INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student’s Name:

INDIVIDUALIZED EDUCATION PROGRAM (IEP) School Age

Student’s Name: Ava Anderson

IEP Team Meeting Date (mm/dd/yy): 11/20/17
IEP Implementation Date (Projected Date when Services and Programs Will Begin): 11/27/17
Anticipated Duration of Services and Programs: 6 Months
Date of Birth: 9/17/2012
Age: 5
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): 740-854-0989
Henry and Elizabeth Anderson Phone (Work): 740-223-4682
989 Park Dr
Weirton, WV 26062

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

Ava is a preschool student in a universal classroom including peers with and without a disability. At this point, Ava has not been diagnosed
with a specific disability other than a speech impediment. Ava was assessed on November 20, 2017 with the Brigance Inventory of Early
Development III Standardized, which looked at her developmental progress across a number of different areas. After looking at the results of
Ava’s testing, she shows many areas of strength as well as a few areas in which she could use more assistance. Overall, the Brigance test shows
Ava to be at an age equivalent to four years one month with an instructional range of four years zero months to four years two months. She
scored a composite score of 87 for her total developmental score which puts her in the nineteenth percentile among her peers.

When it comes to physical development, Ava scored in the twenty first percentile with a composite score of eighty eight. With gross motor
skills, Ava scored at an accurate age equivalent to her correct age with a composite score of ninety four; whereas, with her fine motor skills
she scored below average with a composite score of eighty seven. Ava is able to complete many fine motor activities such as building with
blocks or tracing given shapes, her difficulty with fine motor affects her ability to write, such as her numbers or the letters in the alphabet.

Like mentioned above, Ava struggles when it comes to language development with her speech. Overall, Ava’s language development composite
score was seventy four which puts her in the fourth percentile. Her composite score in the subdomain of receptive language is seventy two and
in the subdomain of expressive language she received a composite score of eighty six. Although she is below average in both subdomains, she
especially has difficulties with receptive language, which affects her ability to understand what is said to her.

Ava scored a composite score of ninety-nine putting her in the sixteenth percentile when it comes to academic/cognitive development. She
scored below average in the literacy subdomain putting her in the ninth percentile and an age equivalent of four years zero months. Whereas,
with the mathematics subdomain, she scored in the thirty-fourth percentile putting her at an age equivalent of five years four months. Ava
specifically struggles with identifying letters and sounds that in the literacy subdomain.

Ava is right on track with her adaptive behavior as well as the subdomain of daily living, scoring a composite score of ninety-nine putting her in
the forty-eighth percentile. Ava is very capable of eating on her own as well as toileting a bathing on her own, the only areas in which she
could use further practice is with completely dressing herself including putting on her shoes, tying the laces, and fastening all fasteners.

With the last domain of social and emotional development, Ava scored a composite score of one hundred and one putting her in the fifty-third
percentile. In the subdomain of interpersonal skills, Ava scored above average with a composite score of one hundred and nine putting her in
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the seventy-third percentile. In the other subdomain of self-regulatory skills, Ava was placed in the thirty-ninth percentile with a composite
score of ninety-six. She is a very friendly little girl, saying hello to everyone she passes and plays very well with her peers showing her above
average score with her interpersonal skills.

Areas of Strength (per information from above):

 Ava has very strong gross motor skills, she was able to jump in many different ways including on one foot, two feet, backwards, and
with her eyes closed.
 Ava is able to count all the way up to thirty and then even a little higher.
 Ava feeds herself without any assistance needed, and is able to do it with little to no spilling.
 Ava has advanced interpersonal skills, showing affection and care specifically to adults.
Areas for improvement (per information from above):
 Ava needs more practice on writing the twenty six letters of the alphabet, uppercase, and in sequence.
 Ava could use more practice identifying the name of an object by looking at a picture of the object.
 Ava needs practice in phonological awareness and her familiarity with sounds, specifically identifying rimes and segmenting words.
 Ava needs more practice with writing her numbers from one to ten in order.

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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Ava’s progress towards Quarterly with report cards.

When prompted, Ava will be able to write the this goal will be measured
twenty six letters of the alphabet in uppercase formally through a writing
letters and in order with two or less errors over activity. The student will
five consecutive sessions by the end of the IEP. be asked at the end of
each session to write the
alphabet in uppercase
letters and in order.

Given pictures of common objects, Ava will Ava’s progress will be Quarterly with report cards.
identify the proper name of the object, with one measured informally
hundred percent accuracy in four out of five through observations
weekly checks. during the week, and
formally at the end of
each week when given a
picture and they must
identify the name of the
object.

Given words, Ava will be able to decode what the Ava’s progress will be Quarterly with report cards.
rime of the word is and segment larger words, measured formally
eighty percent of the time over six consecutive through writing activity.
sessions. The student will be asked
to circle the rime of the
word as well as segment a
larger word into two
individual words. The
student’s progress will
also be measured
informally through
observation throughout
the week.
During math time, Ava will be able to write her Ava’s progress will be Quarterly with report cards.
numbers from one to ten in order, ninety percent monitored formally
of the time in five out of five weekly checks. throughout the week.
The student will be asked
to write their numbers in
order from one to ten.

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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.

Modifications and SDI Location Frequency Projected Beginning Anticipated Duration

Date
The student will be given a copy of the alphabet Student Desk Duration of the IEP 11/27/17 Length of IEP
letters laminated so they are able to trace over them
for extra practice.

The student will be given extra practice by having a The instruction will 4x per week 11/27/17 Length of IEP
worksheet that has a single letter and then dotted take place during
lines for the student to trace one individual letter writing time, and the
several times. This will be given for the specific student will receive
letters the student is having difficulties to write. extra assistance from
the paraprofessional
when needed.
The instruction will 3x per week 11/27/17 Length of IEP
The student will be given a color coded lined piece of take place one-on-one
paper. Starting at the top, the student will write the with the
first letter of the alphabet across the line staying in paraprofessional in
the one color, the student will then move to the next the classroom or at a
color or line and write the second letter. The student table in the hallway.
will continue to write until they have completed each
letter.

The student will be given a picture of an object on a The instruction will 4x per week 11/27/17 Length of IEP
popsicle stick, on the other side of the picture is the take place one-on-one
name of the object. with the
paraprofessional in
the classroom or at a
table in the hallway.

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The student will be given a picture and a selection of The instruction will 3x per week 11/27/17 Length of IEP
words of possible names for the object. take place one-on-one
with the
paraprofessional in
the classroom or at a
table in the hallway.
The instruction will 2x a week 11/27/17 Length of IEP
The student will be given an iPad, and using an app take place during free
they will touch a picture and the iPad will say the time in the classroom.
name of that object.

The student will be given a list of common rimes that The instruction will Daily as needed 11/27/17
is laminated and they may have with them when take place during Length of IEP
spelling. writing centers in the
classroom.
The student will be given CVC word puzzles, looking The instruction will 2x a week 11/27/17
at putting an initial letter with a rime to form a word. take place one-on-one Length of IEP
with the
paraprofessional in
the classroom or at a
table in the hallway.
The student will listen to a video from YouTube The instruction will 4x a week 11/27/17
sounding out different phonemes while displaying the take place during Length of IEP
picture of the phoneme. center time in the
classroom.
The student will be given a worksheet with the The instruction will 3x a week 11/27/17
numbers in order for them to trace. With each take place during Length of IEP
number, there will be a green circle for where the center time in the
student should start writing their number, and a red classroom.
circle to show where they should end.
The student will be given a list of phrases that are Student Desk Duration of the IEP 11/27/17
clever ways to remember how to write the number. Length of IEP
For example, for number one it would say, ‘One is
fun! Straight down and then you’re done’. Three
would say, ‘Around the tree, around the tree, that
is how you make a three’.
The student will be given a number line on their Student Desk Duration of the IEP 11/27/17
desk that they may trace and use for reference Length of IEP
when needed.

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