INDIVIDUALIZED EDUCATION PROGRAM: PRESENT LEVEL

OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Form I-4 (Rev. 9/13)

Name of Student _Briana, 5th, EBD_______________________________

Describe the students strengths and the concerns of the parents about the students education.
Briana can be very polite. Does her homework and completes tasks in a timely manner. Loves to color, do
crafts, and listen to music. Plays Legos and Pictionary with staff and peers. Parent concerns: Per previous IEP,
mother had concerns about Briana staying in school, that throughout Briana's history schools could not handle
her behavior. She was concerned about the frequency and length of Briana's suspensions. She also stated that
several schools had neglected to provide a report card to her.
Describe the students present level of academic achievement and functional performance including how the
students disability affects his or her involvement and progress in the general education curriculum. For
preschool children, describe how the disability affects involvement in age-appropriate activities. (Note:
Present level of performance must include information that corresponds with each annual goal)

Reading: Briana's reading benchmark assessment score was 206 for Spring 2014. This was an increase of 10
points from the previous assessment. The average Reading score for students in the same grade within the
national norm group was 207. Briana's percentile rank was 48. Briana is able to read and comprehend multiple
types of reading materials. She does really well with comprehension questions, because she can go back and
reference the material read. Briana can describe a character and the setting of a story. Struggles with using
specific details from the story to explain her answers or highlight a point. She reads fluently and is able to
learn other subjects by reading materials related to the topic. She does not need any assistance in tracking. She
can read without becoming distracted, but likes to share interesting facts as she reads non fiction books. She
has a harder time answering questions that are not directly answered in the reading.
Writing: Briana has great spelling skills. She writes in proper sentence structure. She can write in an
organizational manner. She tends to rush through writing assignments instead of giving more details to make
the story or paper more complete and more vivid. She loves making power points and can type papers nicely.
Briana struggles with paraphrasing information from other sources. On PowerPoint presentations she copies
and pastes information instead of paraphrasing and including only the really important parts. She can write her
name, number, and address. She is easily frustrated if she thinks the work is too hard or too easy.
Math: Briana's math benchmark assessment score from Spring 2014 was 207. This was an increase of 7 points
from the previous assessment. The average Math score for students in Briana's grade level within the national
norm group was 213. Briana's percentile rank was 35. She knows how to calculate the four major operations
without a calculator and answer story problems. Multistep problems can trip her up from time to time, mostly
because she is rushing through and does not stop to read the problem thoroughly. She can identify coins and
make change. She uses recipes to cook frequently. Briana can tell time with a digital clock, but does not do
well with an analog clock. She has been working on Fractions and Decimals. She can calculate area and
perimeter.
On the 4th grade WKCE, Briana scored at the Proficient level in English Language Arts and Social Studies;
Basic level in Math and Science; and Minimal Performance level in Reading.
Behavior: When frustrated, Briana yells, hits, kicks, pushes, and throws things. She is easily frustrated when
things are not done her way or if she does not get it as quickly as she thinks she should. Her wait time is about
2 seconds. This behavior is observed in school and on the unit. Briana can be very polite, but then she can lose
all control and become physically and verbally aggressive toward peers and staff, 2 to 3 times a week.
Physical altercations for the month of March were observed 1 time a week. After these incidents, Briana can
return to class most of the time after 30 minutes to 2 hours. Signs she is about to become upset include:
clenched fists, heavy breathing, and lack of eye contact. She does know how to hold a social conversation and
to take turns. She responds to peer negativity in quick retaliation. She is quick to fight back instead of taking a
step back and thinking about the consequences of her choices or to allow an adult to handle the situation. Still
continues to deny and blame others for what happens, a couple of times per week usually during her biggest
blow ups. Will argue with staff a few times a week. She can work in a group of 3 or more people, but some

days she is not able to handle this either. She knows the rules and can explain them to the peers, but she does
not always follow the rules.
Briana has several coping skills that she knows how to use in order to help calm herself, but in the moment
she is not able to choose one and use it to regulate her emotions. When frustrated and upset, she uses vulgar
and obscene language. Will berate staff. On any given day she can do all the appropriate things, but if its not a
good day, then she will have difficulties doing all the appropriate skills she knows and can use.
Briana does speak up for herself even if it isn't always in an appropriate way. She has been Since a behavior
plan (sic) was created involving Briana's mother and the opportunity to go home, Briana is showing more of
an ability to control herself and respond appropriately. Briana is staffed with a 1:1 during PMs on the
residential unit. This staff member is also available to Briana during school if needed.
This student receives educational services at a residential care center. This placement provides a higher level
of emotional and behavioral support than traditional school. Therefore, the team agrees that there is currently
no need for school psychologist or counseling services to facilitate emotional and behavioral management
skills in order to access FAPE.
Functional Skills: Briana can do most personal care, but struggles to keep her hair brushed neatly. She does
laundry by herself. Knows her daily schedule and can read time on a digital clock accurately. Briana earns an
allowance and is responsible for saving money for big purchases. She knows how to walk around the
neighborhood and follow street rules properly. Briana helps in the kitchen doing dishes, cooking, clearing, and
clean up.
Briana has been identified as having an emotional/behavioral disability which manifests as social, emotional,
or behavioral functioning that so departs from generally accepted age appropriate, ethnic or cultural norms in
the form of aggression, refusal to accept consequences, and inability to problemsolve within her peer group
which affects her involvement in the general education curriculum.
Will the student be involved full-time in the general education curriculum or, for preschoolers, in ageappropriate activities? Yes
No
(If no, describe the extent to which the student will not be involved full-time in the general curriculum or,
for preschoolers, in age-appropriate activities)
Yes Briana will receive the general curriculum.
SPECIAL FACTORS After consideration for special factors (behavior, limited English proficiency, Braille
needs, communication needs including deaf/hard of hearing, and assistive technology), is there a need in any
of the areas?
Yes No (If yes or student has a visual impairment, attach I-5, Special Factors page)

INDIVIDUALIZED EDUCATION PROGRAM

SPECIAL FACTORS
Form I-5 (Rev. 7/06)

Note: For any need(s) identified below, there must be a statement of the service(s) to meet that need (including
amount/frequency, location, and duration) on the Program Summary page (I-9).

Name of Student_Briana_____________________________
A. Does the students behavior impede his/her learning or that of others?
Yes No
(If yes, include the positive behavioral interventions, strategies, and supports to address that behavior)
Due to her behavior, Briana will have a Positive Behavior Support Plan to help her manage her behaviors.
See goals pages for specifics on skills to be taught.
B. Is the student an English Language Learner?
Yes No
(If yes, include the language needs that relate to this IEP)
C. If visually impaired, does the student need instruction in Braille or the use of Braille?
Yes
No
Cannot be determined at this time
(If yes, include Braille needs; if no or cannot be determined, attach ER-3, Determining Braille
Needs from the latest evaluation/reevaluation)
D. Does the student have communication needs that could impede his/her learning?
(If yes, include communication needs)

Yes

No

{If yes and the student is deaf or hard of hearing, identify the communication needs including (a) the students language;
(b) opportunities for direct communication with peers and professional personnel in the students language and
communication mode; and, (c) academic level and full range of needs including opportunities for direct instruction in the
students language and communicative mode}:

E. Does the student need assistive technology services or devices?

{If yes, specify particular device(s) and service(s)}

Yes

No

INDIVIDUALIZED EDUCATION PROGRAM

ANNUAL GOAL
Form I-6 (Rev. 10/06)

Name of Student _Briana_______________________________

Measurable annual academic or functional goal to enable the student to be involved in and progress in the
general education curriculum, and to meet other educational needs that result from the students disability.
(Note: present levels of academic achievement and functional performance must include information that
corresponds with each annual goal)
Upon review: Goal met Goal not met

Goal: Briana will decrease instances of verbal aggression towards staff and peers from a present level of 2.5
times/week to a level of 1x/week by increasing her self-awareness of her emotional state.

Benchmarks:

Briana will self-identify signs of anxiety (clenched fists, heavy breathing, lack of eye contact) when
prompted to look for them 4 out of 5 times.
Briana will identify her stress level using a five-point scale when calm when prompted 4 out of 5
times.
o When previous benchmark has been met, Briana will identify her stress level using a five
point scale when showing signs of anxiety when prompted 4 out of 5 times.

Goal: Briana will decrease instances of physical aggression towards staff and peers from a present level of
1x/week to 1x/month by increasing her use of coping strategies.

Benchmarks:
(Note: there coping strategies Briana presently uses were not included in the PLAAFP sample, so the coping
skills included here are placeholders. Had this been my student I would have included the skills she has so
that they can be included in the goal writing.)
Briana will practice coping skills A, B, and C with staff when calm in 4 out of 5 attempts.
o When previous benchmark has been met, Briana will use her coping skills when anxious and
prompted by staff in 4 out of 5 attempts.
Briana will practice 2 new coping strategies with staff when calm in 4 out of 5 attempts.
o When previous benchmark has been met, Briana will use her new coping skills when anxious
and prompted by staff in 4 out of 5 attempts.
Procedures for measuring the students progress toward meeting the annual goal.
Behavior data will be collected daily in the areas of Agitated/Disruptive, Physical Aggression, and Coping
Skill Use.

Will the student participate in an alternate assessment aligned with alternate achievement standards for
students with disabilities in any subject area? Yes No
(If yes, include benchmarks or short-term objectives for the student)

When will reports about the students progress toward meeting the annual goal be provided to parents?
Teacher will have regular email/phone contact (minimum of once/week) to keep parents informed about how Briana is
behaving in class. Data and documentation on behavior incidents and emergency interventions will be provided
quarterly, based on the IEP date.

INDIVIDUALIZED EDUCATION PROGRAM:

participating
PARTICIPATION IN STATEWIDE ASSESSMENTS

To be completed for students

in Dynamic Learning Maps

Form I-7-DLM (Rev 9/15)

Name of Student__Briana_________________________
The student will be in (circle one) 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th or 11th grade when the Dynamic Learning
Maps assessment is administered in English language arts, mathematics and/or science. The student will be taking
the alternate assessment1 for all content areas required at this grade level (the I-7-A Participation Guidelines for
Alternate Assessment must be included with the IEP).
Supports and accommodations for Dynamic Learning Maps are specific to this assessment. Please refer to the
Office of Student Assessment website for the current policies.
Section A: Supports
Supports are for all students, as needed; they do not alter the content being tested. Please list.
Though the test itself is not timed, staff will give student the option of taking breaks as needed.

Section B: Accommodations (complete both charts):

English language
arts (for students
in grades 3-11)

ELA without
accommodations.

ELA with accommodations (list) :

Mathematics
(for students in
grades 3-11)

Mathematics without
accommodations.

Mathematics with accommodations (list) :

Science
(for students in
grades 4 and
8-11)

Science without
accommodations.

Science with accommodations (list) :

INDIVIDUALIZED EDUCATION PROGRAM:

SUMMARY
Form I-9 (Rev. 10/06)

Name of Student __Briana___________________________

Projected beginning and ending date(s) of IEP services & modifications __12/8/15____ to
_12/7/16_________
(month/day/year)
(month/day/year)

Physical education:
Vocational education:

Regular
Regular

Specially designed
Specially designed

Include a statement for each of I, II, III and IV below to allow the student (1) to advance appropriately toward
attaining the annual goals; (2) to be involved and progress in the general education curriculum; (3) to be
educated and participate with other students with and without disabilities to the extent appropriate, and (4) to
participate in extracurricular and other nonacademic activities. Include frequency, location, & duration (if
different from IEP beginning and ending dates).

I. Special education
Standard curriculum to be provided. Visual supports
provided for development of emotional awareness.

Frequency/
Amount
360
minutes/day

Location
Residential
Facility

Duration
Length of
IEP

II. Related services needed to benefit from special education including frequency, location, and
duration (if different from IEP beginning and ending dates).

None needed to benefit from special education

Freq / Amt

Assistive Technology
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
Transportation
Other: specify

Location

Duration

III. Supplementary aids and services: aids, services,

Freq / Amt
and other supports provided to or on behalf of the
student in regular education or other educational
settings.
Yes
No (If yes, describe)
Note: The PLAAFP notes that her residential
placement is providing staff to work with her. As the
school is not providing this service I am not
including that staff member in this section.

IV. Program modifications or supports for school

personnel that will be provided.
Yes No (If yes, describe)

Location

Duration

V. Participation in Regular Education Classes

The student will participate full-time with non-disabled peers in regular education
classes, or for preschoolers, in age-appropriate settings.

The student will not participate full-time with non-disabled peers in regular education
classes, or for preschoolers, in age-appropriate settings. (If you have indicated a
location other than regular education classes or age-appropriate settings in the case of a
preschooler in I, II, or III above, you must check this box and explain why full-time
participation with non-disabled peers is not appropriate.)

Brianas behaviors infringe on other students ability to learn in a safe environment. Accordingly,
Briana will receive educational services at her residential placement.

VI. Participation in Extracurricular and Nonacademic Activities

Will the student be able to participate in extracurricular and nonacademic activities with
nondisabled students?
Yes
No
(If yes, include under I., II., III., and IV. any special education, related services, supplementary
aids and services, and program modifications or supports necessary to assist the student. If no,
describe the extent to which the student will not be involved in extracurricular and nonacademic
activities with nondisabled students)

Participation will be dependent upon staffs judgment regarding Brianas ability to participate
safely in the activities.