Completed Sample IEP
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.
by Eileen Bailey Health WriterDo 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
When Parents Feel Their Child Needs Special Accommodations
Suggestions for IEPs and Section 504s
How IDEA Applies to Children with ADHD
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 or 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 or No
General 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
Attendees:
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: 10/15/2009
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 or No
Student Will Participate in Testing: Yes or No
If No, Reason Why Student Should Not Participate:
Student Will Participate With: Grade Level Peers or 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:
