ADE SPED

REQUIRED FORM
MAY 2018
Individualized Education Program (IEP)

Skylar Smith N/A N/A

12 6th Fantasy Middle School

N/A N/A
(Excluding summer months and school holidays unless otherwise indicated)

IEP Type: SCHOOL AGE - No Postsecondary Transition

Purpose of IEP:

10/28/2012

N/A

Parent Rights Parent Method of Participation:

Provided:

Excusal(s): Translation/Interpretation
Needed:

N/A

Parent Agreement to Excusal:

Is excused member's area of curriculum being discussed?

Parent/guardian input regarding enhancing the education of the child was considered.
Parent/guardian input:
Skylar’s parented contacted Mrs. Knowzit, Skylar’s gen ed teacher, about the upcoming school year to try and get
a head start on some of the things that may be a struggle regarding Skylar. They mentioned organization skills,
coming up with a way to make sure Skylar’s work gets sent home and gets back to school, and making sure she is
more responsible for her space staying clean in the classroom.
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Present Level of Academic Achievement and Functional Performance

Skylar is receiving special education services for OHI (other health impairment) as a 6th grader at Fantasy Middle
School. Skylar was adopted when she was 8 years old and she is diagnosed with ADHD. Skylar’s educational
performance is adversely affected because her inability to remain attentive has a negative impact on her classroom
performance. Skylar is currently functioning with an IQ score of 85 (low average range of intelligence). Skylars strengths
as described by the IEP team are that she is well liked by peers and faculty, she exhibits proficiency in math calculation,
and she is good at math problem solving. In regards to reading, Skylars fluency level is dropping and she requires
numerous breaks due to off task behavior. Skylar can be disorganized and this causes her to struggle in an academic
setting as well. Skylar seems to do well with the fact that she was adopted unless her birth mom is in the picture. Skylars
assessment data is as follows: WISC-IV- is average to low average, WIAT-III- is low average in reading and average in
math, and Conners-3- inattention, hyperactivity, impulsivity, learning problems, executive functioning, and peer relations.
Skylar Smith

X
Put a class calendar, or reminder
system in place to keep Skylar on task.
Make classwork digital on a lockdown
browser so Skylar is encouraged to
stay on task.

X
Possibility of a behavior plan in the
future in regards to Skylars adoption
situation.
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ESY is not necessary

ESY is necessary. (Document services below).
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IEP Goals

Annual Goals: provide measurable annual goals, including academic and functional goals to enable the child to be
involved in and make progress in the general education curriculum and to meet other educational needs that result from
the disability.
Skylar will complete and turn in her worksheets on time, 80% of the time, by the end of
1 the school year.

Annual Goals: provide measurable annual goals, including academic and functional goals to enable the child to be
involved in and make progress in the general education curriculum and to meet other educational needs that result from
the disability.
Skylar will increase her reading comprehension and fluency skills from low average to
2 average by the end of the school year.
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IEP Goals with Objectives
Annual Goals: provide measurable annual goals, including academic and functional goals to enable the child to be
involved in and make progress in the general education curriculum and to meet other educational needs that result from
the disability.
Skylar will decrease the occurrences of attention seeking behavior and hyperactivity, through self
3 monitoring, by 30% by the end of the school year.

Goal 1 - Objective 1: Skylar will use a checklist to make sure her desk is organized and have the teacher check and sign off on the
checklist, 3 out of 5 days of the week, by spring break.
Goal 1 - Objective 2: Skylar will use a set of binders to organize her school work, and bring those binders home to be checked and s
igned off by her parents, and then back to school and turned in on time, 3 out of 5 days of the week, by spring break.

Goal 2 - Objective 1: Skylar will fill out graphic organizers when reading in order to remain on task and increase
comprehension skills.

Goal 2 - Objective 2: Skylar will complete a sight word work sheet, with 85% accuracy every week, to improve her fluency in reading.

Goal 3 - Objective 1: Skylar will collaboratively participate in filling out a behavior chart with her teacher at the end of every class period where
she reflects on her own behavior during said class; this will be done daily and Skylar will receive rewards when she passes 3 out of 5 classes within the day.

Skylar will use charts to mark off her completed work and if the chart is full by the
end of the day, she will be rewarded.
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Reading
Resource

1
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For K-12: The general education environment includes all academic instruction as well as meals, recess, assemblies, field trips, etc.
Will this child participate 100% of the time with non-disabled peers in the general education environment?
Yes
x No

The child's acquisition of academic/developmental skills cannot be addressed through modification/adaptation of

the general curriculum.
Small group instruction is necessary for the child to acquire skills specified in the IEP.
Behavior intervention strategies established in the child's IEP require a degree of structure that cannot be
implemented in a large group setting.
The child's needs cannot be achieved in the general education environment even when supplemental aids and
supports are provided.
The child's behavior significantly impedes his or her learning and that of others.
Additional individualized instruction is needed to facilitate learning.
A more structured environment is needed than can be provided in the general education setting.

The continuum of placements for the least restrictive environment (LRE) includes regular classes with indirect service (RG), regular
class 80% or more (RG), regular class 40% to 79% (RR), regular class less than 40% (SC), School-based Day Treatment, Special Day
School, Residential School, Hospital Program, and Homebound Instruction.

80
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X Skylar will need breaks and extra time

X X X
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