SAMPLE INDIVIDUAL EDUCATION PLAN

Reason for Development of IEP

X Student identified as exceptional by IPRC
Student not formally identified but requires special education program/services including modified/alternative
learning expectations and/or accommodations

Name: Bob Thorton Gender: Male Date of Birth: March 19, 2001
School: Bishop Elementary
Student ID#: 985732 Principal: Mr. Strict
Current Grade/Special Class: Grade 4 School Year: 2010 - 2011
Most Recent IPRC Date: Dec. 5, 2010 Date Annual Review Waived by Parent:
Exceptionality: Behaviour
IPRC Placement Decision: (check one)
Regular Class With Indirect Support X Special Education Class With Partial Integration
Regular Class With Resource Assistance Special Education Class Full Time
Regular Class With Withdrawal Assistance

Assessment Data:
List relevant educational, detailed medical/health (hearing, vision, physical, neurological) psychological,
speech/language, occupational, physiotherapy, and behavioural assessments.

Information Source Date Summary of Results

WISC-IV Nov. 15, 2012 Below average for oral arithmetic, and high score on
comprehension
Wide Range Achievement Nov. 15, 2012 below average for arithmetic and spelling, but above average
Test Fourth Edition reading level
Bender-Gestalt Nov. 15, 2012 problems with fine motor precision, age norm is 8.5 years

Areas of Strength Areas of Need

- kinesthetic learner - visual memory processes
- reading - oral arithmetic
- articulate - self-regulation
- one-on-one-learning - coping techniques
- following directions
- dealing with consequences appropriately

Specialized Health Support Services/Personal Support Required Yes (List Below) X No

Student’s Strengths and Needs: Subjects, courses, or alternative programs to which the IEP applies: Identify each
as Modified (MOD), Accommodated only (AC), or Alternative (ALT)
1. Math MOD X AC ALT 6. MOD AC ALT
2. Language Arts MOD X AC ALT 7. MOD AC ALT
3. Behavour MOD AC X ALT 8. MOD AC ALT
4. MOD AC ALT 9 MOD AC ALT
5. MOD AC ALT 10. MOD AC ALT

Elementary Program Exemptions or Secondary School Compulsory Course Substitutions

Yes (Education rationale required) X No

Student is currently working toward the attainment of a: Ontario Secondary School Diploma
Ontario Secondary School Certificate
Certificate of Accomplishment

Accommodations:
(Assume common to all subjects unless indicated)

Instructional Accommodations Environmental Accommodations Assessment Accommodations

- frequent breaks - computer - extra time
- reinforcement incentives - cool down area - use of manipulatives
- use of manipulatives - use of computer to complete tests
- high structure and assignments
- non-verbal signals
- extra time

Accommodation and Exemptions for Provincial Assessments:

Accommodations: Yes (List Below) No

Exemptions: Yes (State educational rationale) No

 Special Education Program

To be completed for each subject/course with modified expectations Student ID#: 985732
and/or alternative expectations.

SUBJECT/COURSE/ALTERNATIVE PROGRAM: Behaviour

Current Level of Achievement: Current Level of Achievement for Alternative Program:

(Describes starting point for plan development) Bob is able to accept consequences for inappropriate behaviour
Letter Grade/Mark when frustrated or angered appropriately 1 out of 10 times. He is
Curriculum Grade Level compliant in 2 out of 10 situations.

Annual Program Goal(s): A goal statement describes what a student can reasonably be expected to accomplish by the
end of the school year in a particular subject, course or alternative program.

By the end of June, Bob will be able to accept consequences for inappropriate behaviour when frustrated or angered 5 out of 10
times. He will be compliant in 6 out of 10 situations.

Learning Expectations Teaching Strategies Assessment Methods

(Knowledge and/or skills to be assessed by
reporting period, including Grade level)
Term 1
- be able to identify and self-regulate
frustration and anger when it occurs
(List only those that are different for this (For expectations for each reporting period)
student and specific to the learning
expectations for the subject/course/alternative
program)
- breathing techniques and calming - reward chart for appropriate behaviour
strategies

- be able to identify the importance of
honesty, and to be honest in interactions
with others
- be able to recognize and remember other
people’s personal space
- role play truth-telling scenarios - reward chart for appropriate behaviour
- have Bob make hands-off posters - observation that his posters show
appropriate behaviour

- be able to recognize the value of other - have Bob write a letter explaining how - checklist with success criteria
people’s property, and to only handle what he would feel if someone stole from him
belongs to others with their permission
- be able to following directions when given - one-to-one instruction - observation
- be able to recognize when behaviour - have Bob participate in an anti-bullying - conference with Bob after campaign to
towards other students is inappropriate, campaign see if his stance on his bullying others
and to change that behaviour has changed
IEP Developed by: Sources Consulted in the Development of the IEP:
(check)
Staff Member Position X IPRC Statement of Decision (if applicable)
Mr. Strict Principal X Provincial Report Card
Mr. Oats Special Education Teacher Previous IEP
Mr. Garrison Classroom Teacher
X Parents/Guardian
Student
Other (List Below)
Other Sources:

Date of Placement in Special Education Program: (select and appropriate option and provide date)

X 1) First day of attendance in new special education program

2) First day of the new school year or semester in which the student is continuing in a placement
3) First day of student’s enrollment in a special program that he/she begins mid-year or mid-semester as
a result of a change in placement

Date of Placement: Dec. 6, 2010

Completion Date of IEP Development Phase: Dec. 20, 2010

(Within 30 school days following the Date of Placement)

Transition Plan:
For Student who are 14 years of age or older, unless solely identified as gifted.

Transition Goal
Specific Goal(s) for Transition to Postsecondary Activities

Actions Required Name of Person(s) Responsible for Timelines

Actions

Implementation and Monitoring:

Human Resources: (Teaching/non-teaching)

Include service, initiation date, frequency or intensity, and location.
- Mr. Oats, the Special Education teacher, will be giving Bob direct instruction 60-80% of the school day in a class with
no more than 10 students. Starting December 6, 2010.
Evaluation

Reporting Dates: February 15, 2011 June 28, 2011

Reporting Format: (please check) X Provincial Report Card X Alternative Report

(Required if student has
modified expectations and/or
accommodations only)

Log of Parent/Student Consultation and Staff Review/Updating

Date Activity Outcome
(Indicate Parent/Student Consultation or Staff Review)
December 5, 2010 IPRC Decision - Bob identified as behaviour
exceptionality

December 7, 2010 IEP Team Meeting - Mr. Strict has applied for a High
Needs Amount so that a Teachers
Assistant may be assigned to Bob.

The Principal has the legal requirement to implement and monitor the IEP.

The plan has been developed according to the Ministry’s standards, addresses the student’s strengths and needs, and
the learning expectations will be reviewed and student progress monitored at least once every reporting period.

Principal’s Signature: Date:

Parent/Guardian/Student Involvement:
I was consulted in the development of this IEP
I declined the opportunity to be consulted in the development of this IEP
I have received a copy of this IEP

Parent/Guardian/Student Comments:

Parent/Guardian Signature: Date:

Student Signature: Date:

(If 16 or older)