Completed Sample IEP

Health Writer

Do you wonder what type of information should be included in an IEP? The following provides a basic IEP, filled out for you to review. You can print out a blank sample IEP as well, and complete information specific to your child.

For more information:

Documentation and Reports to Bring to an IEP Meeting

The Difference Between Accommodations and Modifications

When Parents Feel Their Child Needs Special Accommodations

Suggestions for IEPs and Section 504s

How IDEA Applies to Children with ADHD

Next week, I'll provide tips to help you write an IEP for your child.

IEP For School Age Children

School: Western Middle School

Student Name:       Jennifer McCormick                                 Student ID#   123456

Age:           12                                                                                     Date of Birth:   June 23,1997

Disability Classification:   Learning Disabled/ADHD

Student Information:

Street: 123 Barton Road

City: Any City

State/Zip:                       55555

Phone:   555-555-5555

County: Any County

Current Grade: 7th Grade

Ethnic Group: Caucasian

Gender: Female

Native Language: English

Interpreter Needed:       Yes No

Medical Alerts: None

Additional Information:

Jennifer has been diagnosed with Learning Disabilities and ADHD.

Parent/Guardian Information

Parent/Guardian Name(s): Thomas and Marta McCormick

Street: 123 Barton Rd

City: Any City

State/Zip: PA

Phone:   555-555-5555

County: Any County

Ethnic Group: Caucasian

Native Language: English

Interpreter Needed:       Yes      Neneral IEP Information

Date of Initial Referral:   09         /       15           /         2009

Date of Initial IEP Meeting:       10           /     15               /2009

Date IEP Initially Implemented:                 /                       /

Projected Date of Next Review:   04               /         15             /     2009

Current Meeting

Date: 10           /   15                       / 2009

Type of Meeting:         Initial                        Requested Review                       Annual Review


Joan Carson (School Psychologist)

Thomas Dunn (Principal)

Roberta Davis (Teacher

Theresa Snyder (Teacher)

Thomas McCormick (Parent)

Marta McCormick (Parent)

If Requested Review, Reason for Request:

Current Student Needs

Student Strengths:

Positive responses to positive reinforcement programs

High level in mathematics

Desire to do well

Gets along with other

Enjoys drawing

Parent Concerns:

Below grade level in reading

Difficulties with spelling and writing

Takes extended amounts of time to complete homework each night

Forgets assignments or materials/books to complete assignments

Teacher Concerns:

Behavior issues within the classroom, can be disruptive

Problems with fluency in reading

Poor spelling and writing skills

Misses completing or handing in assignments

May understand work but performs poorly on tests

Student Needs

Specific Student Needs: (list assistive technology, use of Braille, limited English proficiency, etc.)

Specific Ways Disability Interferes with Academic Abilities:

Comprehending 7th grade curriculum, especially when reading and writing required

Reading Comprehension

Staying organized

Coming to class prepared

Taking tests within allotted time

Transitional Needs: (based on student's age)  Not applicable ** Current Student Performance and Accommodations**

(Please attach copy of most recent evaluations, report card and state or district performance tests.)

Current level of knowledge, level of intellectual functioning, expected rate of progress, current accommodations:

In reading, Jennifer is currently testing on a 5.9 grade level but has been making progress

She has decoding skills

Fluency is hindered by word recognition

Reading comprehension is difficult, Jennifer can read a paragraph but not retain the information as she does not grasp the concept immediately

Jennifer does well in math, she is currently working on grade level in math

Social Development and Current Accommodations:

Jennifer does get along well with classmates but can be disruptive at times. She is likable and friendly but can be hyperactive and have a difficult time focusing, possibly because of her energy level.

Because this is an initial evaluation Jennifer does not have any formal, current accommodations however, her teachers have been giving spelling tests orally rather than written and she has responded well to this.

Physical Development and Current Accommodations:

Not applicable

Annual Goals

Goal: Will be reading on a 6th grade level by 4/15/2010

Procedures for Evaluation: Use current testing procedures to determine reading level

Evaluation Schedule: Test between 4/1/2010 and 4/10/2010 so results will be available for follow up meeting on 4/15/2010

Goal: Jennifer will raise her hand during class time for attention

Procedures for Evaluation: Teacher will provide tick mark each time Jennifer calls out and disrupts class without raising her hand

Evaluation Schedule: Teacher will share information with parents on a daily basis on whether Jennifer succeeded in raising her hand during class that day.

Goal: Raise spelling test scores to be above 80% each week

Procedures for Evaluation: Spelling tests will continue to be given orally

Evaluation Schedule: Teacher will share spelling test grade with parents weekly via email.

Recommendation Services and Programs

(Include Special Education Services, Related Services, Modifications/Accommodations, Assistive Technology, Aids)

Service: Provide spelling tests orally

Frequency: Weekly

Duration: Remainder of school year

Location: Jennifer will take spelling tests in the resource room

Start Date: 10/15/09

End Date: Continue until end of school year 2010

Service: Jennifer will be given extended time for completing tests

Frequency: For all tests

Duration:Until the end of the school year

Location: Within the regular classroom

Start Date:10/15/2009

End Date: End of school year 2010

Service: Jennifer will have an extra set of books at home

Frequency: N/A

Duration: Until the end of the school year 2010

Location: N/A

Start Date: 10/15/2009

End Date: June 2010

Service: Seating in the front of the classroom

Frequency: Every day

Duration: Until review of IEP

Location: Within regular classroom

Start Date: 10/15/2009

End Date: 4/15/2010

Service: Teachers will provide a written study guide 3-4 days prior to tests

Frequency: Before each test

Duration: Until IEP review

Location: Within regular Classroom

Start Date: 10/15/2009

End Date: 4/15/2010

Testing Accommodations for State and District Achievement Tests

Is Student Eligible for Testing Accommodations:   Yes         No

Student Will Participate in Testing:   Yes           No

If No, Reason Why Student Should Not Participate:

Student Will Participate With:                       Grade Level Peers                   Chronological Peers

Testing Accommodation: None at this time, will review needs again at follow up meeting in April 2010

Conditions for Accommodations:

Testing Accommodation: None at this time, will review needs again at follow up meeting in April 2010

Conditions for Accommodations:

Testing Accommodation: None at this time, will review needs again at follow up meeting in April 2010

Conditions for Accommodations: