Ages 6 20 individualized education program iep public

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Ages 6-20
INDIVIDUALIZED EDUCATION PROGRAM (IEP) Public Agency/School District: Forrest Child’s Name: Sam Samson Notification of Progress Provided to Parents/Guardians Type x Progress Notes Report Cards Goals Sheets Other: Frequency Every 4 ½ weeks Every 6 weeks xEvery 9 Weeks Other: *TA = Transition Activity Rev. 7/1/2014 Mississippi Department of Education–Office of Special Education Page of .
INDIVIDUALIZED EDUCATION PROGRAM (IEP) Public Agency/School District: Forrest Child’s Name: Sam Samson SPECIAL CONSIDERATIONS* Communication (Required) Does the child have special communication needs? Yes x No If yes, describe the specific needs and document the basis for the decision: Assistive Technology (Required) Does the child need assistive technology services or devices to maintain or improve functional capabilities? Yes No Does the child need assistive technology assessment? Yes x No If yes, describe the specific needs and document the basis for the decision: Service for Children who are Blind or Visually Impaired x N/A In the case of a child who is blind or visually impaired, provide for instruction in and the use of Braille unless the IEP Committee determines, after an evaluation of the child’s reading and writing media, Braille instruction is not appropriate. Instruction in Braille considered? Yes No Evaluation Date: Is instruction in Braille appropriate? Yes No Document the basis for the decision: Were the parents provided information about the Mississippi School for the Blind? Yes No Service for Children who are Deaf or Hearing Impaired N/A x N/A In the case of the child who is deaf or hearing impaired, consider language and communication needs, opportunities for direct communication needs, academic level, and full range of needs, including direct instruction in the child’s language and communication mode. Child’s language and communication mode: Is direct instruction in the child’s language and communication mode needed? Yes No Document the basis for the decision: Were the parents provided information regarding the Mississippi School for the Deaf? Yes No Behavior Intervention x N/A In the case of a child whose behavior impedes the child’s learning or the learning of other children, consideration is given to the use of positive behavior interventions, supports, and other strategies to address that behavior. Does the child have/need a functional behavioral assessment (FBA)? Yes No Assessment Date: Does the child have/need a behavior intervention plan (BIP)?** Yes No Implementation Date: Has the behavior intervention plan (BIP) been reviewed/revised? Yes No Review Date: Revision Date: Document the basis for the decision: **If a child has a BIP, s/he must have a corresponding annual goal(s) to address behavioral concerns. Services for Children with Limited English Proficiency x N/A Rev. 7/1/2014 Mississippi Department of Education–Office of Special Education Page of .
INDIVIDUALIZED EDUCATION PROGRAM (IEP) Public Agency/School District: Forrest Child’s Name: Sam Samson

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