Appendix 1-A

IPP Template
Individualized Program Plan

Individualized Program Planning

Student Information Student: Bobby Smith Date of Birth: April 29, 2002 Parents: Scott and Abigail Smith Address: 56 Silver Valley Creek N.W. T3G 3S7 Phone #: (403) 589-3877 Eligibility Code: 51,53,57,59 (Mild Cognitive Disability, Emotional/Behavioural Disability, Communication Disability, Multiple Disability) Year of School/Grade: 2011-2012/ Grade 3 Background information: Classroom context School: Silver Valley Elementary School I.P.P. Coordinator and Classroom Teacher: Mrs. Simpson Additional IPP Team Members: Mr. Stanley, Resource Teacher; Ms. Mahley, Aide Bobby is in a regular stream Grade 3 classroom in his designated school. There are currently 21 students in his classroom: four students have been identified as having special educational needs. A resource teacher is available to the teacher for assistance, when needed, Background Information: Parental input and involvement Age as of Sept. 1/200X: 9 years Date I.P.P. Created: November 2011

Alberta Education, Alberta, Canada (2006)

October 8 - Parents receive a standard questionnaire from Mrs. Simpson. The questionnaire is to get a better understanding of Bobbys current situation; his strengths and weaknesses. November 12- Parents met with Mrs. Simpson to discuss Bobbys goals for the upcoming year. During the meeting the following areas came to attention; Bobbys need to improve his social skills by increasing his receptive and expressive language, improve his self regulation skills by teaching Bobby to recognize and self-advocate for his needs, encourage the exploration of new possibilities by trying new things, and work in collaboration to increase cohesion in strategies at home and at school (the team consists of Bobby, his parents, Mrs, Simpson, Mr. Stanley, Ms. Mahley, and the aide at home). March 1- Parents met with Mrs. Simpson to review Bobbys progress in his personal goals as well as the curriculum goals. Mrs. Simpson shows them a sample of Bobbys work. The parents can see that Bobby has been involved in several assignments that required collaboration with his peers. These assignments targets his collaboration goals and to improve his social skills. June 10- Mrs. Simpson had a telephone conference with mom to review Bobbys progress throughout the entire school year. Bobby has improved in his social skills, self-regulation skills, and flexibility to explore new things and ideas. Mrs. Simpson encourages Bobby to continue working on these goals over the summer. Mrs. Simpson also adds that she is willing to met with Bobbys teacher for next year to share strategies that she used that worked well to help Bobby this year.
Individualized Program Planning

Alberta Education, Alberta, Canada (2006)

Appendix VI

Appendix 1-A

IPP Template

Strengths - Funny and quirky personality; highly likeable Good memory; able to retain information easily Pays great attention to detail Loves working with technology; very skilled at using technology (for example: computer, iphone, ipad)

Individualized Program Planning

Areas of Need - Self- regulation; Bobby is working towards recognizing when he does something positive as well as negative Bobby has a lot of friends but needs to work on controlling his emotions in certain situations and to develop social skills through improving his expressive and receptive language Bobby works well on certain tasks assigned to him but needs to work on his flexibility by trying new things out of his comfort zone Bobbys can read at grade level but needs to work on reading comprehension skills as well as understanding math problem solving Coordinated Support Services Occupational Therapy Psychological Therapy Speech Therapy Home Aide and School Aide (2 different personnel)

Medical Conditions that Impact Schooling - Have had seizures in the past

No current medical conditions that

None required at this time

impact schooling Assessment Data (Specialized Assessment Results) Date April 2010 University of Calgary Clinic Dr. Berenstein, psychologist April 200X University of Calgary Clinic Dr. Berenstein, psychologist
Alberta Education, Alberta, Canada (2006)

Test WISC-IV

Results

Full score: average (slightly below average on verbal comprehension) Reading: average but below on reading comprehension Math: average but below on word problems

WIAT-II

Written language: average Oral language: below average April 200X University of Calgary Clinic Dr. Berenstein, psychologist Behaviour Assessment for Children (BASC) Self-report; parents, and teacher rating scale placed student at risk for anxiety difficulties

Individualized Program Planning

Alberta Education, Alberta, Canada (2006)

Appendix 1-A

Sample IPP Template

Current Level of Performance and Achievement

September - Grade 3 report card indicates that Bobby is working at grade level in all academic subjects Bobby is reading independently at grade level but he needs help in reading within Math and English comprehension Bobby is having a difficult time connecting with his peers and teachers Bobby is having difficulty deviating from regular routine and feels anxious when flexibility is required

Year-end Summary
June Continues to work at grade level in all academic subjects Bobby is still able to read independently and needs partial prompts for his Math and English comprehension Bobby is working towards long lasting peer connections and developing a healthy relationship with his teacher Although Bobby is trying new things, he is still choosing his familiar options

Individualized Program Planning

Grade Level of Achievement Reporting Information Adapted programming Modified programming graded curriculum not graded curriculum
If students modified programming does not follow a graded curriculum, indicate category of each goal and achievement level relative to each goal category:

foundational skills (e.g., communications, classroom behaviour, gross and fine motor skills) Goals achieved: all most some none not applicable academic readiness skills (e.g., readiness skills to prepare student for learning outcomes in the programs of study in Grade 1 and subsequent grade levels) Goals achieved: all most some none not applicable life skills (e.g., skills that will assist the student in developing independence in the home, school and community) Goals achieved: all most some none not applicable

Alberta Education, Alberta, Canada (2006)

Appendix 1-A

Sample IPP Template

Goal # 1
Individualized Program Planning

Long-term Goal: Bobby will independently regulate himself when he requires breaks at school. Short-term Objectives By November 12 Bobby will be introduced to a scale of 1-5. Each level will be identified by specific physical behaviors that Bobby engages in depending on his anxiety level. By March 17 Bobby will indicate to his teacher his level of arousal from 1-5 on the scale that is taped on his desk by place an eraser beside the level of his arousal. By June 30 Bobby will verbally ask for a break when he notices signs that he is overwhelmed. Assessment Procedures Bobby will learn to recognize his physical behaviors that indicates his level of anxiety from 1-5. He will be asked what level are you and what behaviors make you think you are at that level? He will answer correctly 4/5. When he is at 4 or 5 Bobby will verbally ask the teacher for a break 4/5. Progress Review November 10 Progressing. Bobby has related 3/5 anxiety levels to certain behaviors but still needs to work on identifying 2/5 levels. He still becomes upset before thinking about reading his anxiety level. March 12 Achieved. Bobby is independently asking for a break 4/5 times when his arousal level is at 4-5. If Bobby does not verbally ask for a break he is prompted to ask. June 15 Achieved. Bobby is independently asking for a break 4/5 times when his arousal level is at a 4-5 without visual cues or verbal prompts.

Bobby will verbally ask the teacher for a break 4/5 without a visual cue or prompts.

Accommodations and strategies to support objectives Helping Bobby understand his signs of increased anxiety level by making it concrete and recognizable to himself. He also needs a 1-5 scale on his desk, eraser, and breaks. Breaks could include; movement breaks(going to a drink to the fountain, taking something to the office) having a fidget toy, theraband around his legs, bathroom break. Caution: if the teacher suspect that Bobby is asking for a break to get out of an activity, finish the activity before giving him the break.
If modified programming does not follow graded curriculum, this goal is related to: foundational skills academic readiness skills life skills

Alberta Education, Alberta, Canada (2006)

Goal # 2
Long-term Goal: Bobby will independently initiate interactions with his peers. Short-term Objectives By November 12 Bobby will learn pro-social skills like; eye contact, appropriate turn taking, accepting others ideas for play, Assessment Procedures In group settings, Bobby will appropriately use the prosocial skills (eye contact, appropriate turn taking, accepting others ideas for play) he learnt 4/5 Progress Review November 1 Progressing/Achieved. Bobby is taking turns appropriately and does accept others ideas for play. However, he needs to work on eye contact when talking to his peers March 12 Achieved. Bobby is now able to independently approach his peers. In addition, he chooses his own partners when doing group work.

Individualized Program Planning

By March 17 Bobby will independently approach a friends during free time in the classroom

Bobby will move closer to a group of his peers during free time in the classroom 4/5 trials

By June 30 Bobby will independently approach and initiate play with a friend during free time in the classroom.

Bobby will interact with his peers during recess and lunch time 4/5 times per week.

June 15 Achieved. Bobby is willing to play with his peers at recess or at lunch time. He does not need prompts but willingly interacts with his friends.

Accommodations and strategies to support objectives Bobby requires special coaching to improve his pro-social skills which he will receive from his school and home aide. His aide will model interactions for Bobby with his peers.

If modified programming does not follow graded curriculum, this goal is related to: foundational skills academic readiness skills life skills

Alberta Education, Alberta, Canada (2006)

Goal # 3
Long-term Goal: Bobby will learn to try new things that are out of his comfort zone. Short-term Objectives By November 12 Bobby will explore new possibilities in the classroom. He will be able to think outside of the box. Assessment Procedures When working on projects and assignments, Bobby will complete the task differently than he has done so before. He will do this 3/5 times. Progress Review November 10 Progressing. Bobby is trying to think outside the box and do things differently. However, he needs prompts to do so and needs help from teacher/aide to think of new ideas for his assignments. March 12 Progressing. Bobby understands that changes can be made to the schedule and why. However, he needs to focus on learning to be calm and not acting out when these changes are made. June 15 Achieved. Bobby is able to interact with different peers and has made several new friends.

Individualized Program Planning

By March 17 Bobby will learn to accept changes in the daily schedule. For example, if math class is in the afternoon instead of the morning.

Bobby will be taught that changes can be made to the daily schedule and why they are made. He will also remain calm when these changes are made 4/5 trials.

By June 30 Bobby will independently make new friends.

Bobby will interact with peers that he normally does not associate with. He will do so 4/5 times per week.

Accommodations and strategies to support objectives Bobby needs assistance from his teacher and aide when he is in the classroom to guide him to think outside the box. Ms. Mahley will provide Bobby with prompts until he is able to try new things independently.

If modified programming does not follow graded curriculum, this goal is related to: foundational skills academic readiness skills life skills

Alberta Education, Alberta, Canada (2006)

Sample IPP Template

Planning for Transition
Individualized Program Planning

Additional Information

Signatures
I understand and agree with the information contained in this Individualized Program Plan.

Parents

Date

IPP Coordinator/Teacher

Date

Principal

Date

Alberta Education, Alberta, Canada (2006)