Navigating the landscape of special education can be a challenge for families and educators alike. At the heart of this process is the Individualized Education Program (IEP), a crucial document designed to ensure that students with disabilities receive tailored educational support. This foundational piece outlines a comprehensive plan that caters to the unique needs of a student, including academic and behavioral goals, and the services required to achieve these objectives. From detailing student demographics to setting forth a vision for the student's future, including employment, community participation, and post-secondary training, the IEP covers extensive ground. The form delves into the student's primary and secondary exceptionalities, pinpointing areas that need attention such as math, reading, written language, and behavior, among others. It also encompasses the student's strengths, concerns, and the collective vision of the parents, teachers, and the student for the future. Moreover, the IEP sets the stage for transition services that are critical as the student nears adulthood, outlining a course of study and addressing the transition to life after high school. Through this detailed plan, all stakeholders are offered a roadmap to support the student's educational journey and overall well-being.
| Question | Answer |
|---|---|
| Form Name | Iep Form |
| Form Length | 21 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 5 min 15 sec |
| Other names | iep pdffiller form, iep form picture, sample iep form filled out, how to fill in the iep form |
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
Student Name:_____________________________________________ Date:________________
Student #: |
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DOB: |
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Age: |
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Grade Level: |
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Gender: M F |
Ethnicity: |
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Parent(s)/Guardian(s): |
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Address: |
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Home Phone: |
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Work/Message Phone: |
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School: |
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School Phone: |
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School Address: |
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Most Recent Evaluation Report Date: Next Evaluation Report Date:
IEP Purpose:___________________________________ Next Annual IEP Date: _____________
Based on assessment and evaluation information:
The primary exceptionality is: |
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Identified areas of need: |
Math |
Reading |
Written Language |
Behavior |
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Other: |
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The secondary exceptionality is: |
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Identified areas of need: |
Math |
Reading |
Written Language |
Behavior |
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Other: |
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STUDENT PROFILE
What do the parent and student envision as the student’s future?
Employment:
Community Participation:
Recreation & Leisure:
Daily/Independent Living:
Student/Family Vision Statement: ________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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STUDENT PROFILE (continued)
Note: When completing this section the IEP team must consider and describe the following: the student’s strengths and concerns as identified by the parent, student, teachers, related service staff, and other team members; results from district and statewide assessments; results from initial and most recent
Domain |
Strengths |
Concerns / Recommendations |
Academic:
(input from the general and special education teachers)
Recreation & Leisure:
Community
Participation:
Home/
Independent Living:
Jobs and
Job Training:
Training or Learning:
Other Areas:
(health considerations, communications, motor, emotional or behavioral, assistive devices needs, attendance)
TRANSITION SERVICES
Course of Study (Required beginning by age 14, or sooner if appropriate)
School Year Year
Courses Selected for High School Program
Yr. 1
Yr. 2
Yr. 3
Yr. 4
Ages
The student’s planned program of study meets the requirements for
Standard Pathway Career Readiness Pathway Ability Pathway
For the Career Readiness Pathway:
Explain why the Standard Pathway was rejected:
Note: The team is responsible for documenting progress on all five Career Readiness Standards on the IEP goals/objectives pages.
For the Ability Pathway:
Explain why the Standard and Career Readiness Pathways were rejected:
For all Pathways:
Projected date of graduation:
Is the student on target with graduation requirements? YES NO
If NO, what are the concerns (credits, NMHSCE, attendance or behavior concerns) and how will they be addressed?
For a Certificate, the IEP Team must agree:
The student’s program and instruction have been appropriate
The student has maintained realistic efforts to meet IEP goals
The student has successfully completed four or more years of high school
The student can participate equitably in all graduation activities
The student has a
Projected date of graduation for the student:
TRANSITION SERVICES/INTERAGENCY LINKAGE
Needed to Accomplish Desired
Student Needs |
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Agency/ |
Provider/ |
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Activities/Strategies |
Responsibility |
Payer |
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Instruction: |
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Related Services: |
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Community |
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Experiences: |
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