Edu 347 Iep Anna This One

INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student’s Name: Jordan Williams
INDIVIDUALIZED EDUCATION PROGRAM (IEP) School Age

IEP Team Meeting Date (mm/dd/yy): 10/23/2020
IEP Implementation Date (Projected Date when Services and Programs Will Begin): 10/25/2020
Anticipated Duration of Services and Programs: 10/26/2021
Date of Birth: 05/18/2015
Age: 5
Grade: K
Anticipated Year of Graduation: 2031
Local Education Agency (LEA): Steubenville City School District
County of Residence: Jefferson County
Name and Address of Parent/Guardian/Surrogate: Phone (Home): (111)-222-3333
Lani and Daveed Williams Phone (Work): (123)-456-3210
2222 Drury Ln
Steubenville, Ohio 43952
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
Page 1 of 30 April 2020

IEP TEAM/SIGNATURES
The Individualized Education Program team makes the decisions about the student’s program and placement. The student’s parent(s), the student’s special
education teacher, and a representative from the Local Education Agency are required members of this team. Signature on this IEP documents attendance, not
agreement.
Role Printed Name Signature

Parent/Guardian/Surrogate Daveed Williams
Parent/Guardian/Surrogate Lani Williams
Student* N/A
Regular Education Teacher** N/A
Special Education Teacher Barbara Drey
Local Ed Agency Rep N/A
Career/Tech Ed Rep*** N/A
Community Agency Rep N/A
Teacher of the Gifted**** N/A
Speech and Language Pathologist Rebekah Nevarez
Occupational Therapist N/A
Principal Carl Mozzarella
* The IEP team must invite the student if transition services are being planned or if the parents choose to have the student participate.
** If the student is, or may be, participating in the regular education environment
*** As determined by the LEA as needed for transition services and other community services
**** A teacher of the gifted is required when writing an IEP for a student with a disability who also is gifted.
One individual listed above must be able to interpret the instructional implications of any evaluation results.
Written input received from the following members:
N/A
Transfer of Rights at Age of Majority
For purposes of education, the age of majority is reached in Pennsylvania when the individual reaches 21 years of age. Likewise, for purposes of the Individuals
with Disabilities Education Act, the age of majority is reached for students with disabilities when they reach 21 years of age.

PROCEDURAL SAFEGUARDS NOTICE
I have received a copy of the Procedural Safeguards Notice during this school year. The Procedural Safeguards Notice provides information about my rights,
including the process for disagreeing with the IEP. The school has informed me whom I may contact if I need more information.
Signature of Parent/Guardian/Surrogate: Daveed William
MEDICAL ASSISTANCE PROGRAM BILLING NOTICE

(Applicable only to parents who have consented to the release of billing information to Medical Assistance programs)
I understand that the school may charge the School-Based Access Program (“SBAP”)—or any program that replaces or supplements the SBAP—the cost of certain
special education and related services described in my child’s IEP. To make these charges to the SBAP, the school will release to the administrator of that
program the name, age, and address of my child, verification of Medicaid eligibility for my child, a copy of my child’s IEP, a description of the services
provided and the times and dates during which such services were provided to my child, and the identity of the provider of such services. I understand that
such information will not be disclosed, and such charges will not be made, unless I consent to the disclosure. I acknowledge that I have provided written
consent to disclose such information.
I understand that my consent is ongoing from year-to-year unless and until I withdraw it. I can withdraw my consent in writing, or orally if I am unable to
write, at any time. My refusal to consent or my withdrawal of consent will not relieve the school of the obligation to provide, at no cost to me or my family,
any service or program to which my child is entitled under the Individuals with Disabilities Education Act (“IDEA”) or that is necessary to enable my child to
receive a free appropriate public education as described in my child’s IEP.
I understand that the school cannot—
Require me or my family to sign up for or enroll in any public benefits or insurance program, such as Medicaid, as a condition of receiving a free appropriate
public education for my child;
Require me or my family to incur any expense for the provision of a free appropriate public education to my child, including co-payments and deductibles,
unless it agrees to pay such expenses on my or my family’s behalf;
Cause a decrease in available lifetime coverage or any other insured benefit;
Cause me or my family to pay for services that would otherwise be covered by a public benefits or insurance program and that are required for my child
outside the time that he or she is in school;
Risk the loss of eligibility for home and community-based waivers, based on aggregate health-related expenditures.

I. SPECIAL CONSIDERATIONS THE IEP TEAM MUST CONSIDER BEFORE DEVELOPING THE IEP. ANY FACTORS CHECKED AS “YES” MUST BE ADDRESSED IN THE IEP.
Is the student blind or visually impaired?

Yes The IEP must include a description of the instruction in Braille and the use of Braille unless the IEP team determines, after
an evaluation of the student’s reading and writing skills, needs, and appropriate reading and writing media (including an
evaluation of the student’s future needs for instruction in Braille or the use of Braille), that instruction in Braille or the use
of Braille is not appropriate for the student.
X No
Is the student deaf or hard of hearing?

Yes The IEP must include a communication plan to address the following: language and communication needs; opportunities for
direct communications with peers and professional personnel in the student’s language and communication mode; academic
level; full range of needs, including opportunities for direct instruction in the student’s language and communication mode;
and assistive technology devices and services. Indicate in which section of the IEP these considerations are addressed. The
Communication Plan must be completed and is available at www.pattan.net
X No
Does the student have communication needs?

X Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction (SDI), annual goals, etc.)
No
Does the student need assistive technology devices and/or services?

Yes Student needs must be addressed in the IEP (i.e., present levels, specially designed instruction, annual goals, etc.)
X No
Does the student have limited English proficiency?

Yes The IEP team must address the student’s language needs and how those needs relate to the IEP.
X No

Does the student exhibit behaviors that impede his/her learning or that of others?
Yes The IEP team must develop a Positive Behavior Support Plan that is based on a functional assessment of behavior and that
utilizes positive behavior techniques. Results of the functional assessment of behavior may be listed in the Present Levels
section of the IEP with a clear measurable plan to address the behavior in the Goals and Specially Designed Instruction
sections of the IEP or in the Positive Behavior Support Plan if this is a separate document that is attached to the IEP. A
Positive Behavior Support Plan and a Functional Behavioral Assessment form are available at www.pattan.net
X No
Other (specify):
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
Introduction:
Jordan is a five-year-old boy in Kindergarten. A few weeks into the school year, Jordan was diagnosed
with Autism and was placed in an Autism Unit Classroom with a total of ten other students. All of the
students in this classroom have some form of Autism. At this time, Jordan is non verbal. He is learning
to use a communication app on his iPad to communicate with the teacher and others around him. He
struggles with social skills and fine motor skills.
Present levels of academic achievement:

Literacy: Jordan is able to identify 19/26 uppercase letters and 20/26 lowercase letters. He was only
able to identify these letters when asked “Can you find the letter C?”. Jordan struggles to say his
alphabet in order and can only recite and verbalize the letters from A to C. Jordan does not seem
interested in reading books and when he does sit down to listen, he does not show interest, ask
questions, or have any comments. He is not able to verbalize letter sounds or words.
Mathematics: Jordan is able to verbally count to the number 7 with no assistance and count to 15 with
some assistance. Jordan has no understanding of number concepts, sorting, matching quantities, or
identifying word problems. He is able to name and match objects by color and shape. Jordan is unable
to create patterns using different shapes.
Present levels of functional performance:

Behavior: Jordan is kind, hardworking, goofy, and observant. He enjoys doing simple favors for the
teacher and for his peers. He does not have any friends in the classroom and does not socialize with his
peers without them coming up to him first. When Jordan does not get his way, he quickly becomes
upset and angry. He will hit the desk when he becomes extremely angry and will tense up his body.
Jordan does not actively engage in learning opportunities. He does not raise his hand or show any
physical signs that he is actively listening the majority of the time during class participation. Jordan
becomes easily distracted and does not usually stay engaged in one activity for more than five minutes.
Communication: Jordan is nonverbal and is currently being taught how to communicate through an app
on his pad. Jordan is able to repeat simple words that have been spoken to him but he never speaks on
his own. Because he is non verbal at this time, he his expressive language is not at Kindergarten level.
When asked to complete or follow a task he is usually only able to complete two steps on his own.
Jordan is not able to distinguish between his left and his right. When Jordan needs help or cannot
verbalize what he wants, he will point to the object.
Social Skills: Jordan has moderate relationships with adults and enjoys holding their hands. He does not
have any relationships with his classmates. He usually engaged in solitary play, and rarely participates
in social play with others. When prompted by an adult, he is able to share his toys. When given positive
reinforcement, Jordan will become very happy with a huge smile on his face.
Gross and Fine Motor Skills: Jordan is a very active students who cannot sit for too long. His gross
motor skills are age appropriate but struggles with fine motor skills. He is able to walk in a straight line.
He is able to stand on his preferred foor for 7 seconds and his non preferred foor for three. He is able to
hop on one foot at least two times before losing balance. Jordan cannot gallop and when walking down
the stairs, he has to hold on to the railing. He can jump up and down fifteen times consecutively. He
can throw and catch both a large ball, but cannot catch a small ball. Jordan is unable to hold a pencil
properly in his hand, and struggles control when writing. He is not able to draw a straight line but can
draw a circle. He cannot draw any other shapes. Jordan can use scissors properly to cut paper. He
cannot write his name.
Adaptive Skills: Jordan is able to eat independently but is unable to correctly use silverware when
needed. He can get dressed with little assistance, but cannot tie shoes or use zippers. He needs help
taking his backpack and jacket off every morning at school. Jordan is able to use the bathroom by
himself but needs assistance when washing his hands. He can get dressed with little to no assistance.
He cannot, however, tie his shoes or zip up his jacket.
Present level related to current post secondary transition goals:

Transition services are not appropriate at this time.
Parental concerns for enhancing the education of the student:

Jordan’s parents would like Jordan to be able to show how he is feeling with the use of the iPad. They
would also like to see him interact with his peers more and to participate with others in specific
learning activities.
How the student’s disability affect involvement in the general education curriculum:
There is not a significant difference between his functional performance and his chronological age.
Jordan is not too far behind his typically developing peers. The support and services given in this
document will be beneficial and help close the small gap.
Strengths:
- Jordan can go to the bathroom and eat independently.
- Jordan can jump well.
- Jordan is helpful around the classroom and enjoys helping the teacher.
- Jordan loves to listen to music and is usually more engaged in classroom activities when they have to
do with music or dancing.
Academic, developmental, and functional needs related to student’s disability:

Cognitive (Mathematics):
Jordan is unable to identify isolated numbers and is unable to count past 6 without assistance.
Cognitive (Literacy):
Jordan is unable to recite the alphabet. He is unable to identify all of the letters in the alphabet with
accuracy. The skill of identifying letters is the most basic prerequisite skill of reading.
Communication:
Jordan is currently nonverbal. This inhibits most of his academic, developmental, and adaptive skills.
He uses the app on his ipad to communicate but just began learning how to use it. Jordan is unable to
create peer friendships because of his communication needs.
Physical Development:
Jordan is unable to write his name or any letters of the alphabet.He does not know how to properly
hold a pencil. This skill is something he must learn in the writing process.

III. TRANSITION SERVICES – This is required for students age 14 or younger if determined appropriate by the IEP team. If the student does not attend the
IEP meeting, the school must take other steps to ensure that the student’s preferences and interests are considered. Transition services are a coordinated
set of activities for a student with a disability that is designed to be within a results oriented process, that is focused on improving the academic and
functional achievement of the student with a disability to facilitate the student’s movement from school to post school activities, including postsecondary
education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent
living, or community participation that is based on the individual student’s needs taking into account the student’s strengths, preferences, and interests.
POST SCHOOL GOALS – Based on age appropriate assessment, define and project the appropriate measurable postsecondary goals that address education
and training, employment, and as needed, independent living. Under each area, list the services/activities and courses of study that support that goal.
Include for each service/activity the location, frequency, projected beginning date, anticipated duration, and person/agency responsible.
For students in Career and Technology Centers, CIP Code:
N/A
Postsecondary Education and Training Goal:

Measurable Annual Goal
N/A Yes/No
(Document in Section V)
Courses of Study:
N/A
Projected Anticipated Person(s)/Agency

Service/Activity Location Frequency
Beginning Date Duration Responsible
Employment Goal:
N/A
Yes/No
Courses of Study:
N/A



Independent Living Goal, if appropriate:

N/A Yes/No
Courses of Study:
N/A

IV. PARTICIPATION IN STATE AND LOCAL ASSESSMENTS

Instructions for IEP Teams:
Please select the appropriate assessment option. Information on available testing accommodations may be found in the Accommodations Guidelines
available on www.education.state.pa.us.
State Assessments
Not Assessed
X No statewide assessment is administered at this student’s grade level.
X No English proficiency assessment administered because the student is not an English Language Learner.
PSSA (Math administered in grades 3-8; Science administered in grades 4 and 8; Reading administered in grades 3-8; Writing administered in grades 5
and 8; and ELA*)
Without With
Tested Subject Accommodation Accommodation Accommodations to be Provided
s s
Math
Science
Reading
Writing
ELA*
*ELA will replace the Reading and Writing PSSAs in 2014-15 for grades 3-8.

Keystone Exam (Replaces the 11th grade PSSA in high school; Student must participate by 11th grade)
Without With
Tested Subject Accommodations Accommodations Accommodations to be Provided
Algebra 1
Literature
Biology
Keystone Project Based Assessment (Available when student is unable to demonstrate proficiency on a Keystone Exam or Keystone Exam module.)
Without With
Algebra 1
Literature
Biology
Validated Local Assessment (Available when selected as option by LEA)

Without With
Algebra 1
Literature
Biology
PASA (Administered in grades 3-8, 11 for Reading and Math; Grades 4, 8, 11 for Science)
Student will participate in the PASA.
Explain why the student cannot participate in the PSSA or the Keystone Exam for Reading/Literature, Math/Algebra 1,
Science/Biology, and Composition (The Composition exam will be available for the 2016-17 school year):
Explain why the PASA is appropriate:
Choose how the student’s performance on the PASA will be documented.

Videotape (preferred method)
Written narrative notes (requires prior approval in accordance with PDE

guidance)

ACCESS for ELLs (Administered in grades K-12)

Domains Without With Unable to Accommodations to be Provided or Rationale for Inability to
Accommodations Accommodations Participate Participate in Selected Domains
Listening
Reading
Writing
Speaking
Alternate ACCESS for ELLs (Administered in grades 1-12)

Student will participate in the Alternate ACCESS for ELLs.
Explain why the student cannot participate in the ACCESS for ELLs:
Explain why the Alternate ACCESS for ELLs is appropriate:
Domains Without With Unable to Accommodations to be Provided or Rationale for Inability to

Accommodations Accommodations Participate Participate in Selected Domains
Listening
Reading
Writing
Speaking
Local Assessments
X Local assessment is not administered at this student’s grade level; OR
Student will participate in local assessments without accommodations; OR
Student will participate in local assessments with the following accommodations; OR

The student will take a local alternate assessment.
Explain why the student cannot participate in the local regular assessment:
Explain why the local alternate assessment is appropriate:

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 WHEN

Include: Condition, Name, Behavior, and Criteria Describe HOW the student’s progress toward periodic reports on Report of
(Refer to Annotated IEP for description of these meeting this goal will be measured progress will be Progress
components) provided to parents
When presented with a piece of paper and a Every morning, the special education teacher will Periodic reports on
writing tool, Jordan will write his first name with present Jordan with a piece of paper and a writing progress will be
75% accuracy, in four out of five trials. utensil. The special education teacher will then provided to parents
prompt the student to write his name on the paper. quarterly by report
The special education teacher will observe and card.
record the number of letters Jordan is able to print
correctly, in the correct order.
When presented with a writing utensil, Jordan will Every morning, the special education teacher will Periodic reports on
know how to properly hold it with his hand with present Jordan with a writing utensil. The special progress will be
85 percent accuracy, in four out of five trials. education teacher will then prompt the student to provided to parents
hold the utensil properly. quarterly by report
card.
During unstructured play, Jordan will play with Once a week, the special education teacher will Periodic reports on
one to two peers for five minutes with no more present Jordan with five 5-minute trials of progress will be
than one adult prompt in two out of five unstructured play time. The teacher will start a provided to parents
opportunities. timer for 5 minutes and will observe the student quarterly by report
during this time. The teacher will look for how card.
many peers the student is engaging with and
whether or not they are engaging in cooperative
play.
SHORT TERM OBJECTIVES – Required for students with disabilities who take alternate assessments aligned to alternate achievement standards (PASA).
Short term objectives / Benchmarks
N/A


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 Date Anticipated Duration
SDI for Goal 1:
The special education teacher will
provide Jordan with bold lined
paper during any instruction
involving writing. Jordan will be Special Education 2 times a week for 15
10/25/20 10/25/20 – 10/26/21
taught where to start writing on this Classroom minutes
paper. The teacher will do this
through direct instruction and
guided practice. Reinforcement will
be provided continuously.
SDI for Goal 2:
provide explicit and clear
instruction by working one-on-one
with Jordan teaching him how to
hold his pencil. The teacher will
implement the “I do, we do, you
do” strategy to help him hold the Special Education 5 times a week for 15
10/25/20 10/25/20 – 10/26/21
pencil. First the teacher will model Classroom minutes
how to hold the pencil, then the
teacher will use physical guidance
to help Jordan properly hold the
pencil, then the teacher will let
Jordan the opportunity to correctly
hold the pencil independently.
SDI for Goal 2: Special Education 2 times a week for 15 10/25/20 10/25/20 – 10/26/21
The special education teacher will Classroom minutes
provide instructions on how to
respond to verbal prompts. After
the teacher has asked a question,

the teacher will use a time delay

and give the student a gestural
prompt to indicate that it is time to
answer a question. Reinforcement
will be provided continuously.
SDI for Goal 3: Social skills

provide instructions using social
stories to help Jordan learn how he
should behave in unstructured play
time. Jordan will have a station Special Education 2 times a week for 15
10/25/20 10/25/20 – 10/26/21
that focuses on this social skill. Classroom minutes
Since he enjoys the iPad, he will be
given an iPad that has a video
model of the desired behavior of
correctly interacting with his
classmates.
SDI for Goal 3: Behavior
provide direct instruction of
calming strategies. The teacher will
first teach these skills through Special Education 2 times a week for 10
10/25/20 10/25/20 – 10/26/21
repeated teaching and modeling. Classroom minutes
Then the teacher will ask the
student, “What can you do if start
to feel upset?”. Reinforcement will
be provided.
B. RELATED SERVICES – List the services that the student needs in order to benefit from his/her special education program.
Service Location Frequency Projected Beginning Date Anticipated Duration
With speech and language

Speech and Language pathologist, outside of his 30 minutes three a week 10/25/20 10/25/20 – 10/26/21
classroom
Social Skills Special education teacher 30 minutes twice a week 10/25/20 10/25/20 – 10/26/21
in the special education
classroom

C. SUPPORTS FOR SCHOOL PERSONNEL – List the staff to receive the supports and the supports needed to implement the student’s IEP.
School Personnel to Projected Beginning

Support Location Frequency Anticipated Duration
Receive Support Date
Update on Jordan’s
progress from the
Special Education Special Education Twice a month for 20
Speech and 10/25/20 10/25/20 – 10/26/21
Teacher Classroom minutes
Language
Pathologist
N/A (The special

Special Education Special Education
education teacher is N/A 10/25/20 10/25/20 – 10/26/21
Teacher Classroom
the one providing
the service)

D. GIFTED SUPPORT SERVICES FOR A STUDENT IDENTIFIED AS GIFTED WHO ALSO IS IDENTIFIED AS A STUDENT WITH A DISABILITY – Support services are
required to assist a gifted student to benefit from gifted education (e.g., psychological services, parent counseling and education, counseling services,
transportation to and from gifted programs to classrooms in buildings operated by the school district).
Support Service N/A

Support Service N/A
Support Service N/A
E. EXTENDED SCHOOL YEAR (ESY) – The IEP team has considered and discussed ESY services, and determined that:
Student IS eligible for ESY based on the following information or data reviewed by the IEP team:
OR
X As of the date of this IEP, student is NOT eligible for ESY based on the following information or data reviewed by the IEP team:
Jordan does not currently qualify for ESY. However, the data will continuously be collected to see if he will qualify as he
progresses. Data concerning his levels of performance before after winter break will be looked over when determining his eligibility
for ESY services.
The Annual Goals and, when appropriate, Short Term Objectives from this IEP that are to be addressed in the student’s ESY Program are:
N/A
If the IEP team has determined ESY is appropriate, complete the following:
ESY Service to be Provided Location Frequency Projected Beginning Date Anticipated Duration


VII. EDUCATIONAL PLACEMENT
A. QUESTIONS FOR IEP TEAM – The following questions must be reviewed and discussed by the IEP team prior to providing the explanations regarding
participation with students without disabilities.
It is the responsibility of each public agency to ensure that, to the maximum extent appropriate, students with disabilities, including those in public
or private institutions or other care facilities, are educated with students who are not disabled. Special classes, separate schooling or other removal
of students with disabilities from the general educational environment occurs only when the nature or severity of the disability is such that education
in general education classes, EVEN WITH the use of supplementary aids and services, cannot be achieved satisfactorily.
 What supplementary aids and services were considered? What supplementary aids and services were rejected? Explain why the supplementary
aids and services will or will not enable the student to make progress on the goals and objectives (if applicable) in this IEP in the general
education class.
 What benefits are provided in the general education class with supplementary aids and services versus the benefits provided in the special
education class?
 What potentially beneficial effects and/or harmful effects might be expected on the student with disabilities or the other students in the
class, even with supplementary aids and services?
 To what extent, if any, will the student participate with nondisabled peers in extracurricular activities or other nonacademic activities?
Explanation of the extent, if any, to which the student will not participate with students without disabilities in the regular education class:
Jordan is performing below grade level. Functionally and academically he needs extensive help. Jordan
will spend 10% of the day with students without disabilities. Jordan will spend a total of an hour and a
half outside of the classroom. This time will be spent in the Speech therapist’s office/classroom.
Jordan will work on his social skills within the special education classroom with the special education
teacher.
Explanation of the extent, if any, to which the student will not participate with students without disabilities in the general education curriculum:
Jordan does not function at his grade level and will not be participating in the general education
curriculum at all. He is learning to function well with his peers who are all on the autism spectrum at
different levels in his special education classroom (Autism Unit).

B. Type of Support
1. Amount of special education supports
Itinerant: Special education supports and services provided by special education personnel for 20% or less of the school day
Supplemental: Special education supports and services provided by special education personnel for more than 20% of the day but less than
80% of the school day
x Full-Time: Special education supports and services provided by special education personnel for 80% or more of the school day
2. Type of special education supports
x Autistic Support
Blind-Visually Impaired Support
Deaf and Hard of Hearing Support
Emotional Support
Learning Support
Life Skills Support
Multiple Disabilities Support
Physical Support
X Speech and Language Support
Page 22 of 30 November 2020

C. Location of student’s program
Name of School District where the IEP will be implemented: Steubenville City School District
Name of School Building where the IEP will be implemented: East Garfield Elementary School
Is this school the student’s neighborhood school (i.e., the school the student would attend if he/she did not have an IEP)?
X Yes
No. If the answer is “no,” select the reason why not.

Special education supports and services required in the student’s IEP cannot be provided in the neighborhood school
Other. Please explain:

VIII. PENNDATA REPORTING: Educational Environment (Complete either Section A or B; Select only one Educational Environment)
To calculate the percentage of time inside the regular classroom, divide the number of hours the student spends inside the regular classroom by the total number of hours in the school day (including
lunch, recess, study periods). The result is then multiplied by 100.
SECTION A: For Students Educated in Regular School Buildings with Non Disabled Peers – Indicate the Percentage of time INSIDE the regular classroom for this student:
Time spent outside the regular classroom receiving services unrelated to the student’s disability (e.g., time receiving ESL services) should be considered time inside the regular classroom.
Educational time spent in age-appropriate community-based settings that include individuals with and without disabilities, such as college campuses or vocational sites, should be counted as time
spent inside the regular classroom.
Calculation for this Student:
Column 1 Column 2 Calculation Indicate Percentage Percentage Category

Total hours the student Total hours in a typical (Hours inside regular Section A: The percentage of
school day classroom ÷ hours in
spends in the regular time student spends inside the
school day) x 100 = %
classroom per day regular classroom: Using the calculation result – select the appropriate percentage
(including lunch, recess category
& study periods) (Column 1 ÷ Column 2)
x 100 = %
N/A 7 N/A 0% INSIDE the Regular Classroom 80% or More of the Day
INSIDE the Regular Classroom 79-40% of the Day
X NSIDE the Regular Classroom Less Than 40% of the Day
SECTION B: This section required only for Students Educated OUTSIDE Regular School Buildings for more than 50% of the day – select and indicate the Name of School
or Facility on the line corresponding with the appropriate selection: (If a student spends less than 50% of the day in one of these locations, the IEP team must do the
calculation in Section A)
Approved Private School (Non Residential) _________________________ Other Public Facility (Non Residential) _________________________
Approved Private School (Residential) _________________________ Hospital/Homebound _________________________
Other Private Facility (Non Residential) _________________________ Correctional Facility _________________________
Other Private Facility (Residential) ________________________ Out of State Facility _________________________
Other Public Facility (Residential) ________________________ Instruction Conducted in the Home _________________________
EXAMPLES for Section A: How to Calculate PennData–Educational Environment Percentages

Column 1 Column 2 Calculation Indicate Percentage
Total hours the student spends in the Total hours in a typical school (Hours inside regular classroom ÷ hours in school day) Section A: The percentage of time student
day (including lunch, recess & x 100 = % spends inside the regular classroom:
regular classroom per day
study periods)
(Column 1 ÷ Column 2) x 100 = %
Example 1 5.5 6.5 (5.5  6.5) x 100 = 85% 85% of the day
(Inside 80% or More of Day)
Example 2 3 5 (3 5) x 100 = 60% 60% of the day
(Inside 79-40% of Day)
Example 3 1 5 (1 5) x 100 = 20% 20% of the day
(Inside less than 40% of Day)
For help in understanding this form, an annotated IEP is available on the PaTTAN website at www.pattan.net Type “Annotated Forms” in the Search feature on the website. If you do not have access
to the Internet, you can request the annotated form by calling PaTTAN at 800-441-3215.

Appendix A
Teacher Interview
Date: 11/04/2020 Time: 8:45AM Duration: 20 minutes
Student Pseudonym: Jordan
Grade: Kindergarten/ Autism Unit Room
Age: 5 years old
Environment: Urban
Parents/Guardians: Mom and dad are married. Mom does not work and Dad works for the Steel Mill.
Siblings: Older brother who is 8 years old
Current Grades in School: N/A (The students in the Autism Unit do not have official grades)
Present Level of Performance:
Reading: He is non-verbal. Is very rarely interested in listening to books being read aloud. Cannot read.
Spelling: He can identify more than half of the letters of the alphabet when prompted. He cannot recite/sing
the alphabet in order.
Writing: Jordan does not know the correct way to hold a writing utensil. He cannot write the letters of the alphabet. He does not know how to
mmm write his name. He cannot color in between lines.
Math: He is able to count to seven and can identify isolated numbers from 1 to 15. He can
identify and match shapes when prompted by the teacher.

Any adaptations in place for taking assessments? No
Academic Strengths: He becomes extremely engaged when the content being presented is in the form of a song. He will also pay attention to videos
on his iPad.
Academic Areas for Improvement: Non-verbal, needs to learn how to use communication technology on his iPad. Jordan needs countless verbal
prompts. He needs to learn how to use visual schedules for completing tasks.
Behavioral Strengths: Jordan is very loving and can be affectionate when he wants to be. He enjoys holding hands with adults.
Behavioral Areas for Improvement: Jordan will pout and hit his desk when he does not get what he wants. This becomes a constant problem with his
iPad. He will refuse to do anything if it is taken away. Sometimes he exits his work or communication app on his iPad to play games when he is not
supposed to.
Behavior Intervention Plan (BIP)? No
Describe the level of independent functional skills: He can dress himself in the morning but cannot take his jacket or backpack off. He cannot tie
shoes or use zippers. He is able to use the toilet independently but cannot wash his hands properly.
Describe social skills and relationships with peers: Jordan does not have any form of relationship with his classmates. He does not socialize unless his
classmates come to him first, in which case he will interact 10% of the time this happens. He will participate in independent play but does not ever
play with his peers.
Describe organization and decision-making skills: When he wants something, he will point at what it is he wants. He is learning to use the
communication app on his iPad.
Describe things that he finds motivating and reinforcing: He loves playing games on his iPad. He also enjoys dancing to music.
Goals or aspirations the parents have for their child for this school year: His parents would like Jordan to be able to express how he is feeling using
his communication app on his iPad or through sign. They would also like him to learn how to interact with others and make at least one friend in his
class.
What are some of the challenges that you face on a daily basis with this student? Jordan has a very short attention span and it is very difficult for him
to complete any sort of task without constant prompting from the teacher. This is also due to his lack of communication. He throws a fit on a daily
basis when his iPad is taken away during specific classes. He will hit the desk and become very pouty. Sometimes he will try and sneak the iPad from
the teacher’s desk.


Appendix B
Review of Records Form
Reviewed 11/4/2020
1. What items did you review (e.g., sample work, report card, progress reports, behavioral records, IEP, BIP, FBA, anecdotal notes, etc.)?
○ IEP
○ Anecdotal notes from his Special education teacher
○ 1 weekly progress report from speech pathologist
○ He has a diagnosis of autism
○ He is currently non-verbal
○ He has poor social skills
2. Record information on the student’s current level of performance as it related to their grades, goals, and current level of development.
○ Can identify almost every letter of the alphabet
○ Can count to 7 on his own, and up to 15 with verbal prompts
○ He does not know how to properly hold a writing utensil
○ He cannot write letters, numbers, or shapes
○ Currently nonverbal
3. Does the student receive any accommodations or modifications in the classroom or during assessments?
○ He is currently learning how to use a communication app on his iPad because he is nonverbal. He also practices his letters and sounds
on the iPad during half of reading class.
4. How much of the school day does the student spend in the general education environment per the IEP?
He does not spend time in the general education classroom.
5. Does the student have a completed FBA, BIP, or another behavior-specific plan?
○ He does not have an FBA, BIP, or another behavior specific plan
6. After reviewing the information, what was most helpful and interesting? What impact, guidance, or influence does it have on your chaining
project?
It is very interesting observing a student begin learning how to use a communication app on the iPad. The special education teachers did not
seem to be familiar with this before and it is interesting watching them figure it out and help the student. The fact that he is learning how to
communicate affects all parts of his academic and functionality throughout the day as well.
7. What additional information would you be interested in obtaining?
I would like to see how well he performs and functions once he is comfortable and better equipped with using the communication app
on his iPad.

Appendix C
Observation Document (Hypothetical Summary of Both Observation Sessions)
1. How does the student interact socially in the class?

a. Jordan does not initiate social interactions.
b. Jordan does not have friends.
c. Jordan participates in independent play.
d. Jordan interacts with adults more than his classmates.
2. How does the student respond to complete academic work?

a. Jordan does not respond well because he usually does not understand what the teacher is asking.
b. Jordan needs consistent assistance and verbal prompting when completing any kind of task or work.
c. Jordan enjoys learning through songs.
d. Jordan enjoys learning through videos and games on his iPad.
3. How would you describe the student’s strength and areas of need relative to behavior?
a. Jordan can go to the bathroom independently.
b. Jordan enjoys helping the teacher.
4. If you have to pick 2 areas for academic and 2 areas for behavior to work on, what would you suggest?
a. Identifying all the letters of the alphabet and their sounds.
b. Writing his name
c. Learning how to use visual schedules and the communication app on his iPad
d. Engaging in cooperative play with his classmates
5. Do you think this student would benefit from accommodation during assessments? If so, what would you recommend?
Yes, assistive technology.
6. What are some current modification and accommodation being implemented for this student in the classroom?
a. Social skills training
b. iPad communication app
c. The use of visual schedules

7. Does the student currently participate in any related services (e.g., speech and language therapy, occupational therapy, vision support, hearing
support, physical therapy, nursing services, etc.)?
a. Speech and language therapy
8. Is there any other information about the student you feel is important to document?
N/A

Edu 347 Iep Anna This One

Uploaded by

Copyright:

Available Formats

Edu 347 Iep Anna This One

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Edu 347 Iep Anna This One

Uploaded by

Copyright:

Available Formats

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student’s Name: Jordan Williams

INDIVIDUALIZED EDUCATION PROGRAM (IEP) School Age

Student’s Name: Jordan Williams

Date of Revision(s) Participants/Roles IEP Section(s) Amended

Page 1 of 30 April 2020

Role Printed Name Signature

Written input received from the following members:

Transfer of Rights at Age of Majority

Page 2 of 30 April 2020

PROCEDURAL SAFEGUARDS NOTICE

Signature of Parent/Guardian/Surrogate: Daveed William

MEDICAL ASSISTANCE PROGRAM BILLING NOTICE

I understand that the school cannot—

Cause a decrease in available lifetime coverage or any other insured benefit;

Page 3 of 30 April 2020

Is the student blind or visually impaired?

Is the student deaf or hard of hearing?

Does the student have communication needs?

Does the student need assistive technology devices and/or services?

Does the student have limited English proficiency?

Page 4 of 30 April 2020

II. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Include the following information related to the student:

Present levels of academic achievement:

Present levels of functional performance:

Present level related to current post secondary transition goals:

Parental concerns for enhancing the education of the student:

Academic, developmental, and functional needs related to student’s disability:

Page 7 of 30 April 2020

For students in Career and Technology Centers, CIP Code:

Postsecondary Education and Training Goal:

Projected Anticipated Person(s)/Agency

Projected Anticipated Person(s)/Agency

Page 8 of 30 April 2020

Page 9 of 30 April 2020

Independent Living Goal, if appropriate:

Projected Anticipated Person(s)/Agency

IV. PARTICIPATION IN STATE AND LOCAL ASSESSMENTS

Page 10 of 30 April 2020

Validated Local Assessment (Available when selected as option by LEA)

Explain why the PASA is appropriate:

Choose how the student’s performance on the PASA will be documented.

Written narrative notes (requires prior approval in accordance with PDE

Page 11 of 30 April 2020

ACCESS for ELLs (Administered in grades K-12)

Alternate ACCESS for ELLs (Administered in grades 1-12)

Explain why the Alternate ACCESS for ELLs is appropriate:

Domains Without With Unable to Accommodations to be Provided or Rationale for Inability to

X Local assessment is not administered at this student’s grade level; OR

Student will participate in local assessments without accommodations; OR

Student will participate in local assessments with the following accommodations; OR

Page 12 of 30 April 2020

The student will take a local alternate assessment.

Explain why the local alternate assessment is appropriate:

Page 13 of 30 April 2020

MEASURABLE ANNUAL GOAL Describe WHEN

Short term objectives / Benchmarks

Page 14 of 30 April 2020