(Duplicate as needed) - Summit County ESC.doc

INDIVIDUALIZED EDUCATION PROGRAM (IEP) Services PlanName Date of Birth Grade Level Male FemaleStudent Identification Number Child/Student Address Parent/Guardian Parent Address Home Phone Work Phone Effective IEP Dates from to Meeting Date Initial IEP Periodic ReviewDistrict of Residence District of Service Step 1 Discuss future planning. (Family and student preferences and interests) Step 2 Discuss present levels of academic and functional performance. (What do we know about this child, and how does that relate in the context of content standards, or for preschool children, in the context ofappropriate activities and how the disability affects the student’s involvement in the general education curriculum.) Step 2 (cont.) Discuss present levels of academic and functional performance. (What do we know about this child, and how does that relate in the context of content standards, or for preschool children, in the context ofappropriate activities and how the disability affects the student’s involvement in the general education curriculum.)Annual Goals and Short-Term ObjectivesStep 3: Identify needs that require specially designed instructionStep 4: Identify measurable annual goals, including academic and functional goalsGoal # Content area addressed: Benchmarks or short-term objectivesStatement of Student Progress Step 5: Identify servicesService: Initiation date: Expected duration: Frequency: (how often) Step 6: Determine least restrictive environmentDetermine where services will be providedAnnual Goals and Short-Term ObjectivesStep 3: Identify needs that require specially designed instructionStep 4: Identify measurable annual goals, including academic and functional goalsGoal # Content area addressed: Benchmarks or short-term objectivesStatement of Student ProgressStep 5: Identify servicesService: Initiation date: Expected duration: Frequency: (how often) Step 6: Determine least restrictive environmentDetermine where services will be providedAnnual Goals and Short-Term ObjectivesStep 3: Identify needs that require specially designed instructionStep 4: Identify measurable annual goals, including academic and functional goalsGoal # Content area addressed: Benchmarks or short-term objectivesStatement of Student Progress Step 5: Identify servicesService: Initiation date: Expected duration: Frequency: (how often) Step 6: Determine least restrictive environmentDetermine where services will be providedAnnual Goals and Short-Term ObjectivesStep 3: Identify needs that require specially designed instructionStep 4: Identify measurable annual goals, including academic and functional goalsGoal # Content area addressed: Benchmarks or short-term objectivesStatement of Student Progress Step 5: Identify servicesService: Initiation date: Expected duration: Frequency: (how often) Step 6: Determine least restrictive environmentDetermine where services will be providedSpecial FactorsBased on discussions of the information provided regarding relevant special factors and other considerations as noted below, the following is applicable and incorporated into the IEP. Incorporated into IEP(Check box)Behavior: In the case of a student whose behavior impedes his or her learning or that of others. Limited English proficiency (LEP)Children/students with visual impairments (See IEP page )Communication Deaf or hard of hearing Assistive technology services and devices Other ConsiderationsPhysical education Extended school year services Beginning at age 14…transition service needs which focus on the student's courses of study [See IEP page ]Transition services statement, no later than age 16 [See IEP page ] Testing and assessment programs, including proficiency tests [See IEP page )Transfer of rights beginning at least one year before the student reaches the age of majority under state law (Ohio law is age 18)Relevant Information/Suggestions (e.g., medical information, other information):Children/Students with Visual ImpairmentsCHILD/STUDENT GRADE。