IEP Forms

Sample Form
Use of this IEP form or any other form, will not in and of itself, ensure compliance with IDEAs. Whether or not a state or local education agency chooses to require or recommend that teams use this form for IEPs, all IEP team participants, including parents, need to receive clear guidance and training regarding requirements. There should be a transparent understanding of the importance of the IEP in focusing instruction to meet the unique needs of each child with a disability.

Individualized Education Program (IEP)

Student Name ___________________________

Date of Meeting to Develop or Review IEP _________________________

Transition service needs:

The statement must focus on the courses the student needs to take to reach his or her post-school goals. _________________________________________________________

Statement of Transition Service Needs (if student is 14 or under) _________________________________________________________ _________________________________________________________ _________________________________________________________

Statement of Present Levels of Educational Performance:The IEP for each child with a disability must include a statement of the child's present levels of educational performance, including:

· How the child's disability affects the child's involvement and progress in the general curriculum (i.e., the same curriculum as for nondisabled children)

· For preschool children, as appropriate, how the disability affects the child's participation in appropriate activities _________________________________________________________ _________________________________________________________ _________________________________________________________

Measurable Annual Goals (including Benchmarks or Short-Term Objectives):The IEP for each child with a disability must include a statement of measurable annual goals, including benchmarks or short-term objectives, related to:

· Meeting the child's needs that result from the child's disability, in order to enable the child to be involved in and progress in the general curriculum (i.e., the same curriculum utilized for nondisabled children)

· Enabling preschool children, as appropriate, to participate in appropriate activities

· Meeting each of the child's other educational needs that result from the child's disability _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________

Special Education and Related Services: _____________________________

Start Date__________________________

Location ___________________________

Frequency _________________________

Duration ___________________________

Supplementary Aids and Services ___________________________

Start Date ________________________

Location __________________________

Frequency ________________________

Duration __________________________

Program Modifications or Supports for School Personnel ____________________

Start Date ________________________

Location __________________________

Frequency ________________________

Duration __________________________

Statement of the Special Education and Related Services, Supplementary Aids and Services, Program Modifications, and Supports for School Personnel:The IEP for each child with a disability must include a statement of the special education, related services, supplementary aids, and services to be provided to the child, or on behalf of the child. A statement of the program modifications or supports for school personnel that will be provided for the child in order for him or her:· To advance appropriately toward attaining the annual goals · To be involved and progress in the general curriculum in accordance with 34 CFR §300.347(a)(1), and to participate in extracurricular and other nonacademic activities · To be educated and participate with other children with disabled and nondisabled children in the activities described in this section _________________________________________________________ _________________________________________________________ _________________________________________________________

Beginning Date, Frequency, Location, and Duration of Services and Modifications:The IEP for each child with a disability must include the projected date for the beginning of the services and modifications as described in 34 CFR §300.347(a) (3), and the anticipated frequency, location, and duration of those services and modifications. _________________________________________________________ _________________________________________________________ _________________________________________________________

Explanation of the extent, if any, to which the child will not participate with nondisabled children:The IEP for each child with a disability must include an explanation of the extent, if any, to which the child will not participate with nondisabled children in the regular class and in the activities described in 34 CFR §300.347(a)(3) _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________

Administration of State and District-Wide Assessments of Student Achievement:Statement of any Individual Modifications in Administration of State or District-wide Assessments The IEP for each child with a disability must include a statement of any individual modifications in the administration of State or District-Wide assessments of student achievement that are needed in order for the child to participate in the assessment. _________________________________________________________ _________________________________________________________ _________________________________________________________

If the IEP Team Determines That Child Will Not Participate in a Particular State or District-Wide Assessment If the IEP team determines that a child with a disability will not participate in a particular State or district-wide assessment of student achievement (or part of an assessment), the IEP must include a statement of why the assessment is inappropriate for the student and how the child will be subsequently assessed.· Why isn't the assessment appropriate for the child___________________________________________________·

How will the child be assessed? ___________________________________________________

The standard of measuring the Child's Progress toward Annual Goals: The IEP for each child with a disability must include a statement of how the child's progress toward the annual goals described in 34 CFR §300.347(a) (2) will be measured. ____________________________________________________________

How will the Child's Parents Will Be Regularly Informed Of Child's Progress Toward Annual Goals And Extent To Which Child's Progress Is Sufficient To Meet Goals By End of Year: The IEP for each child with a disability must include a statement of how the child's parents will be regularly informed (through such means as periodic report cards); at least as often as parents are informed of their nondisabled children's progress. The parents must be kept informed of:· Their child's progress toward the annual goals · The extent to which that progress is sufficient to enable the child to achieve the goals by the end of the year _________________________________________________________ _________________________________________________________ _________________________________________________________

Statement of Needed Transition Services: At the beginning of age 16, or younger if determined appropriate by the IEP team, the IEP must include for each student with a disability a statement of needed transition services for the student. This statement should include, if appropriate, a statement of the interagency responsibilities or any needed linkages. The definition of "Transition Services” is a coordinated set of activities for a student with a disability that: · Is designed within an outcome-oriented process that promotes movement from school to post-school activities, including post-secondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation, etc. · Is based on the individual student's needs, taking into account the student's preferences and interests · Includes instruction, related services, community experiences, development of employment and other post-school adult living objectives, and if appropriate the acquisition of daily living skills and functional vocational evaluation · Transition services for students with disabilities may include special education, uniquely designed instruction, or related services if deemed necessary to assist a student with a disability to benefit from special education _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________

Age of Majority:

For states that transfer rights at the age majority, at least one year before a student reaches the age of majority under State law, the student's IEP must include a statement that the student has been informed of his or her rights under Part B of the Act. If any rights will transfer to the student upon reaching the age of majority, consistent with 34 CFR §300, the student must be notified on year prior to this transfer.

___The student has been informed of the rights under Part B of IDEA, if any, that will transfer to the student on reaching the age of majority.

IEP Forms