!$ "NCLUD"N !C")""E$ O# D!"LL")"N( LE)EL O# "NELLECU!L #UNC"ON"N( !D!'")E E8!)"O&( E'ECED &!E O# '&O&E$$ "N!C:U"&"N $4"LL$ !ND "N#O&M!"ON( !ND LE!&N"N $LE;"n EL!( base< on te "non ,ore rea
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PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS
DOCUMEN!"ON O# $UDEN%$ CU&&EN 'EO&M!NCE !ND !C!DEM"C( DE)ELO'MEN!L !ND #UNC"ON!L NEED$
Jane Doe is able to or? in s>all gro@=s( b@t o+ten reA@ires re- a,,@rate ,on,l@sions a+ter rea@lti=lying( tere ere >any errors. Jane Doe asable to +ollo te ste=s +or ore =rogress i+ se o@l< =rioritie an< stay +o,@seationel= Jane Doe to @n=leB >aterial. E>beains on tas? it +reA@ent tea,er ,e,?-ins to ens@re +o,@s an< @nents. Jane Doe is able to ,o>=reen< s,ienti+i, teBts ile @sing *o,ab@laryre+eren,e so@r,es li?e a teBtboo?. $e also bene+its +ro> s an< i>ages tat =ortray s,ienti+i, i=les.$UDEN $&EN8$( '&E#E&ENCE$( "NE&E$$;
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PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS
DOCUMEN!"ON O# $UDEN%$ CU&&EN 'EO&M!NCE !ND !C!DEM"C( DE)ELO'MEN!L !ND #UNC"ON!L NEED$
Jane Doe enoys s,ool( se eB=resses a e( Jane Doe be,o>es =ting to eor? >ore so ten =re*io@s years. Mo> o@l< li?e Jane Doe to ,ontin@e it "C ,lass anall gro@= instr@,tions-re=eate< =ts-re=eate<
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STUDENT NEEDS RELATING TO SPECIAL FACTORS!$ED ON 8E "DEN"#"C!"ON O# 8E $UDEN%$ NEED$( 8E COMM"EE MU$ CON$"DE& 8E8E& 8E $UDEN NEED$
! '!&"CUL!& DE)"CE O& $E&)"CE O !DD&E$$ 8E $'EC"!L #!CO&$ !$ "ND"C!ED ELO( !ND "# $O( 8E !''&O'&"!E$EC"ON O# 8E "E' MU$ "DEN"# 8E '!&"CUL!& DE)"CE O& $E&)"CEG$H NEEDED;
Does te st@
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E"NN"N NO L!E& 8!N 8E #"&$ "E'O E "N E##EC 8EN 8E $UDEN "$ !E 15 G!ND ! ! OUNE& !E "#DEE&M"NED !''&O'&"!EH
MEASURABLE POSTSECONDARY GOALS
LON-E&M O!L$ #O& L")"N( O&4"N !ND LE!&N"N !$ !N !DUL
EDUCATION'TRAINING:
EMPLOYMENT:
INDEPENDENT LIVING SILLS (WHEN APPROPRIATE):
TRANSITION NEEDS"n ,onsian,e( transition ser*i,e nee
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8! 8E $UDEN "LL E E'ECED O!C8"E)E 8E END O# 8E E!& "N 8"C8 8E
"E' "$ "N E##EC
ME!$U&E ODEE&M"NE "#
O!L 8!$ EEN!C8"E)ED
8O'&O&E$$
"LL EME!$U&ED
8EN '&O&E$$ "LL EME!$U&ED
$C"ENCE
Deter>ine te >eaning o+ sy>bols( ?ey ter>s(an< oter ain-s=e,i+i, or>on Core EL!
"n one year Jane Doe ill be able to inete >eaning o+ ore =er A@arter
ANNUAL GOALS8! 8E $UDEN "LL E E'ECED O
!C8"E)E 8E END O# 8E E!& "N 8"C88E "E' "$ "N E##EC
CRITERIAME!$U&E ODEE&M"NE "#
O!L 8!$ EEN!C8"E)ED
METHOD8O '&O&E$$ "LL
E ME!$U&ED
SCHEDULE8EN '&O&E$$ "LL E
ME!$U&ED
Co>>on Core EL! 7 o@t o+ 10 trials +or ea,er Mae =er A@arter
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"n one year it s@==ort as neee =er A@arter
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r@les +or >@lti=lying an< ate>ati,al o=erations in a *ariety o+,onteBts to ,o>=@te ole n@>bers( +ra,tions(als an< integers.
60 !,,@ra,y
ea,er Maan,e!ssess>ent as?
1 ti>e =er A@arter
ANNUAL GOALS8! 8E $UDEN "LL E E'ECED O
!C8"E)E 8E END O# 8E E!& "N 8"C88E "E' "$ "N E##EC
CRITERIA
ME!$U&E ODEE&M"NE "#
O!L 8!$ EEN!C8"E)ED
METHOD8O '&O&E$$ "LL
E ME!$U&ED
SCHEDULE8EN '&O&E$$ "LL E
ME!$U&ED
M!8EM!"C$itin one a,ai, s,ool year( Jane Doeill in,rease er >@lti=li,ation an< @lti=li,ation an< gra
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!C8"E)ED
Co@nseling;itin one year( Jane Doe ill i>=ro*eer ,o>>@ni,ation s?ills as onstrateeGsH=er ee?
'erio< eneral E
05/13/2015
"ntegrate< Co-ea,ing$er*i,es$,ien,es
Lang@age o+$er*i,e; Englis
3 ti>eGsH=er ee?
'erio< eneral E
05/13/2015
$=e,ial EeGsH=er ee?
'erio< $=e,ial E
05/13/2015
$=e,ial EeGsH=er ee?
'erio< $=e,ial E
05/21/2015
RELATED SERVICES:
Co@nseling $er*i,es ro@= ser*i,e
Lang@age o+$er*i,e; Englis
1 ti>eGsH=er ee?
30 >in@tes $e=arateLo,ation Co@nselor%s o+ii,e
05/13/2015
SUPPLEMENTARY AIDS ANDSERVICES'PROGRAMMODIFICATIONS'ACCOMMODATIONS:
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RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES
ASSISTIVE TECHNOLOGY DEVICESAND'OR SERVICES:
SUPPORTS FOR SCHOOLPERSONNEL ON BEHALF OF THE
STUDENT:
"aBi>@> st@
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STUDENT NAME:Jane Doe NYC ID:555555
TESTING ACCOMMODATIONS GO E COM'LEED #O& '&E$C8OOL C8"LD&EN ONL "# 8E&E "$ !N !$$E$$MEN '&O&!M#O& NOND"$!LED '&E$C8OOL C8"LD&ENH; "ND")"DU!L E$"N !CCOMMOD!"ON$( $'EC"#"C O 8E $UDENI$ D"$!"L"
!ND NEED$( O E U$ED CON$"$ENL 8E $UDEN "N 8E &ECOMMENDED EDUC!"ON!L '&O&!M !ND "N 8E!DM"N"$&!"ON O# D"$&"C-"DE !$$E$$MEN$ O# $UDEN !C8"E)EMEN !ND( "N !CCO&D!NCE "8 DE'!&MEN
'OL"C( $!E !$$E$$MEN$ O# $UDEN !C8"E)EMEN.
TESTING ACCOMMODATIONS CONDITIONSIMPLEMENTATION
RECOMMENDATIONS
NONE
EBtene "n all EBa>s in,l@s
i>e eBtens in,l@ere intens in,l@
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E"NN"N NO L!E& 8!N 8E #"&$ "E' O E "N E##EC 8EN 8E $UDEN "$ !E 15 G!ND ! ! OUNE& !E( "#DEE&M"NED !''&O'&"!EH.
COORDINATED SET OF TRANSITION ACTIVITIES
NEEDED ACTIVITIES TO FACILITATE THESTUDENT+S MOVEMENT FROM SCHOOL
TO POST-SCHOOL ACTIVITIES SERVICE'ACTIVITYSCHOOL DISTRICT'AGENCY
RESPONSIBLE
It./0t12
R3at4 S.510
C2""/1t6 E!7.10
D5327"t 28 E"7326"t a4Ot9. P2t-09223 A4/3t L151O;133 (18a77310a;3)
F/0t12a3 V20at12a3 A"t (18a77310a;3)
STUDENT NAME:Jane Doe NYC ID:555555
PARTICIPATE IN STATE AND DISTRICT-WIDE ASSESSMENTSGO E COM'LEED #O& '&E$C8OOL $UDEN$ ONL "# 8E&E "$ !N !$$E$$MEN '&O&!M #O& NOND"$!LED
'&E$C8OOL $UDEN$H
e st@e $tate an<
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PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES
&EMO)!L #&OM 8E ENE&!L EDUC!"ON EN)"&ONMEN OCCU&$ ONL 8EN 8E N!U&E O& $E)E&"O# 8E D"$!"L" "$ $UC8 8!( E)EN "8 8E U$E O# $U''LEMEN!& !"D$ !ND $E&)"CE$(EDUC!"ON C!NNO E $!"$#!CO&"L !C8"E)ED.
FOR THE PRESCHOOL STUDENT:EB=lain te eBtent( i+ any( to i, te st@
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SPECIAL TRANSPORTATION&!N$'O&!"ON &ECOMMEND!"ON O !DD&E$$ NEED$ O# 8E $UDEN &EL!"N O 8"$/8E& D"$!"L"
NC DOE Co>>@nity $,ool
SUMMARY
STUDENT INFORMATION
St/4t Na":Jane Doe
NYC ID:555555
DOB:7/7/2000
G4.: #e>ale
Pa.t La/a() S72>'M24 C2""/10at12:EnglisIEP INFORMATION
Dat 28 IEP Mt1:05/21/2015
IEP A"4"t: es No
R025 28 IEP Mt1: es No
INSTRUCTIONAL'FUNCTIONAL LEVELS
Ra41:t ra
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Co@nseling $er*i,es Englis
%-M2t9 S.510:
e st@e $tate an<
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PROMOTION CRITERIA
E319 La/a A.t (ELA) e st@@st >eet 50 o+ te 7 gra