IEP Example Updated

IEP/DEC4 Purpose: Annual Review IEP
Form Status: Closed/Verified
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Duration of Special Education and Related Services From: 01/01/2020 To: 12/31/2021
Student: Julia Anne Smith DOB: 01/01/2013 UID: 123456789JAS
LEA: Sesame Street Schools School: Sesame Street Elementary Grade: First Grade
Primary Area of Eligibility*: Autism

*Reported on Child Count
Student Profile
Student’s overall strengths:
Julia is a very happy seven-year-old girl who enjoys art and music. She has strong receptive language skills and can expressively
speak in words or short phrases. She loves to play with her bunny Fluffster and is excited to learn. Her favorite times at school are art
class and calendar time. She especially loves the songs for the days of the week, months of the year, and weather. When focused,
Julia can rote count to fifty and can count to one hundred using manipulatives and can add up to twenty using objects. At the
independent book center, Julia can choose a book and look at the pictures page by page and can independently read Level AA books.
Julia does very well with basic sorting activities, repeating simple patterns, and representing small groups of numbers using counters.
Julia can write her numbers 0-20 and all the letters of the uppercase alphabet independently. Julia is a phenomenal painter
and has extraordinary fine motor skills for her age.
Summarize assessment information (e.g. from early intervention providers, child outcome measures, curriculum
based measures, state and district assessment results, etc.) and review progress on current IEP/IFSP goals:
Julia is currently receiving reading instruction through the Reading Mastery program which helps her build a foundation of sounding
out words and building her current reading ability. Julia has a good understanding of what reading is and can engage in reading
leveled appropriate alone. At the independent book center, Julia can choose a book and look at the pictures page by page. Julia
knows roughly 20 sight words. While she can read them and identify them from a field size of three, Julia continues to have
the most trouble with writing these words from memory during her monthly spelling tests. Julia continues to read at an independent
reading level of “AA” which is a beginning-of-year Kindergarten level. These books often have one to two words which a matching
illustration to one of these words. When shown these words without pictures, Julia is unable to identify them. Julia knows her
uppercase and lowercase alphabet and knows their sounds.
She can sound out letters individually but struggles to blend the sounds together. She can write her uppercase alphabet independently
and can write her lowercase alphabet when shown a model. Julia is receiving math instruction through the Number Worlds
program which helps her build number awareness and math fluency. She is currently on Level A, which is a Kindergarten
level. She can write her numbers 1 - 20 independently and numbers 1 - 100 when shown a model. Julia can rote count to 15 and can
count with one-to-one correspondence and manipulatives to 30. She can add two addends without manipulatives up to 10 but
struggles with adding to sums 10 and over. She can add with manipulatives up to 15. She can subtract using manipulatives with
numbers 9 and below.
Parent’s concerns, if any, for enhancing the student’s education:

No concerns at this time.
Parent’s / Student’s vision for student’s future:

Page: 1
Parent hopes Julia will be able to move into a resource setting sometime in the future.
Page: 2
Consideration of Transitions
I a transition (e.g. new school, family circumstances, etc.) is anticipated during the life of this IEP/IFSP what
information is known about the student that will assist in facilitating a smooth process?
None at this time.
The student is age 14 or older or will be during the duration of the IEP. N/A
Page: 3

Consideration of Special Factors (Note: If you check yes, you must address in the IEP.)
Does the student have behavior(s) that impede his/her learning or that of others? Yes.
Does the student have Limited English Proficiency? No.
If the student is blind or partially sighted, will the instruction in or use of Braille be needed? No.
Does the student have any special communication needs? Yes.

The student receives speech/language therapy.
Is the student deaf or hard of hearing? No.
Does the student require specially designed physical education? No.
Page: 4
SECONDARY TRANSITION COMPONENT

Has the student been informed of his/her own rights, if age 17 and older? N/A
Section C - PostSecondary Goals (Beginning at age 16 and updated annually)

Indicate the student’s measurable postsecondary goals in each of the following areas on an annual basis:
Independent Living (if appropriate):
Page: 5
SECONDARY TRANSITION COMPONENT

Section D - Transition Services (By age 16 and updated annually)

Responsible Anticipated
Person and/or Completion
Transition Areas Transition Activities Agency Date
Daily Living Skills (if
N/A appropriate)
Functional Vocational
N/A Evaluation (if appropriate)
Page: 6

Present Level of Academic Achievement and Functional Performance

Include specific descriptions of what the student can and cannot do in relationship with the area. Include current academic
and functional performance, behaviors, social/emotional development, other relevant information, and how the student’s
disability affects his/her involvement and progress in the general curriculum.
Reading: Julia is currently receiving reading instruction through the Reading Mastery program which helps her build a foundation
of sounding out words and building her current reading ability. Julia has a good understanding of what reading is and can engage in
reading leveled appropriate alone. At the independent book center, Julia can choose a book and look at the pictures page by page.
Julia knows roughly 20 sight words. While she can read them and identify them from
a field size of three, Julia continues to have the most trouble with writing these words from memory during her monthly
spelling tests. Julia continues to read at an independent reading level of “AA” which is a beginning-of-year Kindergarten level.
These books often have one to two words which a matching illustration to one of these words. When shown these words without
pictures, Julia is unable to identify them. Julia knows her uppercase and lowercase alphabet and knows their sounds. She can sound
out letters individually but struggles to blend the sounds together.
Annual Goal Academic Goal, Functional Goal
Goal Description
Julia will correctly sound out 10 CCVC in a sentence with 80% accuracy across 5 consecutive trials.
Does the student require assistive technology devices or services? No.
If yes, describe needs:
(Address after determination of related services.) Is this goal integrated with related service(s)? No.
*If yes, list the related service area(s) of integration:
Competency Goal
Required areas (if any) where student participates in state asssessments using modified achievement standards.
Select Subject Area: Language Arts
List Competency Goal from NC Standard Course of Study:
(Standard must match the student’s assigned grade.)
03-RL2 - Recount stories, including fables, folktales, and myths from diverse cultures; determine the central message, lesson, or moral
and explain how it is conveyed through key details in the text.
Page: 7

Note: selected Grade Standard Competency Goal listed are those identified for specially designed instruction. In addition
to those listed, the student has access to grade level content standards through general education requirements.
Benchmarks or Short Term Objectives (if applicable)

(Required for students participating in the state alternate assessments aligned to alternate achievement standards) Julia will
correctly blend 5 consonant digraphs with 80% accuracy across 5 consecutive trials.
Julia will correctly identify 5 CCVC words from a field size of 3 with 80% accuracy across 5 consecutive trials.
Julia will correctly sound out 10 CCVC words with 80% accuracy across 3 trials.
Describe how progress toward the annual goal will be measured

Progress reports, teacher notes, weekly progress monitoring quizzes
Page: 8


Writing: Julia can write independently 6 of the 20 sight words she knows fluently. She struggles with writing sight words
on her weekly spelling tests. She can write her uppercase alphabet independently and can write her lowercase alphabet when shown a
model. Julia currently uses a fisted grip to write and is receiving occupational therapy to improve her grip
and writing ability.
Goal Description
Julia will write 10 sight words independently with 80% accuracy over 5 consecutive trials.
(Address after determination of related services.) Is this goal integrated with related service(s)? Yes.
*If yes, list the related service area(s) of integration: Occupational Therapy.
Competency Goal
01 - W4 - With guidance and support from adults, produce writing in which the development and organization are appropriate
to task and purpose.
Page: 9


write the lowercase alphabet independently with 80% accuracy across 5 consecutive trials.
Julia will write using a tripod grip with a prompt with 60% accuracy across 5 consecutive trials.

Teacher’s notes, progress reports, weekly progress monitoring quizzes
Page: 10


Math: Julia is receiving math instruction through the Number Worlds program which helps her build number awareness and math
fluency. She is currently on Level A, which is a Kindergarten level. She can write her numbers 1 - 20 independently and
numbers 1 - 100 when shown a model. Julia can rote count to 15 and can count with one-to-one correspondence and manipulatives to
30. She can add two addends without manipulatives up to 10 but struggles with adding to sums 10 and over. She can add with
manipulatives up to 15. She can subtract using manipulatives with
numbers 9 and below.
Goal Description
Julia will add two addends without manipulatives up to a sum of 20 with 80% accuracy across 5 consecutive trials.
(Address after determination of related services.) Is this goal integrated with related service(s)? No.
*If yes, list the related service area(s) of integration:
Competency Goal
Select Subject Area: Math
01-NBT2 - Fluenctly add and subtract within 1000 using strategies and algorithms based on place value, properties of operations,
and/or the relationship between addition and subtraction.
Page: 11


rote count up to 30 with 80% accuracy across 5 consecutive trials.
Julia will add two addends with manipulatives up to 30 with 80% accuracy across 5 consecutive trials. Julia will
add two addends without manipulatives up to 15 with 80% accuracy across 5 trials.

Teacher’s notes, progress reports, weekly progress monitoring quizzes.
Page: 12


Julia’s voice and articulation appear to be age appropriate. Julia presents with receptive and expressive
language delays secondary to Autism. Julia is able to express her basic wants and needs. She speaks in complete sentences when
prompted and focused, although she routinely speaks in sentence fragments and echolalia. Lack of focus and self talk affects her
progress. She is at times able to problem solve and follow 3 step directions but her progress remains inconsistent. Julia needs
continued speech and language intervention to aide in development of basic language skills.
Goal Description
During a variety of language activities , Julia will answer questions in complete sentences with 80% accuracy. Given a
problem/situation, Julia will choose the correct solution with 80% accuracy.
Julia will follow 2 -3 step directions with 100% accuracy 4 out of 5 times per session.
Does the student require assistive technology devices or services? No
*If yes, list the related service area(s) of integration: Speech and Language Therapy
Competency Goal
01-L1 - Demonstrate command of the conventions of standard English grammar and usage when writing or speaking.
Page: 13


(Required for students participating in the state alternate assessments aligned to alternate achievement standards) During a variety
of language activities, Julia will answer questions in complete sentences with 80% accuracy.
Given a problem/situation, Julia will choose the correct solution with 80% accuracy.
Julia will follow 2 -3 step directions with 100% accuracy 4 out of 5 times per session.

Student demonstration of task
SLP data probes
Page: 14


In occupational Therapy, Julia has made great gains. She now demonstrates increased attention to therapist
directed activities, up to 15 minutes, with minimal verbal cues. She enjoys sensory input and movement activities, which assist
students to attend and retain what they have learned. Sensory input also assists with self regulation. This is another area of tremendous
gain. She has met both her cutting skills goal of cutting in a straight line and curved line with less than 3 line errors. She has also met
his self regulation goal of attending and participating during circle for 5 minutes with less than 3 verbal prompts. She follows both
teacher and therapist directions with minimal verbal cues. Julia does still tend to wonder on playground preferring to pull leaves off
plants, than engaging with peers, or using playground equipment. She enjoys art projects, and coloring with increased attention to
lines. Julia continues to work on using a functional grasp with a writing tool consistently. Shorter utensils for coloring and writing are
recommended. She can write his pre-writing strokes accurately. She demonstrates difficulty with distal control while writing,
and a slant board is recommended as well
as vertical writing, such as on an easel. This will promote forearm on the writing surface and increase control. Julia follows
classroom routines and is independent with self care tasks required in the classroom setting.
Occupational therapy services continue to be recommended to address fine motor skills, sensory processing skills
needed for self regulation, visual motor, and attention skills in order to provide greater independence in his educational
setting.
Goal Description
1. Julia will demonstrate increased fine motor, and visual motor skills by writing letters of alphabet legibly and
awareness to lines, sizing, spacing, and correct formation 80% of the time.
2. Julia will cut simple shapes (square, triangle, and circle), with less than 3 line deviations in 4/5 opportunities.
3. Julia will demonstrate increased self regulation skills by attending to non-preferred tasks for 15 minutes with 2 re-
directions or less.
Does the student require assistive technology devices or services? No
*If yes, list the related service area(s) of integration: 2 and 5
Describe how progress toward the annual goal wi
Page: 15
OT/PT/SLP RELATED SERVICES SUPPORT DESCRIPTION

Service (Check all that apply): OT
Description of Student needs (Explanation of why support is needed):

Julia needs support in the education setting in the area of sensory processing due to her diagnosis of Autism
and her sensory seeking behaviors. She has demonstrated the ability to participate in the input tasks and other fine
motor and functional tasks to be successful in slow progress in her current IEP goals in regards to motor. Ashton is demonstrating
the ability to follow most classroom routines with minimal verbal cueing such as pushing in her chair at the table, carrying her cup
to and from the cafeteria, picking up items she drops, and following the directive to come to an adult. Teacher reports she wanders
within the classroom but rarely elopes to the adjacent classroom (classrooms are ajoined by an enclosed restroom and hallway) that
her class uses for sensory motor activities. She still requires close supervision at all times due to wandering in the classroom and
with past attempts to elope from the classroom.
Related service provider support:

Instruction for delegated activities, use of equiptment
Observation of student in classroom settings Collaborate
with other service delivery providers
Equiptment Needed: (P= personal; C= classroom)

C Sensory Processing Tools: soft mat to rest in a space in the classroom with minimal noise and distractions C Other:
Frequent movement breaks and multi-sensory activiites to particpate in with teaching staff
Additional Comment(s) or Explanation(s):

OT will provide support services to Julia and her teaching staff once a month or more frequently as requested by her teaching
staff.
Therapist Signature Date

Guy Smiley, OTR/L 01/01/2019
Page: 16

Least Restrictive Environment
I. General Education Program Participation

In the space provided, list the general education classes, nonacademic services and activities (ex: lunch, recess, assemblies,
media center, field trips, etc.) in which the student will participate and the supplemental aids, supports,
modifications, and/or accommodations required (if applicable) to access the general curriculum and make progress
towards meeting annual goals. Discussion and documentation must include any test accommodations required for state
and/or district-wide assessment. If supplemental aids/services, modifications/ accommodations and/or assistive
technology will be provided in special education classes include in the table below.
General Education Class, Supplemental Aids/Services, Implementation Specifications

Nonacademic Services & Activities, Modifications/Accomodations, (Example: Who? What? When?
Special Education (if applicable) Assistive Technology (if applicable) Where?)
Assemblies Julia will receive modified seating to These activities will involve the E.C.
provide her access to the assembly as well teacher and related service providers were
as easy access to an exit should she applicable to provide small group setting,
become overstimulated. preferential seating, modeling, use of
manipulatives and integration of
technology during instructional and
independent time in the E.C. classroom
with intensive supports.
Language Arts Julia will receive modified These activities will involve the E.C.
assignments based on task analysis teacher and related service providers were
to provide her access to the applicable to provide small group setting,
Extended Content Standards preferential seating, modeling, use of
Curriculum. manipulatives and integration of
Library Julia will receive modified These activities will involve the E.C.
Page: 17

General Education Class, Supplemental Aids/Services, Implementation Specifications

Nonacademic Services & Activities, Modifications/Accomodations, (Example: Who? What? When?
Special Education (if applicable) Assistive Technology (if applicable) Where?)
Math Julia will receive modified assignments These activities will involve the E.C.
based on task analysis to provide teacher and related service providers were
him access to the Extended Content applicable to provide small group setting,
Standards Curriculum. preferential seating, modeling, use of
manipulatives and integration of
Science Julia will receive modified These activities will involve the E.C.
Social Studies Julia will receive modified These activities will involve the E.C.
If the student is in preschool, describe how the student is involved in the general education program.
N/A
Specify the technical assistance, if any that will be provided to the general education teacher(s) and/or
other school personnel for implementation of the IEP.
None
Page: 18

II. Sesame Street Assessment Program

Select the appropriate state assessment(s) that will allow the student to demonstrate his/her knowledge. Select testing accomodations
that correlate to classroom accomodations used routinely throughout the academic year. Accomodations that are listed on the IEP
must be used on a routine basis in classroom instruction. For specifiics regarding acomodations use or availability for
specific tests, refer to the testing STudents with Disabilities publication.
IEP Teams are instructed to select for each assessment, only those accomodations that do not invalidate the score.
Student will participate in the testing program under Standard Conditions, with Accomodations, or will be
assessed using Alternative Assessment. Indicate the student’s testing participation below.
Specifications Regarding
Grade Range Test Participation Accomodation Use
Grade PK-8 SSExtend1 - English Testing in a Separate Room Julia will be assessed in a
Language Arts One-on-One one-on-one setting during
Extend I testing.
Grade PK-8 SSExtend1 - Math Testing in a Separate Room - Julia will be assessed in a one-
One-on-One on-one during Extend 1
Testing
Accomodations: * Test Environment + Assistive Technologies/Devices and Special Arrangements **Test Environment
III. District-Wide Assessment Program

In the space provided, list the district-wide assessments, if any, and any accomodations or alternative assessments to be used by the
student.
District-Wide Assessment(s)
Brigance Inventories
Number Worlds
Accomodation(s) or Alternate Assessment(s)

Close Supervision, Small Group Instruction
Implementation Specifications
EC Teacher, EC Classroom, Extended Content Standards
Page: 19

IV. Alternate Assessment Justification
If the student is participating in any alternate assessment(s), explain why the regular testing program with or
without accomodations, is not appropriate and why the selected assessment is appropriate:
Julia is currently functioning on a pre-k, pre-primer level in his behavioral, functional and academic skills and
communicates nonverbally. Julia will participating in Reading and Math Extend I alternative assessments during the 2020 -
2021 academic year. Her cognitive ability is below average as indicated by her evaluation data noted on the summary page
of the DEC 3, her adaptive scores fall within the below average range based on evaluation data as well. The regular testing
program with or without accommodations is not appropriate for Julia, because her evaluation data and review of
existing data reflect that she has a significant congitive
disability, and requires Extended Content Standard curriculum to address her functional, behavior and academic deficits.
V. Specially Designed Instruction, Related Services, and Nonacademic Services and Activities
A. Anticipated Frequency and Location of Specially Designed Instruction
Special Education Sessions Per Sessions Length Location
Daily Living Skills 5/Week 100 minutes Exceptional Children’s Classroom

Semester 1
Semester 2
Math 5/Week 100 Minutes Exceptional Children’s Classroom

Semester 1
Semester 2
Reading 5/Week 100 Minutes Exceptional Children’s Classroom

Semester 1
Semester 2
Writing 5/Week 100 Minutes Exceptional Children’s Classroom

Semester 1
Semester 2
Comments
N/A
Page: 20

C. Nonacademic Services & Activities (Refer to Section I: General Education Program Participation):
List the nonacademic services and activities in which the student will not participate with nondisabled peers. This time must
be factored into the determination of continuum of alternative educational placement below.
Nonacademic Services & Activities Sessions Per Sessions Length
Electives 5/Week Semester 45 Minutes

1
Semester 2
Lunch 5/Week 30 Minutes
Recess 5/Week 30 Minutes
VI. Continuum of Alternative Educational Placements
Indicate all educational placements considered by the IEP Team:

School Age (K-21): Separate <39% of the day w/ non-disabled peers
Indicate educational placement by checking only one box below:

(Educational placement is determined by calculating the amount of time the student is with nondisabled peers.)
School Age (K-21): Separate <39% of the day with non-disabled peers
VII. Least Restrictive Environment Justification Statement

If the student will be removed from nondisabled peers for any part of the day (general education classroom, nonacademic services
and activities), explain why the services cannot be delivered with nondisabled peers with the use of supplemental aids and services.
Julia requires specialized instruction through a separate setting due to the severity of her behaviors and to address
delays in cognitive, social/emotional, sensory integration, communication skills and behavioral concerns which have
impacted her ability to understand grade level content in all academic areas.
VIII. Progress towards annual goals will be reported with the issuance of report cards unless otherwise
specified below.
Reported with the issuance of report cards.
IX. Extended School Year Status (ESY worksheet available)

Is not eligible for extended school year
Page: 21

IX. Amending the IEP
The IEP was amended due to disciplinary change in placement. N/A
A. IEP Addendum Team
The following were present and participated in the development and writing of the addendum to the
IEP. Name Position Date
Page: 22

Copy given/sent to parent(s) by: Abby Cadabby on: 12/19/2018
*Given
Page: 23

Purpose: Annual Review IEP
X. Record of IEP Team Participation
(Note with a * any team member who used alternative means to participate.)
A. IEP Team. The following were present and participated in the development and writing of the IEP.
Name Position Date

1. Big Bird LEA Representative 12/19/2018
2. Kermit Frog Regular Education Teacher 12/19/2018
3. Abby Cadabby Special Education Teacher 12/19/2018
4. Cookie Monster Speech/Language Pathologist 12/19/2018
5. Guy Smiley Occupational Therapist 12/19/2018
6. Elmo Red Other - Program Specialist 12/19/2018
7. Bert Ernie Parent 12/19/2018
Page: 24

Comments: N/A
Page: 25

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IEP/DEC4 Purpose: Annual Review IEP

Form Status: Closed/Verified

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student: Julia Anne Smith DOB: 01/01/2013 UID: 123456789JAS

Primary Area of Eligibility*: Autism

Parent’s concerns, if any, for enhancing the student’s education:

Parent’s / Student’s vision for student’s future:

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student: Julia Anne Smith DOB: 01/01/2013 UID: 123456789JAS

Does the student have Limited English Proficiency? No.

Does the student have any special communication needs? Yes.

Is the student deaf or hard of hearing? No.

Does the student require specially designed physical education? No.

SECONDARY TRANSITION COMPONENT

Student: Julia Anne Smith DOB: 01/01/2013 UID: 123456789JAS

Section C - PostSecondary Goals (Beginning at age 16 and updated annually)

SECONDARY TRANSITION COMPONENT

Student: Julia Anne Smith DOB: 01/01/2013 UID: 123456789JAS

Section D - Transition Services (By age 16 and updated annually)

Daily Living Skills (if

N/A Evaluation (if appropriate)

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student: Julia Anne Smith DOB: 01/01/2013 UID: 123456789JAS

Present Level of Academic Achievement and Functional Performance

Annual Goal Academic Goal, Functional Goal

Does the student require assistive technology devices or services? No.

If yes, describe needs:

*If yes, list the related service area(s) of integration:

Select Subject Area: Language Arts

List Competency Goal from NC Standard Course of Study:

(Standard must match the student’s assigned grade.)

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student: Julia Anne Smith DOB: 01/01/2013 UID: 123456789JAS

Benchmarks or Short Term Objectives (if applicable)

Describe how progress toward the annual goal will be measured

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student: Julia Anne Smith DOB: 01/01/2013 UID: 123456789JAS

Present Level of Academic Achievement and Functional Performance

Annual Goal Academic Goal, Functional Goal

Does the student require assistive technology devices or services? No.

If yes, describe needs:

Select Subject Area: Language Arts

List Competency Goal from NC Standard Course of Study:

(Standard must match the student’s assigned grade.)

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student: Julia Anne Smith DOB: 01/01/2013 UID: 123456789JAS

Benchmarks or Short Term Objectives (if applicable)

Describe how progress toward the annual goal will be measured

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student: Julia Anne Smith DOB: 01/01/2013 UID: 123456789JAS

Present Level of Academic Achievement and Functional Performance

Annual Goal Academic Goal, Functional Goal

Does the student require assistive technology devices or services? No.

If yes, describe needs:

*If yes, list the related service area(s) of integration:

Select Subject Area: Math

List Competency Goal from NC Standard Course of Study:

(Standard must match the student’s assigned grade.)

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student: Julia Anne Smith DOB: 01/01/2013 UID: 123456789JAS

Benchmarks or Short Term Objectives (if applicable)

rote count up to 30 with 80% accuracy across 5 consecutive trials.

Describe how progress toward the annual goal will be measured

INDIVIDUALIZED EDUCATION PROGRAM (IEP)