Jane Doe Sample IEP

7/25/2019 Jane Doe Sample IEP

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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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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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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@


6/18

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


8/18

"n one year it s@==ort as neee =er A@arter


9/18

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:


12/18

RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES

ASSISTIVE TECHNOLOGY DEVICESAND'OR SERVICES:

SUPPORTS FOR SCHOOLPERSONNEL ON BEHALF OF THE

STUDENT:

"aBi>@> st@


13/18


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@


14/18

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)


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@


16/18

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

Jane Doe Sample IEP

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