Iep in The Philippines

STUDENT NAME:
Jane Doe DISABILITY

DATE OF BIRTH: 7/7/2000 CLASSIFICATION: Learning Disability
LOCAL ID #: 5555555
PROJECTED DATE IEP IS TO BE PROJECTED DATE OF ANNUAL
IMPLEMENTED:02/13/2015 REVIEW:05/19/2016
STUDENT NAME: Jane Doe NYC ID:5555555
PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS

DOCUMENTATION OF STUDENT'S CURRENT PERFORMANCE AND
ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS
EVALUATION RESULTS (INCLUDING FOR SCHOOL-AGE STUDENTS,
PERFORMANCE ON STATE AND DISTRICT-WIDE ASSESSMENTS)
ELA State Exam 2014
Present Level 2
Proficiency Rating- 2.90
Growth Rate- 77%
Scale Score 300
MATHEMATICS State Exam 2014

Present Level- 2
Proficiency Rating- 2.57
Growth Rate- 24%
Scale Score- 324
ACADEMIC ACHIEVEMENT, FUNCTIONAL PERFORMANCE AND LEARNING
CHARACTERISTICS
LEVELS OF KNOWLEDGE AND DEVELOPMENT IN SUBJECT AND SKILL
AREAS INCLUDING ACTIVITIES OF DAILY LIVING, LEVEL OF INTELLECTUAL
FUNCTIONING, ADAPTIVE BEHAVIOR, EXPECTED RATE OF PROGRESS IN
ACQUIRING SKILLS AND INFORMATION, AND LEARNING STYLE:
In ELA, based on the Independent Reading Level Assessment Framework Jane
Doe is reading on a 3rd grade level. This demonstrates that Jane Doe has mastered
common core reading standards up to grade 3. She is currently struggling with skills
that incorporate acquiring and using grade level academic language and word
usage. When asked to use textual evidence to explain her ideas with a grade level
text, Jane Doe demonstrates challenges to achieve this task on her own and
requires supports in the form of scaffolded questions and graphic organizers. In
reading, Jane Doe demonstrates challenges with making inferences and drawing
conclusions. In the ICT ELA classroom, often Jane Doe demonstrates a lack of
focus. She is very easily distracted and requires frequent monitoring to complete
classroom tasks. Jane Doe is able to work in small groups, but often requires re-
direction to stay on task. When Jane Doe is focused she is able to form accurate
conclusions after reading texts on her independent reading level and can respond to
questions verbally and in written form. In writing Jane Doe struggles with structuring
essays and short responses. Currently Jane Doe has shown progress using the
R.A.C.E formula to respond to short assessment questions. Essay writing is still a
challenge. Jane Doe benefits from using graphic organizers that outline where to
place transition words, details and explanations within a paragraph. Jane Doe has
trouble completing and turning in H.W. assignments and benefits from the
reinforcement and monitoring of her school planner to stay organized and to build
responsibility appropriate for middle school.
MATHEMATICS
Jane Doe is a 6th grade student who does not particularly enjoy Mathematics. Jane
Doe has had difficulty grasping the grade level curriculum. Jane Doe has basic
addition and subtraction skills. However, when subtracting numbers with regrouping,
Jane Doe is more likely to make errors. Jane Doe still requires practice with her
multiplication and division skills. Jane Doe was given flash cards to practice her
multiplication and division skills. Therefore, Jane Doe was not able to master topics
such as finding the GCF and LCM. Jane Doe is constantly distracted in class. Jane
Doe had difficulty with fraction and decimal operations as well. Jane Doe was able
to multiply simple fractions, however, when she was instructed to convert mixed
numbers and improper fractions before multiplying, there were many errors. Jane
Doe was able to follow the steps for dividing fractions and again, with simple
fractions, she was able to display some success. Jane Doe is often distracted in
class. Due to the constant lack of focus, Jane Doe struggles with task completion.
Jane Doe is quite talkative in class and could show more progress if she would
prioritize and stay focused.
SCIENCE
Jane Doe shows willingness to learn new concepts. She comes to science class
prepared and ready to work. She greatly benefits from working one on one with a
teacher or in small groups with a teacher. It is helpful for Jane Doe when instructions
are broken down into clear and simple steps. Graphic organizers that chunk or
section pieces of information help Jane Doe to understand complex material.
Embedded questions in chunked reading material help Jane Doe to stay focused
when reading. Jane Doe follows teacher instructions and explanation. Jane Doe is
mostly well mannered and respectful; she remains on task with frequent teacher
check-ins to ensure focus and understanding. Jane Doe benefits from additional
time to complete her assignments. Jane Doe is able to comprehend scientific texts
while using vocabulary reference sources like a textbook. She also benefits from
diagrams and images that portray scientific ideas and concepts, as well as real
world- science curriculum examples.
STUDENT STRENGTHS, PREFERENCES, INTERESTS:
Jane Doe enjoys school, she expresses a desire to learn and likes learning. Her
favorite classes include, science, math, ELA and PE class. She feels like she enjoys
the social aspect of school, she has many friends in her class. Jane Doe's extra
curricular activities include dance and cheerleading. Jane Doe also enjoys spending
time with her family and is looking forwards to this summer vacation as her family
has planned trips. Jane Doe plays in the school orchestra and enjoys learning the
viola.
ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS OF THE STUDENT,
INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN
TO THE PARENT:
Mom is trying to make an appointment with a psychologist but is having difficulty
finding someone. Mom needs a referral for an independent psychologist.
2013, Jane Doe saw a psychologist who recommender her to not be on medication
ADHD, mom feels like Jane Doe would benefit from being on medication now.
Did she receive a promotion in doubt for this year?
Jane Doe would greatly benefit from a tutor outside of school. She requires some
one-to-one instruction.
Mom feels that Jane Doe is struggling at in the ICT classes with SETSS services. At
home, Jane Doe becomes distracted when attempting to do homework more so
then previous years. Mom would like Jane Doe to continue with ICT class and
SETSS services and add medication.
SOCIAL DEVELOPMENT
THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S RELATIONSHIPS
WITH PEERS AND ADULTS; FEELINGS ABOUT SELF; AND SOCIAL
ADJUSTMENT TO SCHOOL AND COMMUNITY ENVIRONMENTS:
Jane Doe gets along well her peers and the staff in the school.
STUDENT STRENGTHS:
Jane Doe is a very social young lady. Jane Doe participates in school events like the
school talent show, she performed a cheerleading routine with other girls in the
school. She also participates in school concerts.
SOCIAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING
CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE
PARENT:
Jane Doe is very socially. It is easy for her to make friends. Mom is concerned that
Jane Doe play fights with other students and can get carried away but mom speaks
to her about this frequently.
PHYSICAL DEVELOPMENT
THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S MOTOR AND
SENSORY DEVELOPMENT, HEALTH, VITALITY AND PHYSICAL SKILLS OR
LIMITATIONS WHICH PERTAIN TO THE LEARNING PROCESS:
Jane Doe has been diagnosed with Attention Deficit/ Hyperactivity Disorder (ADHD).
She does not currently take medication. Jane Doe is otherwise reported to be in
good health.
STUDENT STRENGTHS:
Jane Doe participates willingly in class and sports activities. She likes to dance and
participates in extracurricular activities.
PHYSICAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING
CONSIDERATION OF STUDENT NEEDS THAT ARE OF CONCERN TO THE
PARENT:
No concerns at this time.
MANAGEMENT NEEDS
THE NATURE (TYPE) AND DEGREE (EXTENT) TO WHICH ENVIRONMENTAL
AND HUMAN OR MATERIAL RESOURCES ARE NEEDED TO ADDRESS NEEDS
IDENTIFIED ABOVE:
During classroom lessons, Jane Doe requires:
-small group instructions
-repeated directions
-on-task focusing prompts
-repeated directions
-breaks
-visual aids
-scaffolding to write extended response questions
-extended time to complete questions
EFFECT OF STUDENT NEEDS ON INVOLVEMENT AND PROGRESS IN THE
GENERAL EDUCATION CURRICULUM OR, FOR A PRESCHOOL STUDENT,
EFFECT OF STUDENT NEEDS ON PARTICIPATION IN APPROPRIATE
ACTIVITES
Jane Doe continue to in a general education setting with the structure and support
provided in an ICT setting with where she can access more small group interaction
and individual support throughout the day.
STUDENT NEEDS RELATING TO SPECIAL FACTORS

BASED ON THE IDENTIFICATION OF THE STUDENT'S NEEDS, THE
COMMITTEE MUST CONSIDER WHETHER THE STUDENT NEEDS A
PARTICULAR DEVICE OR SERVICE TO ADDRESS THE SPECIAL FACTORS
AS INDICATED BELOW, AND IF SO, THE APPROPRIATE SECTION OF
THE IEP MUST IDENTIFY THE PARTICULAR DEVICE OR SERVICE(S)
NEEDED:
Does the student need strategies, including positive behavioral interventions,
supports and other strategies to address behaviors that impede the student's
learning or that of others? Yes No
Does the student need a behavioral intervention plan? No Yes
For a student with limited English proficiency, does she need a special education
service to address her language needs as they relate to the IEP? Yes
No Not Applicable
For a student who is blind or visually impaired, does she need instruction in Braille
and the use of Braille? Yes No Not Applicable
Does the student need a particular device or service to address her communication
STUDENT NEEDS RELATING TO SPECIAL FACTORS
BASED ON THE IDENTIFICATION OF THE STUDENT'S NEEDS, THE
COMMITTEE MUST CONSIDER WHETHER THE STUDENT NEEDS A
PARTICULAR DEVICE OR SERVICE TO ADDRESS THE SPECIAL FACTORS
AS INDICATED BELOW, AND IF SO, THE APPROPRIATE SECTION OF
THE IEP MUST IDENTIFY THE PARTICULAR DEVICE OR SERVICE(S)
NEEDED:
needs? Yes No

In the case of a student who is deaf or hard of hearing, does the student need a
particular device or service in consideration of the student's language and
communication needs, opportunities for direct communications with peers and
professional personnel in the student's language and communication mode,
academic level, and full range of needs, including opportunities for direct instruction
in the student's language and communication mode?
Yes No Not Applicable
Does the student need an assistive technology device and/or service? Yes
No
If yes, does the Committee recommend that the device(s) be used in the student's
home? Yes No
BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE

STUDENT IS AGE 15 (AND AT A YOUNGER AGE IF DETERMINED
APPROPRIATE)
MEASURABLE POSTSECONDARY GOALS
LONG-TERM GOALS FOR LIVING, WORKING AND LEARNING AS AN ADULT
EDUCATION/TRAINING:
EMPLOYMENT:
INDEPENDENT LIVING SKILLS (WHEN APPROPRIATE):
TRANSITION NEEDS
In consideration of present levels of performance, transition service needs of the
student that focus on the student's courses of study, taking into account the
student’s strengths, preferences and interests as they relate to transition from
school to post-school activities:

MEASURABLE ANNUAL GOALS
THE FOLLOWING GOALS ARE RECOMMENDED TO ENABLE THE STUDENT
TO BE INVOLVED IN AND PROGRESS IN THE GENERAL EDUCATION
CURRICULUM, ADDRESS OTHER EDUCATIONAL NEEDS THAT RESULT FROM
THE STUDENT'S DISABILITY, AND PREPARE THE STUDENT TO MEET
HIS/HER POSTSECONDARY GOALS.
ANNUAL GOALS CRITERIA
WHAT THE STUDENT MEASURE
WILL BE EXPECTED TO
TO ACHIEVE BY THE DETERMIN METHOD SCHEDULE
END OF THE YEAR IN E IF GOAL HOW PROGRESS WHEN
WHICH THE IEP IS IN HAS BEEN WILL BE PROGRESS WILL
EFFECT ACHIEVED MEASURED BE MEASURED
SCIENCE Teacher Made 1 time per quarter
Determine the central Materials
ideas or conclusions of a Verbal Explanation
text; provide an accurate 60% Accuracy Teacher/Provider
summary of the text Observations
distinct from prior
knowledge or opinions.
CRITERIA
ANNUAL GOALS MEASURE
WHAT THE STUDENT WILL TO METHOD SCHEDULE
BE EXPECTED TO DETERMIN HOW WHEN
ACHIEVE BY THE END OF E IF GOAL PROGRESS PROGRESS
THE YEAR IN WHICH THE HAS BEEN WILL BE WILL BE
IEP IS IN EFFECT ACHIEVED MEASURED MEASURED
SCIENCE Teacher Made 1 time per quarter
Determine the meaning of Materials
symbols, key terms, and other Teacher/Provide
domain-specific words and 60 % r Observations
phrases as they are used in a Accuracy Verbal
specific scientific or technical Explanation
context relevant to grades 6-8
texts and topics.
CRITERIA
BE EXPECTED TO ACHIEVE DETERMIN HOW WHEN
BY THE END OF THE YEAR E IF GOAL PROGRESS PROGRESS
IN WHICH THE IEP IS IN HAS BEEN WILL BE WILL BE
EFFECT ACHIEVED MEASURED MEASURED
Common Core ELA 75% Accuracy Teacher Made 1 time per quarter
Materials
Class Activities
In one year Jane Doe will be Teacher/Provide
able to determine the meaning r Observations
of words and phrases as they Performance
are used in a text, including Assessment
figurative, connotative, and Task
technical meanings. She will
demonstrate this skill by reading
a grade level text and
identifying a new or unfamiliar
word, she will then use context
clues or similar strategies to
determine the meaning.
CRITERIA
Common Core ELA Teacher Made 1 time per quarter
Materials
In one year with support as Class Activities
needed, Jane Doe will be able Teacher/Provide
7 out of 10
to ask and answer questions to r Observations
trials for 32
demonstrate understanding of Performance
weeks
a grade level text. She will Assessment
demonstrate this skill by Task
referring explicitly to the text as
the basis for the answers.
CRITERIA
ELA Common Core- Writing Teacher Made 1 time per quarter
Materials
In one year with with guidance Class Activities
and support, Jane Doe will be Teacher/Provide
able to develop and strengthen r Observations
her writing by planning, 3 out of 5 Performance
revising, editing, rewriting, or trials for 32 Assessment
trying a new approach. She will weeks Task
demonstrate this skill by
constructing an essay on a
grade level topic and
completing all 5 stages of the
writing process.
CRITERIA
MATHEMATICS Teacher Made 1 time per quarter
Within one academic school Materials
year, Jane Doe will be able to Teacher/Provide
develop an understanding of r Observations
fractions as numbers. Jane Class Activities
Doe will be able to represent Performance
60% Accuracy
fractions on a number line, Assessment
identify equivalent fractions and Task
compare fractions. Jane Doe
will also be able to demonstrate
the rules for multiplying and
dividing fractions.
CRITERIA
MATHEMATICS Teacher Made 1 time per quarter
year, Jane Doe will be able to Class Activities
increase her ability to select Teacher/Provide
and apply mathematical 60% Accuracy r Observations
operations in a variety of Performance
contexts to compute whole Assessment
numbers, fractions, decimals Task
and integers.
CRITERIA
MATHEMATICS 60% Accuracy Teacher Made 1 time per quarter
year, Jane Doe will increase Class Activities
her multiplication and division Teacher/Provide
skills. Jane Doe will be able to r Observations
apply her multiplication and Performance
division skills to perform grade Assessment
level tasks including finding the Task
GCF and LCM, order of
operations and operations with
fractions.
ANNUAL GOALS CRITERIA

WHAT THE STUDENT MEASURE
WILL BE EXPECTED TO METHOD
TO ACHIEVE BY THE DETERMIN HOW
END OF THE YEAR IN E IF GOAL PROGRESS SCHEDULE
WHICH THE IEP IS IN HAS BEEN WILL BE WHEN PROGRESS
EFFECT ACHIEVED MEASURED WILL BE MEASURED
Counseling: Check Lists 1 time per quarter
Within one year, Jane Verbal
Doe will improve her Explanation
communication skills as Performance
3 out of 4
demonstrated by Assessment
trials
expressing her thoughts Task
and feelings without the Teacher/Provide
use of foul and/or r Observations
abusive language.

STUDENT NAME: Jane Doe NYC ID: 555555
REPORTING PROGRESS TO PARENTS

Identify when periodic reports on the student's progress toward meeting the
annual goals will be provided to the student’s parents:
at the same time school report cards are issued
RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES
SPECIAL EDUCATION SERVICE FREQU DURA LOCATION PROJE

PROGRAM/SERVICES DELIVERY ENCY TION WHERE CTED
RECOMMEND HOW LENGT SERVICE BEGINN
ATIONS* OFTEN H OF WILL BE ING /
PROVID SESSI PROVIDED SERVIC
ED ON E
DATE(S
)
SPECIAL EDUCATION
PROGRAM:
Integrated Co-Teaching Language of 5 time(s) Period General 05/13/2
Services Service: Englis per Education 015
ELA h week Classroom
Math h week Classroom
Sciences h week Classroom
Special Education Direct Service 3 time(s) Period Special 05/13/2
Teacher Support Services Group service per Education 015
[SETSS] Language of week Classroom
Math Service: Englis
h
Special Education Direct Service 2 time(s) Period Special 05/21/2
Teacher Support Services Group service per Education 015
[SETSS] Language of week Classroom
ELA Service: Englis
h
RELATED SERVICES:
Counseling Services Group service 1 time(s) 30 min Separate 05/13/2
Language of per utes Location Co 015
Service: Englis week unselor's
h ofiice
SUPPLEMENTARY AIDS
AND
SERVICES/PROGRAM
MODIFICATIONS/ACCO
MMODATIONS:
ASSISTIVE
TECHNOLOGY DEVICES
AND/OR SERVICES:
SUPPORTS FOR
SCHOOL PERSONNEL
ON BEHALF OF THE
STUDENT:

* Identify, if applicable, class size (maximum student-to-staff ratio), language if
other than English, group or individual services, direct and/or indirect consultant
teacher services or other service delivery recommendations.
12-MONTH SERVICE AND/OR PROGRAM - Student is eligible to receive special

education services and/or program during July/August: No Yes
If yes:
* Student will receive the same special education program/services as
recommended above.
OR
Student will receive the following special education program/services:
PROJECT
ED
SPECIAL SERVICE BEGINNIN
EDUCATION DELIVERY G/
PROGRAM/SERVI RECOMMENDATI FREQUEN DURATI LOCATI SERVICE
CES ONS CY ON ON DATE(S)

Name of school/agency provider of services during July and August:
For a preschool student, reason(s) the child requires services during July and
August:

TESTING ACCOMMODATIONS (TO BE COMPLETED FOR PRESCHOOL

CHILDREN ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR
NONDISABLED PRESCHOOL CHILDREN): INDIVIDUAL TESTING
ACCOMMODATIONS, SPECIFIC TO THE STUDENT’S DISABILITY AND
NEEDS, TO BE USED CONSISTENTLY BY THE STUDENT IN THE
RECOMMENDED EDUCATIONAL PROGRAM AND IN THE ADMINISTRATION
OF DISTRICT-WIDE ASSESSMENTS OF STUDENT ACHIEVEMENT AND, IN
ACCORDANCE WITH DEPARTMENT POLICY, STATE ASSESSMENTS OF
STUDENT ACHIEVEMENT.
TESTING IMPLEMENTATION
CONDITIONS*
ACCOMMODATIONS RECOMMENDATIONS**
TESTING ACCOMMODATIONS (TO BE COMPLETED FOR PRESCHOOL
CHILDREN ONLY IF THERE IS AN ASSESSMENT PROGRAM FOR
NONDISABLED PRESCHOOL CHILDREN): INDIVIDUAL TESTING
ACCOMMODATIONS, SPECIFIC TO THE STUDENT’S DISABILITY AND
NEEDS, TO BE USED CONSISTENTLY BY THE STUDENT IN THE
RECOMMENDED EDUCATIONAL PROGRAM AND IN THE ADMINISTRATION
OF DISTRICT-WIDE ASSESSMENTS OF STUDENT ACHIEVEMENT AND, IN
ACCORDANCE WITH DEPARTMENT POLICY, STATE ASSESSMENTS OF
STUDENT ACHIEVEMENT.
NONE
Extended Time In all Exams including New Time extended by 50%
York State exams
Breaks In all Exams including New Breaks given as needed.
York State
Revised Test Format In all Exams including New Questions read and reread
York State with the aloud to student
exception of the ELA exam
where intended to assess
reading skills
Revised Test Directions In all Exams including New Questions read aloud to
York State student
Separate Location/Room In all Exams including New Jane Doe needs an area
York State with less distractions in
order to focus and access
her testing
accommodations
On-Task Focusing In all Exams including New On-Tasks focusing prompts
Prompts York State as needed.
*Conditions — Test Characteristics: Describe the type, length, purpose of the test
upon which the use of testing accommodations is conditioned, if applicable.
**Implementation Recommendations: Identify the amount of extended time, type of
setting, etc., specific to the testing accommodations, if applicable.

BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE
STUDENT IS AGE 15 (AND AT A YOUNGER AGE, IF DETERMINED
APPROPRIATE).
COORDINATED SET OF TRANSITION ACTIVITIES
NEEDED ACTIVITIES TO
FACILITATE THE
STUDENT’S MOVEMENT
FROM SCHOOL TO SCHOOL
POST-SCHOOL DISTRICT/AGENCY
ACTIVITIES SERVICE/ACTIVITY RESPONSIBLE
Instruction
Related Services
Community Experiences
Development of
Employment and Other
Post-school Adult Living
Objectives
Acquisition of Daily
Living Skills (if
applicable)
Functional Vocational
Assessment (if
applicable)
PARTICIPATE IN STATE AND DISTRICT-WIDE ASSESSMENTS

(TO BE COMPLETED FOR PRESCHOOL STUDENTS ONLY IF THERE IS AN
ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL STUDENTS)
The student will participate in the same State and district-wide

assessments of student achievement that are administered to general
education students.
The student will participate in an alternate assessment on a particular State
or district-wide assessment of student achievement.
PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES

REMOVAL FROM THE GENERAL EDUCATION ENVIRONMENT OCCURS ONLY
WHEN THE NATURE OR SEVERITY OF THE DISABILITY IS SUCH THAT, EVEN
WITH THE USE OF SUPPLEMENTARY AIDS AND SERVICES, EDUCATION
CANNOT BE SATISFACTORILY ACHIEVED.
FOR THE PRESCHOOL STUDENT:
PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES
Explain the extent, if any, to which the student will not participate in appropriate
activities with age-appropriate nondisabled peers (e.g., percent of the school
day and/or specify particular activities):
FOR THE SCHOOL-AGE STUDENT:

Explain the extent, if any, to which the student will not participate in regular
class, extracurricular and other nonacademic activities (e.g., percent of the
school day and/or specify particular activities):
If the student is not participating in a regular physical education program,

identify the extent to which the student will participate in specially-designed
instruction in physical education, including adapted physical education:
EXEMPTION FROM LANGUAGE OTHER THAN ENGLISH DIPLOMA

REQUIREMENT:
No Yes - The Committee has determined that the student's disability
adversely affects his/her ability to learn a language and recommends the
student be exempt from the language other than English requirement.
SPECIAL TRANSPORTATION
TRANSPORTATION RECOMMENDATION TO ADDRESS NEEDS OF THE
STUDENT RELATING TO HIS/HER DISABILITY
None.
Student needs special transportation accommodations/services as follows:
Student needs transportation to and from special classes or programs at another
site:
PLACEMENT RECOMMENDATION
NYC DOE Community School
SUMMARY
STUDENT INFORMATION
 Student Name: Jane Doe
 NYC ID: 555555
 DOB: 7/7/2000
 Gender: Female
 Parents Language(s) Spoken/Mode Communication: English
IEP INFORMATION
 Date of IEP Meeting: 05/21/2015
 IEP Amendment: Yes No
 Reconvene of IEP Meeting: Yes No
INSTRUCTIONAL/FUNCTIONAL LEVELS
 Reading:4th Grade
 Math:3rd Grade
SUMMARY OF RECOMMENDATIONS
Classification of Disability: Other Health Impairment
Recommended Services:
Special Education Programs
Special Education Teacher Support Services [SETSS]
Integrated Co-Teaching Services
Special Education Teacher Support Services [SETSS]
Related Services
Counseling Services
12-Month Services:
The student will participate in the same State and district-wide assessments of
student achievement that are administered to general education students.
Does Jane Doe have a Behavioral Intervention Plan? No

Recommended for Specialized Transportation: None Student needs
specialized transportation
School Type: NYC DOE Community School
Medical Alert: The student has medical conditions and/or physical
limitations which affect her learning, behavior and/or participation in
school activities.
The student requires medical and/or health care treatment(s) or
procedure(s) during the school day.
PROMOTION CRITERIA
CURRENT YEAR
Multiple Criteria and Modification of
Standard Modified Achievement of Performance
Standards
English Language Arts

Math The student Jane Doe must
("ELA") The student Jane Doe must
meet 50 % of the 6 grade Standards
must be mastered as evidenced by
student work, teacher observation,
assessments/grades, and attendance.
NEXT YEAR
PROMOTION CRITERIA
Multiple Criteria and Modification of
Standard Modified Achievement of Performance
Standards
English Language Arts

Math The student Jane Doe must
("ELA") The student Jane Doe must
Parent Concerns:
OTHER OPTIONS CONSIDERED
 Special Education Teacher Support Services
 Integrated Co-teaching
 Counseling Services
Reason(s) for Rejection: Jane Doe McCall's needs can be met with special
education teacher support services in the general education classroom.
ATTENDANCE PAGE
PLEASE NOTE THAT YOUR SIGNATURE REFLECTS YOUR PARTICIPATION AT
THE CONFERENCE AND DOES NOT NECESSARILY INDICATE AGREEMENT
WITH THE INDIVIDUALIZED EDUCATION PROGRAM.
ROLE (INDICATE IF
NAME SIGNATURE
BILINGUAL)

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STUDENT NAME:

Jane Doe DISABILITY

STUDENT NAME: Jane Doe NYC ID:5555555

PRESENT LEVELS OF PERFORMANCE AND INDIVIDUAL NEEDS

MATHEMATICS State Exam 2014

STUDENT NAME: Jane Doe NYC ID:555555

STUDENT NEEDS RELATING TO SPECIAL FACTORS

needs? Yes No

STUDENT NAME: Jane Doe NYC ID:555555

BEGINNING NOT LATER THAN THE FIRST IEP TO BE IN EFFECT WHEN THE

STUDENT NAME: Jane Doe NYC ID:555555

ANNUAL GOALS CRITERIA

REPORTING PROGRESS TO PARENTS

STUDENT NAME: Jane Doe NYC ID:555555

RECOMMENDED SPECIAL EDUCATION PROGRAMS AND SERVICES

SPECIAL EDUCATION SERVICE FREQU DURA LOCATION PROJE

STUDENT NAME: Jane Doe NYC ID:555555

12-MONTH SERVICE AND/OR PROGRAM - Student is eligible to receive special

STUDENT NAME: Jane Doe NYC ID:555555

TESTING ACCOMMODATIONS (TO BE COMPLETED FOR PRESCHOOL

STUDENT NAME: Jane Doe NYC ID:555555

STUDENT NAME: Jane Doe NYC ID:555555

PARTICIPATE IN STATE AND DISTRICT-WIDE ASSESSMENTS

The student will participate in the same State and district-wide

STUDENT NAME: Jane Doe NYC ID:555555

PARTICIPATION WITH STUDENTS WITHOUT DISABILITIES

FOR THE SCHOOL-AGE STUDENT:

If the student is not participating in a regular physical education program,

EXEMPTION FROM LANGUAGE OTHER THAN ENGLISH DIPLOMA

STUDENT NAME: Jane Doe NYC ID:555555

Does Jane Doe have a Behavioral Intervention Plan? No

English Language Arts

English Language Arts

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