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Last Nam
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INDIVIDUALIZED EDUCATION PROGRAM
First Name
Page 1 of 15
IEP Date: 1010912013
Last AnnuaiiEP 10/0912013 Next AnnuaiiEP 10109/2014 Original Special Ed Entry Date 10125/2012
Last Eval1012512012 Next Eval1012512015
Purpose of Meeting 0 Initial 0Triennial DTransition 0 Pre-Expulsion Dlnterim
Dother
Birthdate Age z_ Gender Grade Second grade Migrant
Native LanguaC'- cnnfi.c;fl_ EL DRedesignated lnt ... rnrpt<or No
Student ID SSN#: SSID# __
Residency 10 Parent or Lea a I guardian
ParenUGuardiar
Home Addre-
City _
State CA
Z:, -
ParenUGuardian
Home Address-------------
City------------
State CA
Zip __ _
District of Residenl._ <esidence Schot.,

Home Phone._._____
Work Phone ___ _
Cell ___ _
Email Address ___ _
Home Phone ___ _
Work Phone ___ _
Cell Phone __ _
Email Address ___ _
Ethnicity: 900 lntentionallv Blank Race 1. 600 African-AmeriCiiil Race-2.-- - Ra-ce 3. __ _
INDICATE DISABILITY/IES
Note: For initial and trienniaiiEPs, assessment must be done and discussed by IEP Team before determining eligibility.
Primary Specific Learning Disability (SLD) Secondary 200 None *Low Incidence Disability
0Not Eligible for Special EducationOExiting from Sp. ED. (returned to reg. ed/no longer eligible)
Describe how student's disability affects involvement and progress in general curriculum( or for preschoolers,
participation in appropriate activities) A significant discrepancy between ability and independent classroom performance, as
well as processing deficits may limit the student's ability to perform at full potential in the classroom.
For Initial Placements Only
Has the student received IDEA Coordinated Early Intervening Services (CEIS) using 15% of IDEA funding in the past two years?
OYesl!tjNo
Date of Initial Referral for Special Education Services 08129/2012
Person Initiating the Referral for Special Education service 10 Parent
Date District Received Parent Consent 09/1912012
Date of Initial Meeting to Determine Eligibility 10/2512012
I
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LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Namb IEP Date: 101912013
StrengthsfPreferencesflnterests _ is learning to add and subtract up to 20 with & without regrouping. He is also
working on reading grade level sight words.
Concerns of parent relevant to educational progress Parents would like for. to be successfully in school.
CA Standards Test
CMA
CAPA
EnglishfLanguage Arts
Math
Hist./Soc.Sciences
Science
English Language Arts
Englishflanguage Arts
Math
Science
CELDT Listening
Physical Education Testing (grades 5, 7 & 9):
0Adv.0Proficient0Basic0Below BasicOFar Below Basic
D Adv. OProficientD BasicO Below Basi cO Far Below Basic
0Adv.0Proficient0Basic0Below BasicOFar Below Basic
0Adv.0Proficient0Basic0Below BasicOFar Below Basic
Mathematics Science Other
---
0Adv.0Proficient0Basic0Below BasicOFar Below Basic
0 Adv. 0 ProficientO Basic 0 Below BasicO Far Below Basic
0Adv. 0Proficient0Basic0Below BasicOFar Below Basic
Speaking Reading Writing __ _
Other Assessment Data (e.g., curriculum assessment, other district assessment, etc.)
Hearing ( 0912412012 ) 0 Pass D Fail D Other Passed Passed Vision ( 09/2812012 ) D Pass 0 Fall 0 Other Failed
Failed
Preacademic/Academic/Functional Skills
1st Trimester Classroom Grades: Reading G- , Mathematics U, History/Social Studies 0+ ,
Communication Development
Age appropriate
Gross/Fine Motor Development
Age appropriate at this time.
Social Emotional/Behavioral
Age appropriate at this time.
Vocational
has access to computer lab, library, assemblies & field trips.
Adaptive/Daily Living Skills
Age appropriate at this time.
Health
Allergy to grass. Asthma medication taken at home twice a day: before and after school. Emergency asthma medication kept in
nurse's office.
- _ _j
. ---r
Student: ~ _
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Statewide Assessments
Participation in Statewide Assessment Program, STAR
Page 3 of 15
IEP Date: 101912013
(California Standards Test, California Modified Assessment Test, California Alternate Performance Assessment)
English Language Arts (ELA) (Grades 2-11; CMA only applies to grades 3-11)
90 Not to participate (outside testing group or plan type /SP)
Math (Grades 2-7 Grade level Math; Grades 8-9 General Math; Grades 8-11 Integrated Math1 ,2, or 3; Grades 9-11 Summative
High School Math; Grades 3-7 CMA)
90 Not to participate (outside testing group or plan type ISP)
Algebra (Grades 8-11; CMA Algebra 1 only) Test to be Administered: DAigebra 1 0Aigebra II (CST Only)
Geometry (Grades 8-11)
Science (Grades 5, 8 & 10 Science Test; Grades 9-11 Biology, Chemistry, Earth Science, Physics, and Integrated Science/ Coord
Science 1 ,2, 3 & 4)
90 Not to participate (outside testing group or plan type ISP)
History/Social Science (Grades 8, 10 & 11)
30 Not to Participate in this sub test due to taking CAPA
Writing (Grade 4 & 7 only)
90 Not to participate (outside testing group or plan type ISP)
EJlf student is taking CMA or CAPA, IEP team has reviewed the criteria for taking alternate assessments.
CAPA ELA (Grades 2-11) Science (Grades 5,8, 10) Math (Grades 2-11) __ _
The student will not participate in the CST or CMA because
Participating in the CAPA is appropriate because
ElPhysical Fitness Test (Grades 5, 7 & 9 only)
Accommodations Modifications
CAHSEE (Grades 1D-12, or ages 15+ and grade code is 'Ungraded')
90 Not to participate (outside testing group or plan type ISP)
Dother State-Wide/ District-Wide Assessment(s) Alternate Assessment(s)
Alternate Assessment(s) appropriate because:
Desired Results Developmental Profile (DROP)- For Preschoolers Ages 3, 4 and 5 years
!Adaptations:
0 Not Applicable 0 Sensory support
0 Alternative response mode 0 Assistive equipment or device
DAiternative mode for written language DAugmentative or alternative communication system
FOR ENGLISH LEARNERS ONLY
OcELOT
DListening without accommodations
Dustening with accommodations:
Dspeaking without accommodations
Dspeaking with accommodations:
DReading without accommodations
DReading with accommodations:
Dwriting without accommodations
Dwriting with accommodations:
0Aiternate Assessment to CELDT
If yes, areas of alternate assessment( s): 0 Listening D Speaking DReading 0 Writing
Name of alternate assessment(s):
D Functional positioning
Dvisual support
Name
Area of Need: ComprehensiOn
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ANNUAL GOALS AND OBJECTIVES
Measurable Annual Goal# 1
Page6of15
IEP Date 101912013
(Annual Goal) By 10/9/2014, when given an appropriate text,
Baseline: struggles with reading grade
will ask 15 clarifying questions related to the text read, using "why/what
If/how questions with 80% accuracy in 4 of 5 trials as measured by teacher
appropriate words.
When he's reading, he sounds out s1ght words &
-charted records.
doesn't read to comprehend I
student to be involved/progress in general
curriculum/state standard 2.2.4
DAddresses other educational needs resulting from the disability
D Linguistically appropriate
0Transltion
Goal: 0 Education/Training D Employment Olndependent Living
Person(s) Respo,!lslble Teacher
1
RSP student & e,arent
Short-Term Objective: By 219/2014 when given an appropriate text . will ask 5 clarifying questions related to the text
read, using "whyo questions with 80% accuracy in 2 of 5 trials as measured by teacher charted records. I
Short-Term Objective: By 519/2014 when given an appropriate text, will ask 10 clarifying questions related to the text
read, using "what if and "how questions with 80% accuracy in 3 of 5 trials as measured by teacher charted records. I
Short-Term Objective:
Progress Report 1:
Summary of Progress
Comment
Progress Report 2:
Summary of Progress
Comment
Progress Report 3:
Summary of Progress
Comment
Goal: Annual Review Date:
Goal Met DYes 0No
Comments:
Name
Area of Need: Number nense
Baseline; is able to add with
manipulatives
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ANNUAL GOALS AND OBJECTIVES
Measurable Annual Goal# 2
(Annual Goal) By (date), when giver "t:: lhrc;
Page 7 of 15
IEP Date 101912013
'iigit addition and subtraction
number sentences with _ will calculate the correct
answers with 80% accuracy in 4 of 5 triar;,-as measured by teacher-made
tests.
I
l!J Enables student to be involved/progress in general
curriculum/state standard 2.2.2
0Addresses other educational needs resulting from the disability
Ll Linguistically appropriate
EJTransition
Goal: El Education/Training D Employment Din dependent Living
Person(s) Responsible
Short-Term Objective: By 2/912014, when given 5 three-digit addition number sentences with regrouping, _ -will
-
calculate the correct answers with 80% accuracy, in 2 of 5 trials as measured by teacher-made tests. I
Short-Term Objective: By 5110/2014, when given 10 3-digit subtraction facts with regrouping, will calculate the
correct answers with 80% accuracy, in 3 of 5 trials as measured by teacher-made tests.l
Short-Term Objective:
Progress Report 1:
Summary of Progress
Comment
Progress Report 2:
Summary of Progress
Comment
Progress Report 3:
Summary of Progress
Comment
Goal: Annual Review Date:
GoaiMetDYesCJNo
Comments:
l
Name
Area of Need:
Baseline:
complete senenteces.
Page 8 of 15
WEST END SELPA
ANNUAL GOALS AND OBJECTIVES
IEP Date 10/912013
Measurable Annual Goal# 3
(Annual Goal) By 1019/2014, when given a list of 15 proper (names,
- iearnmg how to write
months, days of the week, titles, places and initials of people) and
common nouns will correctly capitalize proper nouns with 80%
accuracy in 4 of 5 trials as measured by teacher-made tests.
I
student to be involved/progress in general
curriculum/state standard 2. 1. 6
DAddresses other educational needs resulting from the disability
D Linguistically appropriate
DTransltlon
Goai:0Educatlon!Trainlng0Employment01ndependent Living
Person(s) Responsible Teacher
1
RSP staff
1
student and e_arent
Objective: By 211012014, when given a list of 5 proper (names, months, days of the week) and common nouns,
, will demonstrate knowledge of correct capitalization of proper nouns with 80% accuracy in 2 of 5 trials as measured by
teacner-made tests. I
Short-Tqrm Objective: By 511012014, when given a list of 10 proper nouns (titles, places, initials) and common nouns,
_will demonstrate knowledge of correct capitalization of proper nouns with 80% accuracy in 3 of 5 trials as measured by
teacher-made tests. I
Short-Term Objective:
Progress Report 1:
Summary of Progress
Comment
Progress Report 2:
Summary of Progress
Comment
Progress Report 3:
Summary of Progress
Comment
Goal: Annual Review Date:
Goal Met DYes 0No
Comments:
a
I
Page 9 of 15
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ANNUAL GOALS AND OBJECTIVES
Name . JEP Date: 101912013
--
Area of Need: Decoding_1.1.11 Read common, Measurable Annual Goal#
irregular sight words (e.g_.
1
the
1
have
1
said
1
come
1
By 1012512013, when given a list of 30 priority sight words, will
give
1
of). read these target words aloud with automaticity and 80% accuracy in 3
.:
consecutive trials as measured by teacher- charted records .
Baseline: _. use unable to read the I
sample and practice questions of the reading
subtest of the Woodcock Johnson Ill Normative
Update Test of Achievement on 912412012.
1:!1 Enables student to be involved/progress in general
curriculum/state standard
E!Addresses other educational needs resulting from the disability
El Linguistically appropriate
ElTransition
Goal: EJ Education/Training 0 Employment EJ Independent Living
Person(s) Responsible Student. Ed. Teacher, RS Staff
Short-Term Objective: By 1125/2013, when given a list of 10 priority sight words, . will read these target words aloud
with automaticity and 80% accuracy in 3 consecutive trials as measured by teacher-charted records.
Short-Term Objective: By 9/25/2013, when given a list of 20 priority sight words, will read these target words aloud
with automaticity and 80% accuracy in 3 consecutive trials as measured by teacher-charted records.
Short-Term Objective:
Progress Report 1:
Summary of Progress
Comment
Progress Report 2:
Summary of Progress
Comment
Progress Report 3:
Summary of Progress
Comment
Goal: Annual Review Date:
Goal Met
Comments:
Name
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ANNUAL GOALS AND OBJECTIVES
Page 10 of 15
IEP Date 101912013
Area of Need: Writing_. 1.1.1 Write and se,eak in Measurable Annual Goal#
comeJete, coherent sentences By 10/25/2013, when given a verbal or visual cue,. will
speak/write in complete sentences with 75% accuracy in 3 of 4 trials as
Baseline: Woodcock Johnson Ill Normative
measured by teacher-charted observations/student work samples.
Update Tests of Achievement Writing Fluency
Score. 57
student to be involved/progress in general
curriculum/state standard
0Addresses other educational needs resulting from the disability
D Linguistically appropriate
0Transltion
Goal: D Education/Training D Employment D Independent Living
Person(s) Responsible Student, General Ed. Teacf1er, RS Staff
Short-Term Objective: By 112512013, when given a verbal or visual cue, ; will speak in complete sentences with 65%
accuracy in 3 of 4 trials as measured by teacher-charted observations.
Short-Term Objective: By 9/25/212, when given a verbal or visual cue, will write in complete sentences with 70%
accuracy in 3 of 4 trials as measured by teacher-charted observationslstudenr work samples.
Short-Term Objective:
Progress Report 1 :
Summary of Progress
Comment
Progress Report 2:
Summary of Progress
Comment
Progress Report 3:
Summary of Progress
Comment
Goal: Annual Review Date:
Goal Met 0No
Comments:
Name
WEST END SELPA
ANNUAL GOALS AND OBJECTIVES
Page 11 of 15
IEP Date 10/9/2013
Area of Need: 1.1.1 Count, read, and write whole Measurable Annual Goal#
numbers to 100 By 1012512013, when given a teacher direction, . will orally
counVreadlwrite whole numbers to 100 with 75% accuracy on 3
Baseline: 9/24/2012 Woodcock Johnson Ill
consecutive trials as measured by teacher charted work samples.
Scores: Calculation 90, Math Fluency 83. I
student to be involved/progress in general
curriculum/state standard
E!Addresses other educational needs resulting from the disability
CJ Linguistically appropriate
E!Transition
Goal: EJ EducationfTraining El EmploymentC:hndependent Living
Person(s) .gtudent, General Ed. Teacher, Resource Staff
Short-Term Objective: By 112512013, when given a teacher direction, .... will orally count/read/write whole numbers to
50 with 70% accuracy on 3 consecutive trials as measured by teacher- charted work samples.
Short-Term Objective: By 9/2512013, when given a teacher direction, will orally count/read/write whole numbers to
75 with 70% accuracy on 3 consecutive trials as measured by teacher- charted work samples.
Short-Term Objective:
Progress Report 1:
Summary of Progress
Comment
Progress Report 2:
Summary of Progress
Comment
Progress Report 3:
Summary of Progress
Comment
Goal: Annual Review Date:
Goal Met
Comments:
I
Name
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ANNUAL GOALS AND OBJECTIVES
Page 12 of 15
IEP Date 101912013
Area of Need: Attention Measurable Annual Goal#
By 1012512013, when provided with cues to elicit interest as well
Basel in.. .. IS able to maintain attention
as visual and sensory support. , will demonstrate improved
and engagement for up to 10 minutes with a single
attention, regulation, and engageu1ent to maintain active participation in
prompt.
adult-directed activities for up to 20 minutes with a single prompt in 8110
opportunities as measured by observation/documentation
student to be involved/progress in general
curriculum/state standard
0Addresses other educational needs resulting from the disability
0 Linguistically appropriate
0Transltion
Goai:O Education/Training 0 Employment Dlndependent Living
Person(s) Responsible Student. General Ed. Teacher, Sg_. Ed. Staff
_Short-Term Objective: By 1/2512013, when provided with affective cues to elicit interest as well as visual and sensory support,
will demonstrate improved attention, regulation, and engagement to maintain active participation in adult-directed
laGuvwtJs ror up to 1 5 minutes 2 prompts in 8110 opportunities as measured by observation/documentation.
!Short-Term Objective: By 912512013, when provided with affective cues to elicit interest as well as visual and sensory support,
.
.. will demonstrate improved attention, regulation, and engagement to maintain active participation in adult-directed
'
activities for up to 20 minutes with 2 prompts in 6!10 opportunities as measured by observation/documentation.
Short-Term Objective:
Progress Report 1 :
Summary of Progress
Comment
Progress Report 2:
Summary of Progress
Comment
Progress Report 3:
Summary of Progress
Comment
Goal: Annual Review Date:
Goal Met 12!Yes 0No
Comments:
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Offer of FAPE
SERVICES
Page 13 of 15
Name IEP Date: 1019/2013
The service options that were considered by the IEP team (list all): General Education
Specialized Academic Instruction in General Education
Specialized Academic Instruction outside General Education, (In selecting LRE, describe the consideration given to any
potential harmful effect on the child or on the quality of services that he or she needs)
, ____ slii)f)lementary-"Ai"Ci5;servfce-s"&--6ti1er5uppoi1Sio_r_s_c-J1oolperson.neCor-to-rs-tuCierit;-oron.IJet1alfoTti1e-studenf ____ _
. . ; . :1nfrequen;y-:r !Duration,..
_ - , -.-.: -- - ' _ 1 ::.--" ... -,
I . - - ; t:;_ : .. -_ :_: _. : .,;.:-. < _:_ ; --- . ---<,:::'l;r-_:,>;-., :. - . -['<_._ . -": .. ;. __.-
;Shorten Assignments, Preterentia!ll!jstudent ,110109/2013 Year
!dtrect10ns repetaed, VIsual l
1
:
Modified II!JPersonnel I
1
I l. i
!f?.'()'!!P.!..s.:.__ _ __ ________ ____ ___ _ ____ _ _ ____________________________________________ I__ _ ______ _ ____________________ .......J .................... ____ ...-............ __ ........ _ .._______..____ _j
Transportation Special Ed
SPECIAL EDUCATION and RELATED SERVICES
Service: Se_ecia/ized Academic Instruction
Start Date: 10/09/2013 End Date: 1010912014
Provider: District of Service 0 lnd r!IGrp Osee Transition
Duration/Freq: 120 min _x Totaling: 600 min served
Location: Regular c/assroom!e_ublic school
Comments:
EXTENDED SCHOOL YEAR (ESY)

Programs and services will be provided according to when student is in attendance and consistent with the district of service
calendar and scheduled services, excluding holidays, vacations, and non-instructional days unless otherwise specified.
WEST END SELPA
Offer of FAPE
EDUCATIONAL SETTING
Page 14 of 15
Name ____ .;..;,_::__ IEP Date: 101912013
Physical Education D Specially Designed D Other
District of Service
School Type Public day school
School of Attendance
Federal Setting Regular classroom/Public day school
Federal Preschool Setting __ _
All special education services provided at student's school of residence? 0No (rationale)
35% of time student Is outside the regular class & extracurricular & non academic activities
65 % of time student is in the regular class & extracurricular & non academic activities
Student will not participate in the regular class & extracurricular & non academic activities Language artslmatfl
because intense instruction is provided in RSP
Other Agency Services
Ocallfornia Children's Services(CCS)
0Probation
0Dept. of Social Services(DSS)
Oother
Dcounty Mental Health (CMH)
Promotion Criteria: D Progress on Goals D Other
Parents will be informed of progress
D Semester Dother
How? Summary Report D Other
D Regional Center
D Department of Rehabilitation
ACTIVITIES TO SUPPORT TRANSITION
(e.g. preschool to kindergarten, special education and/or NPS to general education class, 8th-9th grade, etc)
GRADUATION PLAN
(Grade 7 and Higher)
Projected graduation date and/or secondary completion date __ _
Page 15 of 1&?1
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IEP TEAM MEETING NOTES
Name
Notes This meeting, held on 10/9/13, is an annual review.
Birthdate 81112006 Date 1010912013
In Attendance:
Administrator: I
General Education Teacher:
Special Education Teacher:
Parent: _
Other: Student teacher
Introductions were made. Parents were provided with a copy of their Procedural Safeguards/Parent Rights.
The purpose of this IEP meetinf. annual review.
Currently qualifies for Special Education services under the eligibility criteria of E;pecific Learning Disability (SLD).
receives services from the Specialized Academic Instruction in the RSP room.
Progress, Present levels, Assessment: Currently,
Mathematics and 0+ in History/Social Studies.
grades are as follows. G- in Reading, N in Language U in
Mrs. , , shared tha. is mean to his little brother at home. He loves to do Math at home. It is difficult to know what
his homework is since he doesn't write his homework down very well. He has a hard time completing his homework. too. She is
frustrated because he doesn't seem to be making much progress. They have spent a lot of money on tutoring _ . She is
very concerned about how he will do in 3rd grade.
2nd grade teacher, shared ho-v. r 1,. is doing in school. He is a very well behaved student if' r;lpc-c- l-Ie is
respectful and kind to other students. He does daydream throughout the day and is off task at times. Academically, _ -. : is
struggling. He reads about 20 words a minute on DJBELS, which should be 52 words a minute. His grades are modified because
he receives extra support in the RSP room. Currently he has aU in Math. He is having difficulty with regrouping and problem
solving. He is receiving a lot of support throughout the school day. He does much better when he is in a smaller group setting. He
is very distracted in a large class setting. He also has difficulty retaining information from day to day.
The special education teacher- , ; sharel comes into the RSP room twice a day for approximately 2 hours a
day. He is easily distracted by otner students in the classroom. He does much better when learning is fun- not worksheets. He
is a very hard worker. He has met his academic goals. He continues to have difficulty with the paying attention goal.
Statewide assessments were discussed.
take the CST in April.
, will take CST with accommodations, if the state and district have students
'>Qr:ial factors were discussed. = does have Assistive Technology and no other special factros are needed at this time.
. . uses the following AT: slant board, pencil grips, thick pencils, short pencils, 100's chart, computer software .
Progress towards previous goals was discussed. Draft goals to
reviewed and adopted by the IEP team.
. in the areas of Reading, Writing, and Math were
Accommodations and modifications were discussec.. needs the following accommodations/modifications to be able to
access the core curriculum and be successful in seating, modified grades, directions repeated, visual prompts.
The IEP team discussed placement, supports, and servir - - . . Based on the present levels of performance and goals,
the team determined the least restrictive environment for. is general education with Specialized Academic Instruction
provided in the RSP program. , asked about the uistrict Special Day Class get frustrated in the general
education classroom. The SDC program was discussed. He could participate in a blended program to see how he could do. The
team will meet again after parent conferences.
Extended school year was discussed. . ' is not eligible for ESY at this time. The IEP will re-visit this in the Spring of 2014.
Progress will be reported through parent conferences, annuaiiEP meetings, and periodic report cards at the end of each
trimester.
reviewed the IEP with the team.