Republic of the Philippines

Department of Education
REGION X
DIVISION OF CAGAYAN DE ORO CITY
EAST I DISTRICT
EAST CITY CENTRAL SCHOOL
School ID: 127942

SPECIAL EDUCATION CLASS

INDIVIDUALIZED EDUCATIONAL PROGRAM

I. STUDENT INFORMATION
Name: Emma Date of Birth: Gender:
LRN: Primary Disability: Autism Other Disabling Conditions:
Grade for this IEP: NG SPED Teacher: Regular Education Teacher:
Date of IEP Meeting: School Year: Type of IEP: Annual
Percentage of time student spends in regular education classroom: 40-79%  0-39%
II. PARENT/ GUARDIAN INFORMATION
Parent/ Guardian’s Name: AINE CLEMEN Address:
Mobile: 0955-558-6680 Language(s): CEBUANO
III. TRANSITION

IV. ACADEMIC AND FUNCTIONAL STRENGTHS AND NEEDS

V. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

ACADEMIC ACHIEVEMENT
Area of Assessment Date Method of Assessment Findings

FUNCTIONAL PERFORMANCE

VI. IEP GOALS AND OBJECTIVES

Goal 1:
Objective:
Criteria for Mastery: Evaluation Method:
Goal 2:
Objective:
Criteria for Mastery: Evaluation Method: Teacher Observation
VII. RELATED SERVICES
Are related services required for this student to benefit from special education?  Yes No
Area of Service Related Service Location Frequency
Behavioral Therapy Behavior Intervention 3 times a week
VIII. CONSIDERATION OF SPECIAL FACTORS
Special Factors Yes, concern addressed No, not a concern
Assistive Technology Services/ Devices
Behavior
Braille (Blind/ Visually Impaired Only)
Communication Needs
Evaluation
Progress Report every quarter
IX. IEP TEAM MEMBERS
Name Position Signature
 PARENT STATEMENT
I have read or have had explained to me the contents of this IEP. I understand that the IEP will be implemented as soon as it takes
effect and that I will receive a copy of this document.
Name of Parent: Signature: Date: