INDIVIDUALIZED EDUCATION PLAN (IEP)

SECTION A. PERSONAL INFORMATION

LEARNER/PARENT INFORMATION: DIFFICULTIES (select most relevant) MEETING INFORMATION
Date of Meeting
Learner: Kelvin Clyde Valdez ☐ Difficulty in Seeing Date of Last IEP (?)
Birthdate: January 10, 2019 ☐ Difficulty in Hearing
LRN: ☐ Difficulty in Communicating PURPOSE OF MEETING:
Sex: M ☐ Difficulty in Mobility Walking ☐ Interim IEP
Grade Level: ☐ Initial IEP
☐ Difficulty in Displaying Interpersonal Behaviors
Current School: ☐ Term IEP
Address of School:
☐ Difficulty in Performing Adaptive Skills
☐ Difficulty in Basic Skills and Applying ☐ IEP Following 3Yr Reevaluation
Mother Tongue Spoken: Tagalog, Bisaya
knowledge ☐ Revision to IEP Date___________
Address: Ramon Nena Village Forestal
Learner’s Phone (if there is): ☐ Difficulty in in Remembering/ Concentrating ☐ Exit Graduation________
☐ Others (please specify) ☐ IEP Revision Without a Meeting
Parent/Guardian/ Caregiver: Meriam _____________________ At the request of: ☐ Parent ☒School
Valdez, Cesar Valdez Jr. ☐ Medical Diagnosis (If yes, please specify IEP Review Date
Work & Workplace: Housewife, Soldier ______________________ COMMENTS:
Landline/Mobile/Cell Phone:
Email

IEP TEAM MEMBERS IN ATTENDANCE

Parent/Guardian/ Caregiver: School Psychologist:
*Learners: Guidance Counselor/Designate:
Principal / School Head: School Nurse:
Other (name and role): Therapist/Pathologist/Specialist:
Special Education Teacher: Speech/Language Interpreter:
** Regular Education. / Receiving Teacher: *Learner must be
invited when the transition is discussed
**The IEP Team must include at least one regular education teacher of the learner (if the learners is or may be participating in the regular education
environment)

Signature over Printed Name of Parent/ Guardian/Caregiver

ATLEAST ONE YEAR PRIOR TO REACHING AGE 18, LEARNER MUST BE INFORMED OF THEIR RIGHTS UNDER THE LAW AND ADVISED THAT
THESE RIGHTS WILL BE ENJOEYED AT AGE 18
☒ Not Applicable (learner will not be 18 within one year)
 ☐ The learner has been informed of his/her rights under the law and advised of the transfer of rights at age 18
Distribution: _ Learner’s Folder
Parent/ Guardian/ Caregiver Ed Special Education/ Receiving Teacher
LEARNER:
DATE:
I.PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Results of initial or most recent evaluation and results of school and division assessments:
Psycho-Educational Assessment
• Strong verbal comprehension skills
• low reading comprehension, reasoning skills and memorization of arithmetic facts, number sense.
• difficulty with organization (pre-writing) and sentence structure (writing).
Classroom based Learning Styles Inventory
• Visual learner
• Auditory learner
Occupational Therapy Assessment
• Fine and gross motors skills significantly delayed
Speech and Language Assessment
• social communication deficits
• limited vocabulary
Description of academic, developmental and/or functional strengths:
SOCIALIZATION
• Can follow rules of verbal reasoning game
• Knows if a friend needs comfort
• Does his roles in group activities
LANGUAGE AND LITERACY
• Can name 6 animals and knows the sound that they make.
• Able to classify objects according to observable properties like size, color, shape, texture, and weight
• Identifies simple ways to take care of the environment such as throwing trash into proper garbage cans
• Route count up to 20
SOCIO-EMOTIONAL
• Can understand and immediately stops his actions if the person says no.
ADAPTIVE SKILLS
• Uses correct utensils for food
• Can button 3 buttons without needing any assistance
• Wipes nose and sweat without any need of reminding but with assistance
Description of academic, developmental and/or functional needs:
 SOCIAL
• Does not like to share his thoughts with his groupmates
• Does not ask permission from others before acting or borrowing something
• Cannot join in his classmates’ conversations
LANGUAGE AND LITERACY
• Difficulty in telling his school experiences
• Cannot answer “why” questions with an
explanation • Forgets 3-5 numbers during route
counting up to 30
• Has a hard time describing things, situations, and people
SOCIO-EMOTIONAL
• Has a hard time relating to other people
• Does not want to talk about his likes and dislikes
ADAPTIVE SKILLS
• Is unable to prepare his own meal by himself
• Cannot to turn a knob on his own
• Does not want to participate in any physical games or activities
Parental concerns regarding their child’s evaluation:
• Jonas doesn’t initiate conversation with them or any of his family members
• He is very dependent on doing most of his daily tasks

Impact of the disability on involvement and progress in the general education curriculum (for preschool, how the disability affects participation in
appropriate activities):
• He is often alone in the classroom and does not participate with his groupmates/ classmates during discussion time
• Lacks self-confidence
• During lunch time, he can’t prepare his meal unless assisted
• Has a hard time transferring from classroom to canteen, court, restroom, and office and vice versa
II. CONSIDERATION OF SPECIAL FACTORS
a. Does the learner have difficulty relating with people which impedes his/her learning or the learning of others ☐ NO ☒ YES
b. If yeas, consider the appropriateness of developing a Behavior Intervention Plan
Behavior Intervention Plan Developed? ☒ NO ☐ YES
Refer to Behavior Intervention Plan for additional information

Does the learner have difficulty in Moving/Walking

If yes, consider the mobility needs as related to the IEP and describe how

Does the learner have difficulty in seeing or with blindness/visual impairment? ☒ NO ☐ YES
If yes, provide instruction in Braille and the use of Braille, unless the IEP Team determines that instruction in
Braile is not appropriate for the learner after an evaluation of the learner’s reading writing skills, needs, and
 appropriate reading and writing media, including evaluation of future instruction in Braille or the use of Braille.
Describe below.

Does the learner have difficulty in communicating? ☐ NO ☒ YES

If yes, consider the communication needs and describe below.

Does the learner have difficulty in concentrating/paying attention? ☒ NO ☐ YES

If yes, consider the attention span needs and describe below.

Does the learner have difficulty in remembering/understanding? ☒ NO ☐ YES

If yes, consider the understanding needs and describe below.

Does the learner have difficulty in hearing or is the learner deaf or hard of hearing? ☒ NO ☐ YES
If yes, consider and describe the learner’s language and communication needs, opportunities for direct
communication with peers and professional personnel in the learner’s language and communication mode,
academic level and full range of needs, including opportunities for direct instruction in the learner’s language and
communication mode. Describe communication needs below.

Does the learner need assistive technology devices or services? ☒ NO ☐ YES

If yes, describe the type of assistive technology and how it is used. If no, describe how the learner’s needs are
being met in deficit areas.

Does the learner require alternative format for instructional materials? ☒ NO ☐ YES
If yes, specify format(s) of materials required below.
☐ Braille ☐ Large Type ☐ Auditory ☐ Electronic text
SECTION B: DIFFICULTIES, BARRIERS, AND ENABLING SUPPORTS
DIFFICULTY ENVIRONMENTAL BARRIERS ENVIRONMENTAL ACCOMMODATIONS
(enter all areas of difficulty) (describe each factor restricting FACILITATORS (describe each (list items, staff resources, and
participation) factor enabling participation in infrastructure changes required to
response to barriers) enable participation)
Difficulty in Performing Adaptive 1. Climbing stairs (.4) 1. Student assistance (+2) 1. School Buddy
Skills 2. Provision of elevators (+4) 2. Environmental accommodations
2. Turning door knobs (.2) 1. Instead of door knobs, the doors 1. Provision of swing doors
should be swing doors (+3)

3. Going to the restroom and being 1. Restroom inside the classroom 1. Provision of restrooms inside
able to relieve himself and wash his and visual cues/ instructions (+2) classrooms
self afterwards (.3) 2. Teacher/ adult assistance (+4) 2. Visual models/ instructions
 3. Adult supervision
4. Opening his lunch box, bag, and 1. Easy to open lunch box and 1. Modified lunch bag, containers,
utensil box (.4) containers (+ 4) and utensils (Velcro or magnet
buttons)
2. Lunch buddy to assist
5. Physical activities (+4) 1. Use of assistive devices to 1. Frequent breaks
perform adaptive tasks (+3) 2. Break down of tasks
2. Wider spaces (+2) 3. Physical Prompts
Difficulty in Communication 1. Oral examination (.4) 1. Written response (+4) 1. Exam modification
2. Decrease oral test items (+2) a. allow short and simple
3. Allow student to bring prepared sentences in response
script (visual cues) (+3) b. pre-rehearsed questions
and answers
2. Public Speaking (.3) 1. Individual task (+2) 1. Activity modification
2. Recorded video of speaking (+3) 2. Provide tape recorders
3. Text to speech softwares
4. Prompting to correct grammar and
articulation
5. Alternative location during
presentation
6. Pre teaching
7. Guided instruction
Selection of Barriers and Qualifiers for Environmental Barriers and Facilitators (taken from ICF)
DIFFICULTIES (select all relevant Qualifier for Environmental Barriers Qualifier for Environmental Facilities
categories)
• Seeing .0 No +1 Mild facilitator
• Hearing barrier .1 Mild +2 Moderate facilitator
• Communicating
• Moving/ Walking barrier +3 Substantial facilitator
• Concentrating/ Paying attention .2 Moderate +4 Complete facilitator
• Remembering/ Understanding barrier .3 Severe +8 Facilitator, not specified
barrier +9 Not applicable
SECTION C: LEARNER GOALS .4 Complete barrier
.5 Barrier, not
specified .9 Not
applicable
To support identification of learner goals, also confirm:
• To what opportunities are available at the school to support learner goals?
• What are the student interest areas?
 • What disability-specific skills does the learner need to develop to support their participation/ attainment of goals?

Goals (eg- skills to improve participation in education or daily living skills. Goals should be SMART (Strategic, Measurable, Achievable,
Realistic and Time-bound)
INTEREST GOAL INTERVENTIONS TIMELINE INDIVIDUALS REMARKS PROGRESS/
RESOPINSIBLE NEXT STEPS
Independent skills Can climb the Physical activities June-August • Teachers
stairs with such as walking, • Parents
physical jogging, jumping.
assistance Team game

Can open the Simulations, physical June-August

door without activity to move and
assistance develop arm muscle

Can go to the Simulation, role- July-August

bathroom and plays, physical
attend to himself games and activities
there
independently

Can prepare his play and simulation June-August

own lunch
independently.
Speaking Start/ initiate a Brainstorming, role- June-August •
conversation plays Teacher •
Charades, story- Parents
telling, puppetry

Answer “why” Use of scripts August-

questions Role playing September
Problem solving
activities

Share his school Visual prompts November-

experiences Verbal prompts December
“what did we do
yesterday”
 Language and Literacy Tell 30 sights Watching movies, June- August •
words reading a book, Teacher •
word bingo Parents

Increase Reading Audio visual videos September-

comprehension puppet stories, November
graphic organizers,
Picture cards, Role
playing

SECTION D: LEARNER TRANSITION

This section is for learners exiting the school environment and transitioning into work.
INTEREST WORK OPPORTUNITIES INTERVENTION/ INDIVIDUALS REMARKS
TRANISTION SKILLS RESPONSIBILITY

Signatures:

Guardian Principal Special Education Teacher

General Education Teacher School Psychologist Guidance Counselor

School Nurse Therapist/ Specialist/ Speech/ Language

Pathologist Interpreter
Prepared by:

L CO
BSNED-3 Student

SHARIFAH GWEN BUNA

BSNED-3 Student

JUSIAH MARIE DIGNADICE

BSNED-3 Student