Iep Performance Template Rhia

Individualized Education Program (IEP) Performance
Template
© 2019. Grand Canyon University. All Rights Reserved.

Table of Contents
Table of Contents......................................................................................................2
Standard 1: Contextual Factors: School and Community Demographics, Classroom
Demographics, Building Trust Relationships, and Classroom Management............3
Standard 2: Individualized Education Plan – Part 1..................................................4
Standard 3: Individualized Education Plan - Part 2.................................................11
Standard 4: Preparation for IEP Meeting................................................................16
Standard 5: Implementation, Communication, and Progress Reporting.................18
Standard 6: Revised IEP..........................................................................................20
Standard 7: Reflection of the IEP Process...............................................................21
© 2019. Grand Canyon University. All Rights Reserved. Page 2 of 28

Standard 1: Contextual Factors: School and Community Demographics,
Classroom Demographics, Building Trust Relationships, and Classroom
Management
The IEP Performance Standards is the process for preparing and implementing the IEP
process. This template will be used to address specific standards and go through the process
of creating an IEP for a student in your placement.
Part I: Community, District, School, and Classroom Factors

Complete this portion of the IPE Template document using the following link:
Standard 1, Part I
After completing the e-doc portion, submit the PDF you receive into the digital classroom.
Part II: Demographic, Environment, and Academic Factors

Complete this portion of the IEP Template document using the following link:
Standard 1, Part II
After completing the e-doc portion, submit the PDF you receive into the digital classroom.
In order to submit this assignment, you must:

1. Complete each section of Standard 1.
Note: Closing your internet browser before the signing process is completed will result in
a loss of your work. If you will be completing this document in multiple sittings, it is
highly recommended to save and back up your work on another document. When you
are ready to make your final submission, copy and paste your responses into this
document. The data from this electronic document will not be saved until you complete
the signing process.
2. Complete the signing process by entering your name, selecting “Click to Sign,” and
entering your email address.
 An initial email will be sent to you to confirm your email address.
 A completed copy of the document will be emailed to you within minutes of
confirming your email address.
3. After completing the e-doc portion, submit the PDF you receive into the digital
classroom.

Standard 2: Individualized Education Plan – Part 1
Base the IEP on the student you are following throughout your student teaching placement.
All identifiable student information should be replaced with pseudonyms for confidentiality. In
addition, some information has been marked "Do not complete"’ due to confidentiality
concerns.
The present level of academic achievement and functional performance (PLAAFP) will guide
the development of the IEP. Teachers must describe student strengths, interests, and needs
within the PLAAFP. Assessment scores and a description of how the student is performing in
relationship to typically developing peers will provide the rationale for the development of
IEP goals, services, testing accommodations, and supplementary aides and services. It is
important that all sections of the IEP align with the PLAAFP.
Special Education Department

Individualized Education Program (IEP)
Student Name: Daisy Smith
Student Data/Cover Sheet (Form A-1)
IEP Meeting Date:10/04/2023
Demographic Information
Student Number: Student (Pseudo) Birthdate: Gender: Grade:

Name: 12/30/2015 Female 2nd Grade
2438437 Daisy Smith
Student Address: Home Phone:

3500 West Camelback Road Do not complete
City, State, Zip:
Phoenix, Arizona 85017
Parent 1 (Pseudo) Name: Terry Smith Parent 1 Relationship: Mother
Parent 1 Address: Home Phone:

Do not complete. Do not complete.
City, State, Zip: Work Phone:
Parent 1 Email:
Do not complete.
Parent 2 (Pseudo) Name: Micheal Smith Parent 2 Relationship: Dad
Parent 2 Address: Home Phone:

City, State, Zip: Work Phone:
Parent 2 Email:

Do not complete.
Primary Language of Home: Primary Language Survey Date: Language of Instruction:
English Primary Language Survey Results: English
Home District: Baltimore County Service Coordinator:
Attendance District: Baltimore County Christe Stump
Home School: Featherbed Lane Elementary School Attending School: Featherbed Lane Elementary
Vision Screened On: Results: Hearing Screened On: Results:
Meeting Date: 10/04/2023 Anticipated Duration of IEP: Re-evaluation Due: 10/03/24
From: 10/04/23 To:10/04/24 Current Evaluation: 10/03/23
Special Education Primary Category 1: Other Health Impairment
Special Education Eligibility Category 2:
For Students with SLD only, the following area(s) of eligibility was/were previously determined: N/A
Level of Services: (A)

Type of Meeting: Intake (Review and Revise) New to the County
Date Meeting Notice Sent to the Date Procedural Safeguards given to the
Parent(s): 09/05/2023 Parent(s): 09/05/2023

This page will not need to be completed because it is a signature page.
Student (Pseudo) Name: Student Data/Cover Sheet (Form A-2) IEP Meeting Date:
Student ID: DOB:
The following persons participated in the conference and/or the development of the IEP. Additionally, parents have
been given a copy of their rights regarding the student’s placement in special education and understand that they
have the right to request a review of their child’s IEP at any time.
Position/Relation to Student Participant Date (MM/DD/YY)
If during the IEP year the student turns 16, if the student is not present at the IEP meeting, the service coordinator
must review the IEP with the student and obtain the student’s signature and the date of this review.

Student (Pseudo) Name: Daisy Smith Student Data/Cover Sheet
(Form B) IEP Meeting Date: 10/04/2023
Student ID: 2438437 DOB: 12/30/2015
PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

(PLAAFP)
Section 1: Current IEP Information
Summarize special education services the student is receiving: For testing and assessments
Daisy receives small group testing, frequent breaks, reduce distractions to self and others,
change location within school, redirection to student, and general administration directions
clarified. Daisy receives calculation devices and mathematics tools, monitor test response,
and extended time. She receives frequent/immediate feedback daily, check for
understanding daily, repetition on directions daily, allow use of manipulatives, daily, break
down assignments into smaller units daily, breaks daily, reminder of rules, positive
verbal/nonverbal communication daily, strategies to initiate/sustain attention, preferential
seating, parental classroom instruction consult. Daisy receives three sessions for thirty
minutes each weekly in outside general education to address reading, writing, and math
with special education teacher and general education teacher. Daisy receives three sessions
for thirty minutes weekly in general education for written language, ELA, and math with
general education teacher and special education teacher. She is in general education for 31
hours and 40 minutes a week and outside general education for 1 hour and thirty minutes a
week. Student receives social work services as well where she learns about conscious
discipline and a social emotional curriculum.
Section 2: Evaluation Information
Areas of Eligibility:
Special Education Primary Category: Other Health Impairment

For students with SLD only, the following area(s) of eligibility was previously determined:
State and District Assessment Scores: Student is a 2nd grader new to the county and Map would be the
only district or state assessment the student would have taken. Because the student is new to the county
scores are not available. Students have just began MAP testing for the 2023/2024 school year.
Section 3: Present Level of Academic Achievement and Functional Performance

A. Cognitive (academic performance in content areas, e.g., ELA/Reading/Writing, Math, Science, Social
Studies, Technology and Fine Arts, as applicable)
B. Physical (gross motor, fine motor, vision, and hearing)
C. Oral Language and Communication
D. Social and Emotional Behavior
E. Adaptive
Current Classroom-Based Data: Based on observation and teacher's report, Daisy’s disability affects her
involvement in the general education curriculum. Daisy has difficulty in reading and spelling. She has
trouble keeping up with the rest of the class and performs poorly on school assignments. She did not
follow directions or follow the whole group’s prompts. She was given one direct prompt that she did not
comply to. She was also easily distracted by a peer sitting close to her. Overall, Daisy does not respond
well to down time or unstructured learning.
The teacher indicated are related to behaviors associated with depression and social skills. Daisy cries
easily, is irritable, and is negative about things. Her mother also endorsed that Daisy is easily upset and
cries easily. While she may be polite and complimentary, she does not offer to help
other children or congratulate others when good things happen to them.
Family’s Input on Student’s Current Performance: Parent is concern about Daisy's outburst emotions.
Parent reported that Daisy becomes frustrated easily and inattentive when completing schoolwork.
She thought that the need for glasses would help these difficulties, but they did not.
Ms. Smith is concerned for Daisy's behavior, but she is pleased the grades are better. Daisy is
confrontational and getting into a lot of fights which is concerning. Daisy can be kind, enjoys coloring,
and is very outgoing. Daisy can be silly and smiles frequently. Daisy likes to chew and bite on everyday
items, enjoys games, and having conversations. Daisy works well in pairs with certain peers.
Summary of Work Habits: Daisy struggles to work independently on tasks and remain focus. Daisy
struggles in addition and subtraction, the process in solving the problems, steps, and using classroom
strategies. She can use her fingers to find sum and differences but needs occasional reminders for which
operation she is performing. Daisy can use her calculator. She needs prompts and scaffolding for
answering multiple step problems and word problems. Regrouping is difficult as well. Her attention
further complicates her learning, retention, and engagement. Daisy becomes a distraction to herself and
others during guided reading or group reading. Daisy will chew on items and fidget in her seat and hide
under her coat. When asked comprehension questions, Daisy will shrug her shoulders or say she doesn't
know. At times Daisy's focus is the issue in her receiving information from the text and her willingness to
participate. With prompting and scaffolding Daisy can answer questions, especially when questions or
broken down or examples are provided of what is being asked. Daisy was unable to retell the story or
details from a first-grade text. She was able to answer some questions explicitly and implicitly, and
concept questions. Daisy is able to segment sounds heard in single syllable cvc words. At times, she has
difficulty adding or deleting phonemes to make new words during phonological awareness activities and
class activities. Daisy scored 4/5 sight words; 3/5 cvc words-real words; 0/4 nonsense cvc words; 0/5

digraphs and short vowels-real words; digraphs and short vowels-nonsense words-0/4; 0/ blends and short
vowels; 12/22 sentences. This result indicates that Daisy's phonics and decoding skills are below 1st
grade. Daisy is able to write simple sentences or words. She communicates her ideas better verbally and
through conversation. Daisy can copy ideas that are transcribed for her as well. Daisy is not able to work
independently on writing tasks. She has great letter formation, spacing, and punctuation. Daisy will shrug
her shoulders or say she doesn't know. Daisy needs multiple prompts and redirection at times due to
inattention and the need to move. Behaviorally, Daisy exhibits impulsive behaviors at home and at school
that include having poor self-control, hitting other children, and being unable to wait her turn. She is
overactive and is often in constant motion. These behaviors were observed in the classroom and during
testing with her difficulty sitting still and having difficulty maintaining focus on her work. Daisy appears
to exhibit behaviors related to an attentional condition. Children who are impulsive and overactive often
miss out on instruction or engage in inappropriate behaviors as it is difficult for them to stop and think
before they act.
Section 4: Summary of Educational Needs and General Accommodations

Student (Pseudo) Name: Daisy Smith Considerations Form (Form C) IEP Meeting Date:
10/04/2023
Student ID 2438437 DOB: 12/30/2015
ADDITIONAL DOCUMENTATION/CONSIDERATION OF SPECIAL FACTORS
Considered
Not Needed Included
Individual Transition Plan ☒ ☐

Statement of Transfer of Parental Rights at Age of Majority ☒ ☐
Statement of Positive Behavior Interventions, Strategies, and Supports ☐ ☒
Considered for a Student Whose Behavior Impedes his or her Learning,
or That of Others
Statement of Language Needs in the Case of a Child with Limited ☒ ☐

English Proficiency
Statement of Provisions of Instruction in Braille and User of Braille for ☒ ☐

a Visually Impaired Child
Statement of the Language of Needs, Opportunities for Direct ☒ ☐

Communication with Peers in the Child’s Language, and
Communication Mode

Statement of Required Assistive Technology Devices and Services ☒ ☐
Statement of Communication Needs for a Child with a Disability ☒ ☐

Student (Pseudo) Name: Daisy Smith Accommodations (Form F) IEP Meeting Date:
10/04/2023
Student ID: 2438437 DOB: 12/30/2015

ASSESSMENTS
(Rationales for the accommodations that are being chosen specific to assessments.)
Rationale: Written Expression measured Daisy’s fluency of production and quality of expression in
writing. Daisy’s written expression ability is below that of the average individual at age 4-10. Her
written expression standard score is in the very low range (percentile rank of <0.1; standard score
of <40). Her quality of written sentences and fluency in writing sentences are extremely limited
(RPI of 0/90).
Dibels
This assessment measures how students are performing on important reading skills. Daisy’s
performance is significantly below age and grade-level expectations.
CLS-47
WRC-1
Word Reading-14
Oral Reading-4
Word Reading-11
-Beginning Decoding Skills Survey
Daisy scored 4/5 sight words; 3/5 cvc words-real words; 0/4 nonsense cvc words; 0/5 digraphs and
short vowels-real words; digraphs and short vowels-nonsense words-0/4; 0/ blends and short
vowels; 12/22 sentences. This result indicates that Daisy's phonics and decoding skills are below 1st
grade.
WJ1V Tests of Achievement (3/23/2022)

Passage Comprehension measured Daisy’s ability to understand written discourse. The items
required Daisy to read a short passage and identify a missing key word that made sense in the
context of the passage. Daisy’s performance on Passage Comprehension is comparable to that of the
average individual at age 5-6. Her Passage Comprehension standard score is in the very low range
(percentile rank of <0.1; standard score of 49). Her ability to understand written discourse is
extremely limited (RPI of 0/90).
WJ1V Tests of Achievement

Applied Problems is a test of mathematics achievement that required Daisy to analyze and solve
practical problems in mathematics. On applied mathematics problems tasks, she solved problems
in a manner typical for her age. Daisy’s performance on Applied Problems is comparable to that of
the average individual at age 6-6. Her Applied Problems standard score is in the low range
(percentile rank of 5; standard score of 75). Her ability to solve applied mathematics problems is
limited (RPI of25/90.

State Assessments
Standard Accommodation(s): Not Available. Student new to the county.
District Assessments
Standard Accommodation(s): Small group, calculations tools and mathematics tools on calculator
sections and on non-calculator sections, frequent breaks, reduce distractions to self and others,
change location within school, redirect student, general administration directions clarified.
Standardized Test Data Unavailable.
CURRENT STATE STANDARDIZED TEST (i.e., AIMS, PSSA) RESULTS
Testing Area Test Results Grade Semester Year

Reading n/a x x x
Writing n/a x x x
Math n/a x x x
Science n/a x x x
LEAST RESTRICTIVE ENVIRONMENT (LRE)

Provide an explanation of the extent, if any, to which the student will NOT participate with non-
disabled students in the general curricular, extracurricular, nonacademic activities, and program
options. §300.347(a) (4): Apart from services provided outside the general education classroom,
Daisy will participate with non-disabled peers in all other academic, nonacademic and
extracurricular activities.
Consider any potential harmful effects of this placement for the child or on the quality of
services that he or she needs §300.552 (a-b): No. The IEP team considered multiple possibilities
for Daisy and decided on the best option for her with no harmful effects to the student or
services.

Reason for different services at school:
OR, if the above LRE information does not apply to this student, explain why: Daisy apart from
services provided outside the general education classroom, will participate with non-disabled
peers in all other academic, nonacademic, and extracurricular activities. She is in general
education for 31 hours and 40 minutes a week and outside general education for 1 hour and thirty
minutes a week. Daisy is in school for 33 hours and 10 minutes a week.

Standard 3: Individualized Education Plan - Part 2

Student (Pseudo) Name: Daisy Smith
Student Goals and Performance Objectives
IEP Meeting Date: 10/04/2023
Student ID: 2438437 Progress Report DOB: 12/30/2015
Skill Area: Math Calculation

Standard: 2.NBT.B.5 Fluently add and subtract within 100 using strategies based on place value,
properties of operations, and/or the relationship between addition and subtraction.
Annual Goal: By October 2024, when given 2-4 digit addition and subtraction problems,
Lily will use place value understanding, properties of operations, and calculation tools and
strategies (break apart, hundreds chart, number line, calculator, manipulatives e.g.) to add
and subtract numbers, with and without composing and decomposing. with 75% accuracy,
in 3 out of 4 trials, as measured by informal procedures and student work samples.
Baseline Level of Mastery: 75 % Accuracy for 3 out of 4 trials

Service Provider(s) for this goal: Special Educator, General Education Teacher, Instructional
Assistant
Skill Area: Written Language Expression

Standard: W.2.1 Write opinion pieces in which they introduce the topic or book they are writing
about, state an opinion, supply reasons that support the opinion, use linking words
Annual Goal: By October 2024, given a writing prompt to write about a familiar topic and
scaffolded supports (e.g., paragraph frame, sentence starters, model paragraph), Lily will
write 1-5 sentences that give facts about the topic, including one introductory sentence and
one closing sentence for 3 out of 4 writing prompts, as measured by informal assessments,
class assignments, rubrics, and writing samples.

Service Provider(s) for this goal: Special Educator, General Education Teacher, Instructional
Assistant
Skill Area: Reading Comprehension

Standard: RL.2.1 Ask and answer such questions as who, what, where, when, why,
and how to demonstrate understanding of key details in a text.
Annual Goal: By October 2024, after reading and/or listening to instructional level literary
or informational text or listening to grade level text (e.g., text-to-speech, teacher read
aloud, guided reading), Lily will demonstrate comprehension by answering or asking “Wh”
questions, (e.g. verbally or in writing) by referring to key details with support (e.g. picture
choices, graphic organizer, anchor chart, teacher scaffolded guided questions, or sentence
starters),and use text features to locate key details with 80% accuracy for 4 out of 5 texts,
as measured on informal assessments, class assignments, informal observation/charting of
student performance, and student work samples.
Service Provider(s) for this goal: : Special Educator, General Education Teacher, Instructional
Assistant
Skill Area: Reading Phonics

Standard: RF.2.3 Know and apply grade-level phonics and word analysis skills in decoding words.
Annual Goal: By May 2024, given single syllable words, Lily will know and apply grade-level
phonics and word analysis skills to decode the words with 70% accuracy, on 2 out of 3 trials, as
measured by informal procedures and classroom performance.
Baseline Level of Mastery: 70 % Accuracy 2 out of 3 trials

Service Provider(s) for this goal: Resource, Special Educator, General Education Teacher,
Instructional Assistant,

Student (Pseudo) Name: Daisy Smith Accommodations (Form E) IEP Meeting Date: 10/4/2023
Student ID 2438437 DOB: 12/30/2015

ACCOMODATIONS
Date Given to General Education Teacher: 10/5/2023 Service Coordinator: Christe Stump
Accommodations Type Location

Other Instructional Supports: 3 A
Frequent and immediate feedback; check for understanding; repeat
directions
Allow use of manipulatives. 3 A
Allow use of highlighters during instruction and assignments 3 A
Break down assignments into smaller units. 3 A
Strategies to initiate and sustain attention 3 A
Provide frequent changes in activity or opportunities for movement. 3 A
Other Social/Behavior Supports 3 A
Frequent reminder of rules; Reinforce positive behavior
Provide manipulatives and/or sensory activities to promote listening and 3 A
focusing skills.
Preferential seating 3 A
Other School Personnel/Parental Supports
Classroom instruction consult
LEGEND FOR TYPE AND LOCATION FIELDS

Type:
1 = Class work/assignments 2 = Assessments/tests 3 = Both class work/assignments/assessments
Location:
A = All Subjects B = Language Arts/English C = Reading D = Spelling E = Math
F = Science G = Social Studies H = Health I = Electives J = Physical Education
K = Lunch L = Transition / Vocation M = Library N = Title 1 O = Special/Exploratory
Family Communication
How will the family be informed of their child’s academic progress and the extent to which that progress
is sufficient to enable the child to achieve annual goals by the end of the year? The family will be
informed of the students progress quarterly through progress reports and also monthly progress on one
goal through third party billing. Also, weekly or daily communication as needed. Progress will be
monitored and alterations will be made to ensure students are properly prepared to make progress with
supplementary, aids, accommodations, and services.
IEP Team Consideration for Extended School Year

Consideration for eligibility: The team considered whether Daisy had breakthrough opportunities,
demonstrating mastery, had goals related to critical life skills, interfering behaviors, may have
substantial regression, other special circumstances, the severity of the disability, or will the lack of
ESY jeopardize the student,
Eligible for ESY: No, student is not eligible for ESY service.
Written explanation as to why ESY is or is not needed: Daisy has goals related to critical life skills.
Daisy was assessed at the beginning of the school year 2023/2024 and showed no regression of skills.
At this time there is no breakthrough opportunities or demonstration of a degree of mastery. There
is no data to support ESY during this time. The team has determined Daisy is not eligible at this
time. There is also no interfering behaviors. The IEP is also newly developed.

Student (Pseudo) Name: Daisy Smith Services and Environment
(Form I) IEP Meeting Date: 10/4/23
Student ID: 2438437 DOB: 12/30/2015
SPECIAL EDUCATION SERVICES TO BE PROVIDED

Special education services necessary to meet special education goals and objectives during the school
calendar year.
The child is in need of specially designed instruction in the following areas:
Special Instructional
Education Setting/ Start Date Frequency Provider Duration/ End
Services Location Date
Classroom Outside 10/4/23 3 30 minute Special 10/4/2024
Instruction General sessions Educator
Education (weekly)
General
Education
Teacher
Classroom In General 10/4/23 3 30 minute General 10/4/2024
Instruction Education sessions Education
(weekly) Teacher
Special
Educator
Clarification: Daisy will receive outside instruction of the general education setting 3x weekly for
30 minutes each to address her reading, writing, and math skills.
Daisy will receive inside instruction in the general education sitting for 3X a week for each to
address reading comprehension, Written Language, and Math skills.
EDUCATIONALLY RELEVANT RELATED SERVICES
Clarification:
EDUCATIONALLY RELEVANT SUPPLEMENTARY AIDS/ASSISTIVE TECHNOLOGY and

SERVICES for STUDENTS

.
Clarification:
SUPPORTS FOR SCHOOL PERSONNEL
Social Work In General 10/4/23 1 30 minute Social 10/4/24
Services Education session Worker
(weekly)
Clarification: Daisy will receive social work services 1x a week for 30 minutes inside the general
education setting for emotional regulation.

Standard 4: Preparation for IEP Meeting
The IEP team must cover mandated topics during the IEP meeting. Topics that must be
addressed during the IEP include, but are not limited to, an introduction of team members,
clarifying the type of meeting (initial, review, amendment/addendum to current IEP), the
required components of the IEP, the procedural safeguards, and prior written notice.
IEP Meeting Planning

Required Participants/Roles: List the participants of an IEP meeting and their roles, including
whether or not the student is expected to participate.
Student is not expected to participate.
Rhia Hardman-Special Educator
Christe Stump- IEP Facilitator
Doug Valchar- School Psychologist
Debbie Ball- SST/ Instructional Support
Katerine Rossi- Guidance Counselor
Terry Smith- Mother
Juile Krull- General Education Teacher
Lynette Flagg-School Social Worker
Required Agenda Outline: In 500-750 words, create an agenda for the IEP meeting. Discuss the
required topics you must address (i.e., introduction of team members, whether or not this is an initial or
review or an annual IEP, discussion of test results, present levels, goals, services, Least Restrictive
Environment (LRE) statement, Extended School Year (ESY) services, procedural safeguards, and prior
written notice.
The meeting will begin with an introduction of team members and their roles. Next, I will go over the
purpose of the meeting which is an intake meeting now known as a review and revise as well. The IEP
facilitator will inform parent that they will be taken notes on what is discussed that will be provided
after the meeting and also ensure the part was provided with the procedural safe guards and
rehabilitative services was received. A virtual electronic receipt will need to be signed or a paper copy
will be provided. The parent will be asked whether they want to sign electronically or paper. The IEP
facilitator will now start with the parent. The parent will give information on the student, how they fill
the student is making progress and any other updates the parent would like to share. After the parent
has spoken, the general educator will give information that they have thus far on working with the
student. After the teacher, the school guidance counselor will speak on their interactions with the
student. The special educator will now begin to over the IEP or changes that was made since it is an
intake meeting. This is an intake meeting for an IEP out of the county and is almost identical to the IEP
the parent already as. The SST/instructional resource will go over phonics goals. The special educator
will go over plaffp page if information from the present school was added, services, LRE,
supplementary aids and services, and ESY. The IEP facilitator will then ask the team if anything else
needs to be added, if not the IEP facilitator will ask the team and parent agree to finalize the IEP. Once
everyone agrees, the facilitator will then have the team electronically sign the IEP and Eligibility page.
The parent will then be given the details of what will go home in the students bookbag. Because this is
an intake meeting/ review or revise, next evaluation date will be discussed or annual review date. The
possible scheduling will be suggestive. Lastly, the meeting will be ended and the IEP facilitator will

finalize the IEP and send documents home to the parent.
Plan for Conflicts: Provide a description of ways you can involve parents in the development of
the IEP. Discuss whether you anticipate issues or conflicts that may arise during the meeting and your
plan on addressing those concerns.
The special educator will ask the parent if there is anything that they would like to change or
disagree with on the current IEP that is out of county. If there is a yes, the special educator will
make note of those changes and engage the parent on the things they wish to change or
disagree with. Other possible conflicts may be service hours or days. I will explain to the
parent that we will or can collect data to support the increase of services or days. Also, it will
be explained that if we go the max immediately there is not much up we can go without
possibly jeopardizing the LRE. We would be prepared to add in supplementary, aids, or
services to accommodate the potential needs or suggestions of parents. If we come into a
unknow conflict will give the parents the best explanations and listen to the parents to
understand why there is a conflict and what is the need. If the meeting does not provide a
solution we will table the discussion for the sake of the meeting and reconvened within ten
days to find a possible solution that is in the best interest of the student and can support the
parent. If absolutely needed, the IEP Facilitator will enlist the help of the department of special
education to provide better guidelines or solutions.
Mock IEP Introduction Video

Now that you have outlined the IEP meeting agenda, you are prepared to conduct the meeting. In order
to prepare for running your first official IEP meeting, record yourself as if you were conducting the IEP
meeting. Your video should not exceed 15 minutes in length.
Focus your practice on the meeting introduction. Include the following components within your
recording:
 An introduction of all parties represented and their roles
 Reason for the meeting (initial IEP or IEP review)
 Meeting norms so all parties are heard and respected
 Review of the PLAAFP including the discussion of test results, present levels, goals, services,
Least Restrictive Environment (LRE) statement, Extended School Year (ESY) services,
procedural safeguards, and prior written notice (PWN).
Conclude your video by providing an explanation of how you would actively listen to and address the
needs of families and other stakeholders throughout the meeting.

After recording yourself, review and reflect upon the video below.
Mock IEP Introduction Video Link: https://youtu.be/5uG2Cl8Sjpw
Video Recording Link: If you are submitting your video to OneDrive, note it here.
Reflection: In 250-500 words, reflect on your IEP meeting practice session. In what areas do you
feel you did well? In what areas would you like to have more guidance and coaching before conducting
your first official IEP on your own? What plan of action do you have for more coaching and guidance?
I felt uncomfortable. I was watching the time and then also trying to remember what not to
forget. In the future I’ll have notes and points that I should hit and a detailed outline to help the
flow. I also try to watch my pace because I am a fast talker. When I speak fast I tend to mess up
on more words. I also have to watch out for slipping on the alias/ real name. It is different for me
because in my county the special educator does not run the meeting. I have an IEP facilitator
who does that along with scheduling and compliance needs. I hope I do not have to run a meeting
and keep track of notes as well. Organization is hard for me. I will have to focus on not too much
talking or letting conversation go on too long where we lose valuable time. It is hard to gage in a
mock video with little time, but I think I gave good information and explanations, the intro was
fine, and following the schedule. These meetings are usually thirty minutes. I would like more
guidance on the compliance side of running meetings, various types of meetings, and I would like
to learn all the terminology, dos and don’ts. Most of are meetings are virtual, so I’ll need to
explain the difference and guidelines for both. We are gradually moving to being in the same
room or staff together and parents on a web cam. Muting the mic and raising a virtual hand are
important.

Standard 5: Implementation, Communication, and Progress Reporting
Accountability of Free Appropriate Public Education (FAPE) is mandated by the Individuals with
Disabilities Education Act of 2004 (IDEA). IEP teams must have a plan to document the provision of
services as written in the IEP. Appropriate and accurate data must also be collected to document
quarterly progression toward mastery of IEP goals. Teams must have a plan for on-going data
collection, communication, and presentation of data to the parents/guardians during quarterly
progress reports and annual IEP review meetings.
Accommodations Progress and Communication Plan

Complete the Accommodations Table below, demonstrating how you plan to ensure all
accommodations are being met in the general education setting (if applicable). If the student is not in a
general education classroom, indicate how the student will receive accommodations in content specific
areas based on his or her PLAAFP and IEP goals.
On the Accommodations Table, note the dates when you will obtain progress reports from the general
education teacher or related services staff so that you can gather data on progress (if applicable). If no
general education teachers are reporting, indicate the dates of your (special education teacher)
reporting.
In addition, use the Accommodations Table to gather data on the student’s progress for the first
Quarterly Progress Report.
NOTE: Only two dates are included on the Accommodations Table for the purpose of this assignment.
You may not gather data on both dates in the duration of your placement, but dates should be noted.
Accommodations Table
Goal 1: By October 2024, when given 2-4 digit addition and subtraction problems, Daisy will use place value
understanding, properties of operations, and calculation tools and strategies (break apart, hundreds chart,
number line, calculator, manipulatives e.g.) to add and subtract numbers, with and without composing and
decomposing. with 75% accuracy, in 3 out of 4 trials, as measured by informal procedures and student work
samples.
Implemented Accommodations: calculator, resource book (hundreds Person(s) Responsible: Ms. Hardman,
chart, array chart, highlighter, multiplication chart Ms. Krull
Quarterly Progress Report 1 Date: 11/1/2023
Data Results: Daisy is able to use her calculator to add and subtraction. She is also able to use the standard algorithm
with some prompting and scaffolding. The resource book covers topics yet covered but inside the book Daisy can turn to
the page she needs to help solve problems. She can use her highlighter to find important information sometimes needing
to reread the problems. Daisy is keeping up with her class in learning to use the array model and uses the resource book
dry erase chart to solve problems. Daisy just needs to take her time. She gets excited to find the answer and can make
very small errors.

Quarterly Progress Report 2 Date:
Data Results:
Goal 2: By October 2024, given a writing prompt to write about a familiar topic and scaffolded supports (e.g.,
paragraph frame, sentence starters, model paragraph), Daisy will write 1-5 sentences that give facts about the
topic, including one introductory sentence and one closing sentence for 3 out of 4 writing prompts, as
measured by informal assessments, class assignments, rubrics, and writing samples.
Implemented Accommodations: paragraph frames, sentence starters, Person(s) Responsible: Ms. Hardman
model paragraphs, illustrations, graphic organizer
Quarterly Progress Report 1 Date:11/1/2023
Data Results: Daisy can fill in the blanks for sentence starters. She does well to remember content vocabulary. Daisy is
able to see and use model paragraphs and change it to make it her own. She may still need some prompting and
scaffolding to help ideas relate or stay on topic because Daisy often has so many ideas. She needs help narrowing it
down. Daisy loves to draw so using illustrations to accompany her writing comes easy for her and often motivates her to
write. Sentence starters she has grown to become familiar with and can do and even correct errors. It helps to make
sentence starters more challenging for her.
Quarterly Progress Report 2 Date:
Data Results:
Accommodations Summary:
In 100-150 words, summarize information from the Accommodations Table as well as data you have gathered
through teaching and observing the student. Address mastery of goals, progress towards mastery, and overall
service provision. Daisy as access to these accommodations daily across all subjects. The resource book has been a
big help in foster her independence in task/work completion. She is able to navigate the book to find the proper tool
she needs for work. Daisy will also advocate for herself in using her accommodation. She uses her calculator but
also wants to do it herself as well because she is learning classroom strategies as well. Using her accommodations
has increased her participation too. Daisy appears to become more confident. She is very close to mastery, there are
just some moments where she may forget or make a tiny error that then affects whether something is complete or
correct. The general educator will also add how Daisy is doing as well but from conversation she sees the
improvement since Daisy has these accommodations and also noted a behavior decrease and less frustration.
Communication Plan for General Education Teachers and Related Services Staff:
After completing the accommodations table and summary, in 150-250 words, describe a communication plan that
outlines how you plan to share the student’s progress information with the necessary faculty and staff. Address how

you and your colleagues will continue to monitor progress along the way, prior to receiving the quarterly
progression updates. Students with an IEP have progression updates shared through third party billing. This is a
form that parents sign. This form can be signed throughout the year and processed. Through third party billing
parents or guardians receive a monthly update on one of the goals the student is working towards. This
communication has guidelines such has phone conversations, IEP team meetings, progress reports, or email. If the
student is old enough, you can count a meeting with the student. Parents hear about student progress through interim
reporting halfway through the quarter, report cards, progress reports quarterly, if a parent calls a meeting, if a
meeting is held on specific reason, if a student support team meeting is held, when a parent is contacted through a
general non mandatory update, and also during a meeting if the student is not making progress. Special educators
often follow the calendar of the county, and communicate with parents or guardians to tell them of glows and
grows. We are in the classrooms daily and communicate daily with general educators. Collaborating with outside
providers can be tricky and specials teachers as well. We often hear from specials teachers when there is a behavior
problem and outside providers during team meetings.

Standard 6: Revised IEP
IEP teams are expected to regularly analyze and document students’ progress on their IEP
goals throughout the year. This includes identifying when there are changes affecting the
student and presenting evidence of attempts to meet student needs when there is a lack of
progress. To address times when information, services, or goals need to be changed or added
to an existing IEP, the Individuals with Disabilities Education Act of 2004 (IDEA) describes
the regulations and procedures for changing an IEP using an amendment or addendum. An
amendment is used to change something already in the IEP. An addendum is used to add
something new to the IEP, such as goals, services, or accommodations.
After reflecting on your completed Standard 5 content, create a progress report addendum and/or
amendment (based on changes needed) to be added to the initial IEP, or describe why neither an
addendum nor amendment are not needed.
Data Collection and IEP Modifications

Stakeholders involved in special education must be aware of the student progress monitoring
process, keeping the goal of mastering IEP goals and presenting evidence of attempts to meet
said goals in mind. It is vital to keep a record of new information affecting student needs,
including a lack of progress when an IEP is in effect, using an IEP amendment or addendum.
An amendment is a change to the IEP and an addendum is the addition of goals or services and
accommodations to the IEP.
IEP Modification Need

After monitoring and gathering data, analyze how the student is performing on his or her IEP
goals and with the accommodations. Consider whether there is a need for an addendum and/or
an amendment for the student. If there is a need, in 50-100 words explain this need and the
approach to be taken (an amendment or an addendum). If there is no need at this time, simply
explain how the student is performing and progressing toward their IEP goals. At this time, I
do not see a need for immediate modification. Daisy is making progress on all of her goals.
Due to her reading foundational deficits, written language expression is harder, but she
continues to blend, remember sight words, and learn new decoding skills. She is working to
applying these skills daily during phonics intervention and phonics in her general education
classroom. Her behavior has decreased. A lot of the behavior came from frustration towards
the work. Now that she has push in and pull out, small group instruction, and accommodations
Daisy is able to do more in and outside of the classroom. I can see in the very near future, an
addendum is being made to maybe change her math goal to something more challenge or the
next grade level standard. This would happen after an informal assessment is given in math.
Most likely a placement test would be given to compare her progress and maybe develop a
more appropriate goal if she is showing the skill as constantly demonstrating.

Family Communication Plan
In 50-100 words, discuss how you plan to communicate the student’s progress on his or her
IEP goals with the parents/guardians. (You may want to discuss this process with your mentor
so you have a method to use for future practice.) To communicate with parents/guardians on
the student progress, I will send home monthly updates on goals which includes the progress
that is being made. In addition to that interim progress grades just came out in the halfway
mark for the quarter. The quarter is coming to an end which means that the student will receive
a progress report for all goals. The progress report goes home with the student with their report
card. If a team is held in that time for any reason progress will also be discussed as well.
Standard 7: Reflection of the IEP Process

Reflection is an important part of professional practice. Professional special education
teachers plan and frequently reflect on their delivery of services, instruction, data collection
procedures, and individual student progress. Identification of practices that have worked, and
those that have not, can help the special education teacher adjust instruction and services to
better meet the needs of students.
Continued Learning
After completing the Individualized Education Program (IEP) Performance Template, reflect
upon three best practices you have learned from this student teaching experience in 50-150
words.
1. Collect Data. Data should be collected in different forms such as teacher report, informal
assessment, formal assessment, parent report, observation, student work samples, classroom
assessments, state testing, classroom work, psychological assessment, Vanderbilt forms.
Document progress, use of accommodations or lack thereof.
2. Stay organized. Being organized makes compiling data easier and also easier to reflect or
compare data. Having a schedule is also beneficial. Create files for students. Paper and digital
data is equally important.
3. Do not wait until the last minute! Time will catch up to you. It is important to take your
planning time and plan what you will do during that time. When you rush, it is easier to make
small mistakes or forget information. You feel better when you are prepared and familiar with

the data.
Improved Practice
Based on your experience of developing and delivering your Individualized Education
Program (IEP) Performance Template, list three implications for your future teaching practices
in 50-150 words. Consider concepts you want to take with you into your own classroom, such
as how you will establish and maintain organization in order to facilitate the IEP process in
your classroom.
1. I must develop a system to stay organized and decrease chaos and clutter. I need to create a
filing system for paper documentation. Using my planning time effectively can help decrease
the feeling of unpreparedness. I can do this by grade and goals or services.
2. Have work that is differentiated for students handy and in a folder they can access. Create a
way to monitor use of supplementary aids and accommodations. Make sure students are aware
of their accommodations and daily supplementary aids so they can better advocate for
themselves.
3. Collaboration. Don’t be afraid to collaborate and make use of extra hands. It takes a team. Be
open to teaching in diverse ways to help students access the curriculum. Progress monitoring is
a must even if it is an exit ticket or a check for understanding. Compare student performance in
the class and small group pull out instruction to better understand what helps the student learn.

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Individualized Education Program (IEP) Performance

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Part I: Community, District, School, and Classroom Factors

Part II: Demographic, Environment, and Academic Factors

In order to submit this assignment, you must:

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Special Education Department

Student Data/Cover Sheet (Form A-1)

IEP Meeting Date:10/04/2023

Student Number: Student (Pseudo) Birthdate: Gender: Grade:

Student Address: Home Phone:

Parent 1 Address: Home Phone:

Parent 2 Address: Home Phone:

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Special Education Eligibility Category 2:

Special Education Eligibility Category 3:

Level of Services: (A)

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Student ID: DOB:

Position/Relation to Student Participant Date (MM/DD/YY)

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Student ID: 2438437 DOB: 12/30/2015

PRESENT LEVEL OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Section 1: Current IEP Information

Section 2: Evaluation Information

Special Education Primary Category: Other Health Impairment

Section 3: Present Level of Academic Achievement and Functional Performance

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B. Physical (gross motor, fine motor, vision, and hearing)

C. Oral Language and Communication

D. Social and Emotional Behavior

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Section 4: Summary of Educational Needs and General Accommodations

Special Education Department

Student ID 2438437 DOB: 12/30/2015

ADDITIONAL DOCUMENTATION/CONSIDERATION OF SPECIAL FACTORS

Individual Transition Plan ☒ ☐

Statement of Language Needs in the Case of a Child with Limited ☒ ☐

Statement of Provisions of Instruction in Braille and User of Braille for ☒ ☐

Statement of the Language of Needs, Opportunities for Direct ☒ ☐

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Student ID: 2438437 DOB: 12/30/2015

-Beginning Decoding Skills Survey

WJ1V Tests of Achievement (3/23/2022)

WJ1V Tests of Achievement

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Standard Accommodation(s): Not Available. Student new to the county.

Standardized Test Data Unavailable.

CURRENT STATE STANDARDIZED TEST (i.e., AIMS, PSSA) RESULTS

Testing Area Test Results Grade Semester Year

LEAST RESTRICTIVE ENVIRONMENT (LRE)

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Special Education Department

Student ID: 2438437 Progress Report DOB: 12/30/2015

Skill Area: Math Calculation

Baseline Level of Mastery: 75 % Accuracy for 3 out of 4 trials

Skill Area: Written Language Expression

Baseline Level of Mastery: 75 % Accuracy for 3 out of 4 trials

Skill Area: Reading Comprehension