INDIVIDUALIZED EDUCATIONAL PLAN

LRN: 136477160022 Date: October 11, 2022

STUDENT INFORMATION
Name: Age: 12
Birthdate: May 7, 2010 Birth Place: Pasay General Hospital Gender: Female
Home Address: B13 L16 Rambutan St. Mangga 3, Pinagbuhatan, Pasig City
Program: Self - Contained Level: Beginner
Exceptionality: ADHD Diagnostician: Jhon Peter S. Hidalgo, RPm
PARENT/GUARDIAN INFORMATION
Father’s Name: Diosdado Belarmino, Jr.
Contact Number: 09425574658 Occupation: Electrician
Mother’s Name: Roselyn M. Belarmino
Contact Number: 09322207214 Occupation: Housewife
Guardian’s Name: N/A Relationship: N/A
Contact Number: N/A Occupation: N/A

MEDICAL INFORMATION
Asthma Drooling Heart Disease
Pulmonary Issues Seizure Skin Disease
Others: Allergies

Summary of Developmental Assessment:

Mae Kris was assessed last September 20, 2019 with a diagnosis that shows signs and symptoms of
Intellectual Developmental Delay. Mae Kris has Mild Disability. In summary, Mae Kris’ intellectual quotient is
35. The range of her intellectual capacity is within 31 -39. Currently, Mae Kris’ mental age is estimated to be
functioning at 4 years old. Mae Kris’ adaptive functioning is within the poor range. Her adaptive skills are
higher than her reported cognitive functioning.

STRENGTHS NEEDS

 Interested in listening to stories, songs and  Improve waiting time

a variety of listening activities.  Improve tracing/copying skills.
 Loves to dance and sing.  Express personal feelings in a socially
 Gets along well with others easily and is acceptable manner
very friendly.  Answer general information questions
 Can follow simple instructions appropriately
 Can remain on her seat for a long period  Expand phonic skills
of time.  Increase awareness for math skills such as
 Asks permission if she wants to do number sense, spatial skills and
something especially inside the representation
classroom.

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Describe here the present level of performance in each area relevant to educational planning or to
determine eligibility in BOTH narrative and standardized format. Do not report test scores only.

SUMMARY OF PRESENT LEVEL OF FUNCTIONAL PERFORMANCE AND ACADEMIC ACHIEVEMENTS

Mae shows academic performance reflective of individuals with Intellectual

Disability. She shows deficits in cognitive functioning in the areas of attention and
memory, reasoning and academic skills. She is able to sustain concentration on a
particular task/classroom activity for only a short period of time. She is easily
distracted and this greatly contributes to her difficulties in acquiring and
Cognitive Ability
remembering information.
But despite her cognitive delays she knows the following:
Math: Rote Count up to 10; Primary Colors and Basic Shapes
Science: Parts of the Body
Language/Reading: Polite Expressions and Alphabet Song

Mae is a cheerful and friendly student. She loves to engage in interactive play
activities with her classmates. She loves to imitate, follow, and enjoys following
dance steps and moving to music. She engages in cooperative social play
Socio-Emotional interactions and appropriate turn-taking skills. She greets the teacher with a
pleasant disposition as well as her classmates. She knows when to apologize and is
very respectful. However, she suddenly gets mad for no apparent reason and blurt
out senseless things.

Mae can express herself verbally but there are still pronunciations that are still
Oral
unclear. She can answer simple questions and loves to engage in conversations
Communication/
Language
with classmates and with adults. She loves to ask questions and can spontaneously
request for objects or actions.

Mae is a very energetic student. Overall, she has very good gross motor skills.
She can imitate basic physical movements and is very participative in games
during P.E.
Motor/ Perceptual However, her fine motor skills show delays as she is having difficulty
manipulating classroom objects and toys. She also has weak eye-hand
coordination and shows sudden impulsive hand movements. She can only trace
straight horizontal lines but still needs prompting and guiding.

Mae knows where to get and return things inside the classroom. Before
Adaptive entering the classroom, she is still prompted to wear her cover shoes but knows
Behavior/
where to put her bag and to sit immediately in her assigned seat. She shares items
Self-help
with her classmates. She responds to questions during classroom discussion and
can follow classroom routines and rules. She eats finger foods by herself and
washes her hands independently.

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ANNUAL GOAL: Motor / Perceptual
Fine To increase fine motor skills such as ability to manipulate classroom objects, grasp, hold and use
a pencil/crayons and scissors to perform functional activities.
Gross To increase gross motor skills such as ability to execute body actions independently.
Short Term Goal Method Baseline Progress
Fine Motor:
Perform fine motor task/activities __ Performance Assessment See
independently: __ Work Sample present
 Color within borders __ Teacher’s Observation level on
__ Parent’s Observation
 Trace lines/letters page 2
__ Standardized Assessment
 Cut papers using scissors __ Others

Gross Motor:
 Move body in the following __ Performance Assessment See
directions (forward, backward, __ Work Sample present
up, down, sideways, right/left, __ Teacher’s Observation level on
__ Parent’s Observation
diagonally). page 2
__ Standardized Assessment
 Imitate and independently __ Others
perform body actions and
movements.
ANNUAL GOAL: Cognitive/ General Ability
To increase reading readiness skills in the areas of phonemics, print awareness and letter knowledge.
To count, recognize numerals and find appropriate quantities.
To increase recognition of colors and shapes.
Short Term Goal Method Baseline Progress
 Recognize own name in print
 Identify letters of the alphabet __ Performance Assessment See
 Identify numbers 1 – 10 __ Work Sample present
 Count objects with 1: 1 __ Teacher’s Observation level on
__ Parent’s Observation
correspondence up to 10. page 2
__ Standardized Assessment
 Name primary and secondary __ Others
colors.
 Name basic shapes.
ANNUAL GOAL: Oral Communication / Language
To give personal information when asked.
Appropriately initiate and close interaction
Short Term Goal Method Baseline Progress
 Use polite phrases (thank you,
excuse me. etc.) __ Performance Assessment See
 Increase vocabulary/length of __ Work Sample present
utterance and identify picture __ Teacher’s Observation level on
__ Parent’s Observation
words page 2
__ Standardized Assessment
 Indicate name, age, address __ Others
and name of teacher

ANNUAL GOAL: Socio-Emotional

Respond to approaches and attempts to interact from peers and engage in appropriate independent
play/activities.
Identify and express feelings/strengths about self and others
Short Term Goal Method Baseline Progress
 Share and play with a toy or
game. __ Performance Assessment See
 Participate with group __ Work Sample present
activities. __ Teacher’s Observation level on
__ Parent’s Observation

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  Identify/state the __ Standardized Assessment page 2
accomplishments of self & __ Others
others.
ANNUAL GOAL: Adaptive Behavior/ Self-help
To display productive school behavior on a daily basis
Put on and remove own clothing with/without assistance
Control Impulsive behavior
Short Term Goal Method Baseline Progress
Identify and follow rules in
classroom, breaktime, bathroom, and __ Performance Assessment See
dismissal time (wear shoe cover, put __ Work Sample present
bag in assigned shelf, sit and stay in __ Teacher’s Observation level on
__ Parent’s Observation
assigned seat) page 2
__ Standardized Assessment
__ Others
Verbalize difference between
impulsive and self-controlled
behavior.

Cooperate and assist with dressing

procedures.
 Tie and untie shoe laces
 Engage and unzip the zipper.

SUPPLEMENTARY AIDS AND SERVICES

Types of Service Provider Schedule

PARENT/GUARDIAN CONSENT

_____ I give permission to implement this IEP.

_____ I do not give permission to implement this IEP.

Prepared by: Confirmed by:

Anette Grace V. Belleza

SPED Teacher Parent

Noted by:

Approved by:

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