• District County School Board
    Individual Educational Plan (IEP)

    Student Information
    Meeting Date: / /
    School:
    Student Name:
    Student Number:
    Date of Birth: / /
    Age:
    Address:
    Grade: --
    Parent/Guardian 1:
    IEP Initiation Date: / /
    Parent/Guardian2:
    IEP Duration Date: / /
    Primary Exceptionality: -select-
    IEP Review Date Due: / /
    Other Program and Service Areas:
    Reevaluation Date Due: / /
    Purpose of Meeting: (Check all that apply) Initial IEP Annual Review Interim IEP Eligibility Evaluation/Reevaluation Manifestation Determination FBA/PBIP
    Other: Identifying Transition Services Needs (Required at least annually beginning no later than first IEP to be in effect when the student turns 14) Part C to Part B Transition
    Special Considerations The following factors must be considered in the development of the IEP.
    YES
    NO
    N/A
    Does the student’s behavior impede his/her learning or that of others?
    If the student's behavior impedes his/her learning or the learning of others, does the student have a functional behavioral assessment (FBA) and/or positive behavior intervention plan (PBIP)?
    If the student does not have an FBA/PBIP, describe how positive behavioral interventions, supports, and/or other strategies will be used to address the behavior.
    Does the student have limited English proficiency?
    If Yes, describe how the student's needs as an English language learner will be addressed.
    Is the student blind or visually impaired?
    If the student is blind or visually impaired, is instruction in Braille or the use of Braille appropriate? (If No, describe the results of the reading and writing evaluation upon which that determination is based under "General Factors and Assessment Data" or "Present Levels, Goals, and Objectives".)
    Does the student have communication needs? (If Yes, describe them under "Present Levels, Goals, and Objectives" and include the ESE services and/or supports required to meet those needs under the applicable section(s) of the IEP.)
    Is the student deaf or hard-of-hearing?
    If the student is deaf or hard-of-hearing, what opportunities for direct communication with peers and professionals in the student's language does the Communication Plan indicate are needed?
    If the student is deaf or hard-of-hearing, what opportunities for direct instruction in the student's language does the Communication Plan indicate are needed?
    Does the student need assistive technology devices and services? (If Yes, address the need under "Present Levels, Goals, and Objectives" and the applicable service or support area.)
    Is the student able to participate in the regular PE program available to all students? (If No, address the need for specially designed PE under “Present Levels, Goals, and Objectives” and the applicable service or support area.)
    Note: If the student CAN participate in the regular PE program but requires accommodations or supplemental aids and services, respond “Yes” and identify the necessary supports under the applicable section(s) of the IEP.
    Does the student require instruction or the provision of information in the area of self-determination and self-advocacy to be able to actively participate in IEP meetings and self-advocate? If Yes, describe how this need will be addressed.
    Planning for High School Graduation
    Describe how the student is being prepared to graduate with a standard diploma and how the student and parents have been informed of the standard diploma options and designations that are available. (Required NO LATER than the first IEP to be in effect when the student turns 14.) N/A due to age of student
    What graduation option is the student pursuing? (Required NO LATER than the first IEP to be in effect when the student turns 14).