Individualized Education Program (IEP) for Grade Two

IEP Performance Template-Standard 2-4
Student’s Name
Institutional Affiliation
Course
Instructor
Date
Special Education Department
Individualized Education Program (IEP)
Student Name: Jane Doe (Pseudonym)Student Data/Cover Sheet (Form A-1)IEP Meeting Date: 30/3/2023
Student ID: 356DOB: 16/08/2015
Demographic Information

Student Number:
356

Student Name:
Jane Doe

Birthdate:
16/8/2015

Gender:
Female

Grade:
2


Student Address:
N/A

Home Phone:
N/A

City, State, Zip:

Parent 1 Name:
Eve Mendoza

Parent 1 Relationship:
Mother

Parent 1 Address:
N/A

Home Phone:
N/A

City, State, Zip:

Work Phone:

Parent 1 Email:

Parent 2 Name:
Nikolai Stonebridge

Parent 2 Relationship:
Father

Parent 2 Address:
N/A

Home Phone:
N/A

City, State, Zip:

Work Phone:

Parent 2 Email:

Primary Language of Home:
Spanish

Primary Language Survey Date: 12/2/2023
Primary Language Survey Results: 13/2/2023

Language of Instruction:
English

Home District:
Attendance District:

Service Coordinator:

Home School:

Attending School:

Vision Screened On:
13/2/2023

Results: Passed

Hearing Screened On:
13/2/2023

Results: Passed

Meeting Date: 30/3/2023

Anticipated Duration of IEP:
15/2/2023 To 29/3/2023

Re-evaluation Due:
Current Evaluation:

Special Education Primary Category #1: Language Processing Disorder

Special Education Eligibility Category #2: Speech sound disorder

Special Education Eligibility Category #3:

For Students with SLD only, the following area(s) of eligibility was/were previously determined:
The learner expressed dyslexia

Level of Services: (A) Average Participation

Type: of Meeting: Annual IEP Review Meeting

Date Meeting Notice Sent to the Parent(s): 28/3/2023

Date Procedural Safeguards given to the Parent(s): 29/3/2023


Special Education Department
Individualized Education Program (IEP)
Student Name: Jane DoeStudent Data/Cover Sheet (Form A-2)IEP Meeting Date: 30/3/2023
Student ID: 356DOB: 16/8/2015
The following persons participated in the conference and/or the development of the IEP. Additionally, parents have been given a copy of their rights regarding the student’s placement in special education and understand that they have the right to request a review of their child’s IEP at any time.
Position/Relation to Student Participant Date (MM/DD/YY)

Father Nikolai Stonebridge 30/3/2023

Mother Eve Mendoza 30/3/2023

Special Education Teacher 30/3/2023

General Education Teacher 30/3/2023

Teacher 30/3/2023





*If during the IEP year the student turns 16, if the student is not present at the IEP meeting, the service coordinator must review the IEP with the student and obtain the student’s signature and the date of this review.
Special Education Department
Individualized Education Program (IEP)
Student Name:Student Data/Cover Sheet (Form B)IEP Meeting Date:
Student ID:DOB:
PRESENT LEVELOF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Section 1: Current IEP Information
Goal Number Written:
Summarize special education services the student is receiving:
Jane Doe is a Grade 2 learner eligible for special education services. She exhibits struggles in basic reading and comprehension, which signals a primary focus on dyslexia. This is based on evaluation which revealed that she qualifies or confirms his eligibility. Jane receives a daily evaluation to ensure she is improving. The service primarily covers reading and comprehension, which indicates speech and language services to improve her fluency and articulation.
Section 2: Evaluation Information
Areas of Eligibility:
Special Education Primary Category: Language Processing Disorder
Special Education Eligibility Category #2: Speech Sound Disorder
Special Education Eligibility Category #3:
For students with SLD only, the following area(s) of eligibility was previously determined:
Section 3: Present Level of Academic Achievement
READING
Poor fluency signaling a Grade 1 level
Comprehension is also a Grade 1 level.
The accuracy and recognition of certain words is worrying.
WRITING
Spelling or word organization is fair, though still at Grade 1 level. This indicates that her abilities are below average, especially when it comes to grammar and spelling. Problems such as capitalization are occasional, which indicates that written accuracy is above average, however, invites room for improvement.
MATH
Math calculations are still on Grade 1 level. This implies that her basic math solving skills are present; however, barely meet Grade 2 expectations.
Student Name:Present Level of Academic Achievement andIEP Meeting Date:
Student ID:Functional Performance (Form B)DOB:
Parent’s Input on Student’s Current Academic Achievement:
Mr. Stonebridge and Ms. Mendoza expressed gratitude for the service.
Current Classroom-Based Data:
Jane is gradually improving. However, her comprehension, fluency, and articulation still match a Grade one’s. The reading accuracy is approximately at 70%, which indicates that for her instructional level, she is struggling to achieve notable success in overcoming speech sound disorder. She is active in physical education.
State and District Assessments:
Not applicable for this student
Section 4: Functional Performance
Social Emotional and Behavior:
Jane is a reserved student. This implies that she is always quiet, which can be tied to her speech challenges, that arguably impede her confidence and esteem. However, she is always around her friends, which implies she thrives in small groups, including fellow learners that she feels comfortable around. Her friend like hanging out with her. The parents do not report any behavioral issues, nor does the teacher notice any. She follows instructions signaling an obedient and well-mannered child. Her school attendance is also impressive.
Student Name:Present Level of Academic Achievement and IEP Meeting Date:
Student ID: Functional Performance (Form B) DOB:
Parent’s Input and Student’s Current Functional Achievement:
Mr. Stonebridge and Ms. Mendoza expressed gratitude for the service.
Summary of Work Habits:
Jane is a reserved learner. However, she is active in group activities and does not shy from group projects, especially in physical education. She does not speak often, arguably because of the speech challenges and will take her time to complete a task.
Section 5: Summary of Educational Needs
Special Education Department
Individualized Education Program (IEP)
Student Name:Considerations Form (Form C) IEP Meeting Date:
Student ID:DOB:
ADDITIONAL DOCUMENTATION/CONSIDERATION OF SPECIAL FACTORS
Considered Not Included
Needed
47720252628900XXXxXXX00XXXxXXXright15240[Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place this text box anywhere on the page, just drag it.]00[Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place this text box anywhere on the page, just drag it.]Individual Transition Plan
478155013335[Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place this text box anywhere on the page, just drag it.]00[Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place this text box anywhere on the page, just drag it.]right17145[Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place this text box anywhere on the page, just drag it.]00[Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place this text box anywhere on the page, just drag it.]Statement of Transfer of Parental Rights at Age of Majority
47625005715[Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place this text box anywhere on the page, just drag it.]00[Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place this text box anywhere on the page, just drag it.]right5715[Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place this text box anywhere on the page, just drag it.]00[Grab your reader’s attention with a great quote from the document or use this space to emphasize a key point. To place this text box...