INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student’s Name:

INDIVIDUALIZED EDUCATION PROGRAM (IEP) School Age

Student’s Name: Riley Simmons

IEP Team Meeting Date (mm/dd/yy): 08/07/2017
IEP Implementation Date (Projected Date when Services and Programs Will Begin): 08/17/2017
Anticipated Duration of Services and Programs: 12 months
Date of Birth: November 12, 2013
Age: 4
Grade: Pre-K
Anticipated Year of Graduation: 2030
Local Education Agency (LEA): Hancock County School District
County of Residence: Hancock
Name and Address of Parent/Guardian/Surrogate: Phone (Home): 304-614-3222

Julie and Adam Simmons Phone (Work):

304-515-6113
122 Robin Road
Weirton, WV 43952

Other Information:

The LEA and parent have agreed to make the following changes to the IEP without convening an IEP meeting, as documented by:
N/A

Date of Revision(s) Participants/Roles IEP Section(s) Amended

N/A N/A N/A

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II. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Include the following information related to the student:

 Present levels of academic achievement (e.g., most recent evaluation of the student, results of formative assessments, curriculum-based
assessments, transition assessments, progress toward current goals)
 Present levels of functional performance (e.g., results from a functional behavioral assessment, results of ecological assessments, progress
toward current goals)
 Present levels related to current postsecondary transition goals if the student’s age is 14 or younger if determined appropriate by the IEP team
(e.g., results of formative assessments, curriculum-based assessments, progress toward current goals)
 Parental concerns for enhancing the education of the student
 How the student’s disability affects involvement and progress in the general education curriculum
 Strengths
 Academic, developmental, and functional needs related to student’s disability

Riley is a 4 year old Preschool student in an inclusive classroom. She was given the Brigance assessment on November 20, 2017. The purpose of
this assessment was to assess Riley’s level of development in multiple areas. The assessment showed areas in which Riley excelled but also
exhibited areas of needed improvement. Her present levels of performance show that she is in the 82nd percentile for her age. Her age
equivalent is 3 years and 10 months, and her instructional range is 3 years and 9 months to 3 years and 11 months.

Academically, Riley performed slightly above average in literacy scoring in the 53rd percentile. She was able to recite all the letters in the
alphabet. Also, when given two words Riley was able to blend them together to form a compound word. However, she struggled with
identifying rhyming words. She also struggled to identify two words that were the same and two words that sounded the same. For instance,
when given the words Pig and Big she said that these two words were the same and when given the words Job and Job she said that these
words were different. Riley scored in the 90th percentile for math. She was able to count from 1 to 30 without any trouble. She was also able
to successfully compare different amounts and tell which groups had more or less. Riley did struggle, however with reading numerals and
solving word problems. When shown a picture and asked “Are there enough balls for each dog to have one?” she answered no though there
were eight balls and eight dogs.

Functionally, Riley is typically developing. She scored in the 98th percentile for gross motor development. She had an age equivalent of 5 years
and 3 months old. This is above her actual age. She was able to successfully walk, skip, and gallop. She also successfully mastered jumping,
hopping, and stair climbing. The only gross motor skill in which she had some trouble was catching a tennis ball. Riley scored in the 86 th
percentile for fine motor skills with an age equivalent of 4 years and 6 months. She was successfully able to build a tower given any number of
blocks. She was also able to draw shapes such as a circle, plus sign, and an X. She could print her first name but was not able to print her last
name. She also struggled with printing uppercase levels from memory.

Behaviorally, Riley stays on task for the most part when in the classroom. She can become easily distracted and has lots of energy. The flow of
the classroom helps her to focus her attention and provides opportunities for her to be active. However, when asked to participate in activities
that require her to sit for an extended period of time Riley tends to lose focus. The teacher is able to redirect her attention to the activity and
only allows a short period of time for certain activities.

Riley is on target socially scoring in the 71st percentile. She plays well with her peers during center time. She is very social in that she loves
talking to people. She socializes with adults and peers alike and loves individual attention.
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Riley has a speech impediment which affects her ability to communicate with others. Though she is social peers at times have a hard time
understanding what she is saying. This also affects her language skills and phonetic skills. Riley receives speech services to help wither
disability.

Strengths:
 Riley has exceptional motor skills. She was able to complete all of the hopping, skipping, jumping, and stair climbing activities with
success.
 She excels in math. She was able to count from 1-20 with ease. She was also able to successfully build a block tower given any number
all the way up to 12.
 Riley has great social skills with both adults and peers. She is good at sharing and playing with her classmates.
 Riley can say all the letters of the alphabet.

Areas for Improvement:

 Riley needs to work on identifying the numerals 1-20.
 Riley needs practice with identifying groups that are more than or equal too.
 Riley needs additional practice with identifying rhyming words.
 Riley needs more on-on-one phonemic awareness instruction to identify words that are the same and words that are different when
presented verbally.

V. GOALS AND OBJECTIVES – Include, as appropriate, academic and functional goals. Use as many copies of this page as needed to plan appropriately.
Specially designed instruction may be listed with each goal/objective or listed in Section VI.

Short term learning outcomes are required for students who are gifted. The short term learning outcomes related to the student’s gifted program may be
listed under Goals or Short Term Objectives.

MEASURABLE ANNUAL GOAL Describe HOW the

Describe WHEN periodic
Include: Condition, Name, Behavior, and Criteria student’s progress toward
reports on progress will be Report of Progress
(Refer to Annotated IEP for description of these meeting this goal will be
provided to parents
components) measured

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When shown the numerals 1-20, Riley will be able On their own form with On Riley’s report card at
to correctly identify these numerals with 75 number 1-20 the observer the end of every quarter.
percent accuracy four out of every five times in will circle the numbers
the week they are presented to her by the end of that Riley correctly
this IEP. identifies during each
session and score her
progress at the end of
every week.

When given a word verbally and asked to find the The observer will record On Riley’s report card at
picture that rhymes with the word Riley will be the number of words the end of every quarter.
able to correctly identify the rhyming picture five given and the number of
out of every ten times (50%) throughout the week times Riley correctly
by the end of this IEP. identifies the matching
rhyming word. A final
score will be calculated at
the end of the week to
measure progress.

When presented with two amounts in the form of Each day Riley will be On Riley’s report card at
pictorial representation, Riley will be able to presented with five the end of every quarter.
correctly identify whether one group has more or problems. A tally will be
an equal amount for 4 of every 5 problems kept each day of how
presented 80% of the time during the week by the many problems she
end of this IEP. answers correctly. A final
score will be calculated at
the end of the week.

When given two words Riley will be able to The observer will verbally On Riley’s report card at
successfully identify whether the words are the present Riley with ten the end of every quarter.
same or different with 80% accuracy four out of pairs of words each day.
five days during the week by the end of this IEP. On his/her own form
he/she will circle the
pairs Riley correctly
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identifies. A final score

will be calculated at the
end of every week.

VI. SPECIAL EDUCATION / RELATED SERVICES / SUPPLEMENTARY AIDS AND SERVICES / PROGRAM MODIFICATIONS – Include, as appropriate, for nonacademic
and extracurricular services and activities.

A. PROGRAM MODIFICATIONS AND SPECIALLY DESIGNED INSTRUCTION (SDI)

 SDI may be listed with each goal or as part of the table below.
 Include supplementary aids and services as appropriate.
 For a student who has a disability and is gifted, SDI also should include adaptations, accommodations, or modifications to the general
education curriculum, as appropriate for a student with a disability.

Projected Beginning
Modifications and SDI Location Frequency Anticipated Duration
Date
When learning her numerals Riley will be given
This resource will be
sandpaper letters to trace with her finger to help her
at a table during
remember the numerals kinesthetically. 3 times per week 08/17/17 5 weeks
learning labs for Riley
to use.

This will occur at a

Riley will receive one-on-one instruction with the
table in the back
classroom aide to learn numbers 1-20. 2 times per week 08/17/17 5 weeks
corner of the
classroom.
Riley will watch a video that teaches numbers one This will be on an I-
through twenty and how to remember what they look pad at a table in the
2 times per week 08/17/17 4 weeks
like. back corner of the
classroom.
This will be at Riley’s
Riley will be given a chart with pairs of pictures that seat during learning
rhyme with one another labs when Riley
daily 08/17/17 3 weeks
completes an
independent project
on rhyming words.
Riley will play a game on the I-pad that helps teach This will be at a
rhyming words. separate table during
2 times per week 08/17/17 5 weeks
learning labs when
other students are
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also working on I-pads

independently.
Riley will be given a book with words that rhyme to This will occur at a
read with a classroom aide. table in the back of
3 times per week 08/17/17 3 weeks
the classroom during
center time.
This activity will be
Riley will engage in an activity in which she is given completed at a table
two sets of objects that she must pair up and in the classroom with
2 times per week 08/17/17 3 weeks
determine whether they are the same amount or one of the classroom
whether there is more of one than the other. aides during center
time.
This will occur with
the aide one-on-one
Riley will be taught a song to help her learn numbers
at a table in the 2 times per week 08/17/17 4 weeks
that are the same or that are more.
classroom during
center time.
Riley will have a picture chart with strategies of how
This will be at her
to figure out whether a group of objects is more than daily 08/17/17 4 weeks
seat during math.
or equal to another.
This will be at Riley’s
Riley will be given a chart of pairs of words with their
desk when completing
pictures underneath. She will be able to use this to
language arts daily 08/17/17 2 weeks
help visualize words that are the same and words that
activities during
are different.
learning labs.
This will occur one-on
Riley will be given flash cards of letters from the
one with the
alphabet that she must use to name their sounds. This
classroom aide at a 4 times per week 08/17/17 3 weeks
will help her phonetically to hear the differences in
table in the classroom
words that sound similar.
during learning labs.
This will occur
Riley will engage in a game on the I-pad that teaches
independently at a
letter sounds and the difference between words that 2 times per week 08/17/17 4 weeks
table in the classroom
sound similar.
during learning labs.

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