General Directions to Use the State’s Mandatory Individualized Education Program (IEP) Form

The State’s mandatory IEP Form is provided as a Word document (version 2003) which includes form fields to enter or select typed information.  

The form is ‘lock protected’ in order for the form fields to function properly.  The form should be used when it is in ‘lock’ mode.  Unlocking the form during use may result in a modification to the form itself.  It is recommended that each district password protect the form to prevent inadvertent form modifications.  To do so, go to ‘Tools’, ‘Options’ and click on ‘Security’ and follow the directions. 

The State’s IEP form may be used in its current Word format, or may be converted to another format, including a computerized format.  However, for all IEPs developed for the 2011-12 school year and thereafter, the State’s IEP form may not be modified to otherwise change its appearance or content, except as specifically noted below. 

• Rows may be added or deleted within sections of the IEP as necessary.
• Districts must select the appropriate Measurable Annual Goal section of the IEP.
  • For students needing annual goals only, select the section that does not include short-term instructional objectives and/or benchmarks.
  • For students needing short-term instructional objectives and/or benchmarks with the annual goals, select the section of the IEP entitled ‘Alternate Section for Students Whose IEPs will Include Short-term Instructional Objectives and/or Benchmarks’

• For students for whom post-school transition planning is not required (such as preschool and elementary age students), the sections on ‘Measurable Postsecondary Goals’ and ‘Coordinated Set of Transition Activities’ may be deleted.
• The footer "New York State Education Department IEP form" may be removed. 
• The student's name and other identifying information may be added to each page of the IEP.

All other sections of the IEP must appear for each student's IEP, whether or not there are recommendations for the student to be documented in that section of the IEP.

To use this form as a Word form document, you must follow the directions below.

1. A district may save the IEP form on the district’s letterhead or use the ‘School District Identifying Information’ section found on the form itself.  In order to save the document on the district’s letterhead, it is necessary that the form appear as a Word document and be in ‘unlock’ mode. 
   To unlock the form, go to ‘View’, ‘Toolbars’ and click on ‘Forms’.  This action will activate the ‘Forms’ toolbar.  From the ‘Forms’ toolbar, click the ‘Protect Form’ symbol (padlock). The form will then be in ‘unlock’ mode. Go to ‘Edit’, ‘Select All’ and ‘Copy’.  Paste the highlighted form onto district letterhead.  The form, now on district letterhead, must be locked in order to be functional.  To lock the form, go back to the ‘Forms’ toolbar and click the ’Protect Form’ symbol (padlock). The form will then be locked and ready for use.
2. Use the Tab button to advance from field (grey box) to field to insert the required information as appropriate.    These fields will automatically expand as text is entered.  In the event that there is no relevant information to be included in a particular text field, then the district should enter ‘none’ or ‘not applicable.’  
3. Select from the ‘drop-down’ options for the Disability Classification.  Note that for a preschool student, the only appropriate disability classification is ‘Preschool Student with a Disability’.  For a school-age student, select from one of the other 13 disability classifications.  Disability Classification:    
4. Select from the ’drop-down’ options for ‘Special Education Programs/Services’, ‘Testing Accommodations’ and ‘Special Transportation Accommodations/ Services’.  These sections also include text fields (shown on the computer screen as a grey box) to enter information that is not included in the ‘drop-down’ choices.
5. Some sections of the IEP form require a ‘Yes’, ‘No’ or ‘Not Applicable’ response.  To choose one of these options, simply click on the check box and an ‘X’ will appear in the box indicating a choice has been made.  
   For example:  Does the student need a particular device or service to address his/her communication needs?   Yes   No
6. The model form includes a limited number of rows for each section of the IEP.  However, rows should be added as appropriate for each student.  To insert additional rows (e.g., measurable annual goal section, special education services, etc.), the form must first be unlocked (see directions in #1 above).  To add rows, go to ‘Table’, ‘Insert’, ‘Rows Below’.  Once the rows have been added, relock the form (see directions under #1 above). 
7. After completing the IEP information for each student, SAVE the document to the appropriate file.  The document may then be printed.

The IEP form has been developed to present Committee recommendations in the same sequence that the development of IEP recommendations should occur, beginning with present levels of performance and, for adolescent students, post-secondary goals and transition needs, followed by identification of the goals the student is expected to achieve in the school year the IEP is to be in effect.  These sections are followed by recommendations to provide the student with the needed special education services, accommodations, modifications, etc. to assist him/her to reach those annual goals and to document the decisions of the Committee to provide such services to the maximum extent appropriate in regular classes and settings with the student’s nondisabled peers.  The final decision of the Committee is the identification of the least restrictive placement where the student’s IEP can be implemented.

Further information on each section of the State’s mandatory IEP form is provided below, with examples.  Please note that the examples provided for the individual sections of the IEP are each from different students' IEPs and are not intended to represent one student or one disability classification.  Therefore, when compiled, the examples would not represent recommendations for one individual student's IEP.  The assessment and other information used in these examples are fictional and do not represent real students. In providing names of assessments in the examples, the Department is not promoting or encouraging use of these particular assessments over others.

Identifying Information

This section of the IEP includes identifying information for the student and identifies the disability classification for the student (which must be selected from the options that appear in the drop down menu). 

Disability Classification: 

• For all preschool students, select ‘Preschool Student with a Disability’
• For school-age students, select one of the following disability classifications:
  • Autism
  • Deafness
  • Deaf-blindness
  • Emotional disability
  • Hearing impairment
  • Intellectual disability
  • Learning disability
  • Multiple disabilities
  • Orthopedic impairment
  • Other health-impairment
  • Speech or language impairment
  • Traumatic brain injury
  • Visual impairment (which includes blindness)

The IEP must also indicate the projected date the IEP is to be implemented.  Each student must have an IEP in effect at the beginning of each school year.  The IEP must indicate the projected date of review of the student’s need for the services recommended in the student’s IEP.  This date cannot be more than one year from the date the Committee conducted its last review of the student's IEP to determine if the annual goals are being achieved. 

For example:

Student Name: Johnny Jones Date of Birth: 7/4/95                          Local ID #:  123456	Disability Classification:   Autism
Projected date IEP is to be implemented:  September 7, 2010	Projected date of annual review: June 1, 2011

Present Levels of Performance and Individual Needs

The student's 'Present Levels of Performance and Individual Needs' must include documentation of information that is required to be considered in the development of the student's IEP.  Required considerations include:

1. Evaluation/assessment results.
2. The student’s current functioning and individual needs in academic achievement, functional performance and learning characteristics; social development; physical development; and management needs.  These considerations must include the strengths of the student and the concerns of the parent(s) for enhancing the education of the child.
3. The affect the student's disability has on the student's participation and progress in the general curriculum (or, for preschool students, in appropriate activities); and
4. Special considerations relating to behavior, communication, students with limited English proficiency, use of Braille and instruction in the use of Braille and use of assistive technology devices.  The form includes templates to ensure the Committee documents, as appropriate, its considerations for each of these areas. 

Evaluation Results:

In developing the recommendations for the IEP, the Committee must consider the results of the initial or most recent individual evaluation of the student as well as the results of the student’s performance on any general State or district-wide assessment programs.  For students beginning with the first IEP to be in effect when the student turns age 15, and annually thereafter, this section must include information from the age appropriate transition assessment provided to the student that is being considered in the development of the student’s IEP.  This does not mean that an updated transition assessment is required annually.

The following section of the IEP provides space for the Committee to document the evaluation results considered.  The example shows this section of the IEP completed to include a list of the evaluations considered and a brief summary of the results.

Alternately, this section could just list the assessments conducted as long as the instructionally relevant findings from these reports, that were considered and that reflect the students needs and strengths, are reported under the four need areas.

For example:  Student with Other Health Impairment - age 15

Present Levels of Performance and Individual Needs

Documentation of student's current performance and academic, developmental and functional needs
Evaluation Results (including for school-age students, performance on State and district-wide assessments)

Functional Behavioral Assessment - 10-11-09 - Problems identified in the areas of self-regulation, attention and aggression in the form of destruction of materials.  Aggression found to be avoidance / escape behaviors in response to stress and skill deficits. 

Psycho-educational Assessment - 10-20-09 
Wechsler Intelligence Scale for Children – Fourth Edition (WISC-IV): 95 (average) in verbal comprehension, 86 (low average) in perceptual reasoning, 71 (borderline) in working memory, and 88 (low average) in processing speed

Woodcock-Johnson Tests of Achievement-Third Edition (WJ-III ACH): standard (and percentile) scores of 85 (14) in broad math, 80 (11) in basic reading skills, 87 (9) in math calculation skills, and 85 (13) in academic skills).

Silent Reading Test, score of 72 - borderline range. 
Test of Written Language-Third Edition, standard composite score in the borderline range

Speech and Language Assessment - 10-5-09 - Clinical Evaluation of Language Fundamentals-Third Edition standard score in the below average range for the sentence repetition subtest and in the very low range for the listening to paragraphs subtest.

Physical Examination – 9-1-09 – Physical development is within normal range.  Seizures medically controlled.  Some side effects of seizure medication noted.

Classroom Observation - 10-15-09 - Difficulties with transition from one activity to the next.  When presented with reading tasks, he ripped pages from the book.  Broke pencils during math assignments.  Attempted to leave the classroom 5 times during instructional periods.  These behaviors did not present during the observation of the student during lunch, art and adapted physical education classes. 

Transition Assessment - May 2009 - Parent Transition Planning Interview, Independent Living Assessment Inventory. Vineland II Independent Living Skills; Informal Money management checklist. 
Enderle-Severson Transition Rating Scale (ESTR-R);   Jobs & Job Training - score 46%, Recreation & Leisure - score 77%, Home Living - score 25%, Community Participation - score 60%, and Post Secondary Training - score 10%.  Has expressed an interest in animal care.  Has one work experience working in his father's Veterinary Office.  Does not understand factors that influence job retention, dismissal, and promotion.  Does not know how to use resources for assistance in job searching.  Lacks skills necessary to complete a job application or job interview; and does not understand information on a paycheck.  Enjoys swimming at the YMCA.  His family supports the goal that he live outside of their home after high school, in a setting with supervision and support.

State and District-wide Assessments - 
Iowa test results (March 2009) grade equivalent scores of 4.9 in reading, 2.5 in mathematics, 3.0 in science, and 4.6 in social studies. 
State Assessment English language arts - Grade 8 - Level 2 (partially proficient).
State Assessment Mathematics - Grade 8 - Level 3 (proficient).

Four Need Areas:

The following section of the IEP provides the template for documentation of the student’s present levels of academic achievement and functional performance and individual needs of the student according to each of the following four need areas: 

• academic achievement, functional performance and learning characteristics;
• social development;
• physical development; and
• management needs.

The form includes the State’s definition of these four need areas.  The form also includes fields for the Committee to document the student’s strengths and needs, including the concerns of the parents for enhancing the education of their child considered in the development of the IEP for each of the need areas. 

For example: Student with a Learning Disability - age 10 (grade 4)

Academic Achievement, Functional Performance and Learning Characteristics

Levels of knowledge and development in subject and skill areas including activities of daily living, level of intellectual functioning, adaptive behavior, expected rate of progress in acquiring skills and information, and learning style:

Reading: Although Damien’s listening comprehension is age- and grade appropriate, his ability to read and understand grade level materials is hampered by decoding errors that appear comparable to those of a “typical” second grade student.  Specifically, when reading material is too difficult, Damien tends to use the initial and final letters/sounds to guess unfamiliar words, skipping over the middle of multi-syllabic words.  As the percentage of errors increases, Damien soon abandons any attempt to self-correct and make sense of what he is reading.  Fluency is dependent on both automatic decoding and comprehension of the passage; when faced with overly challenging tasks, strategy use is replaced by random guesses.

When Damien attempts books written at the mid-to-late second grade level, his oral reading fluency is within normal limits (for a second grade student) at 85 words per minute.  In contrast, when he attempts grade level text, fluency is greatly reduced to approximately 40 words per minute and Damien resorts to “word calling” with little attention to accuracy or meaning.  Reading comprehension scores are similarly impacted.  Damien benefits greatly from strong introductions to new material, which effectively lowers the text level challenges for him.
Currently, in the area of reading Damien:

• Reads second grade material with adequate fluency and accuracy.
• Reads 40 words correctly within 1 minute on 4th grade level reading material, and 85 words per minute when attempting second grade materials.
• His fluency and accuracy is influenced by text difficulty, familiarity with the topic and relevant vocabulary, and opportunities for multiple readings of the same or related text.
• Decoding skills are not fully mastered, and irregular spelling patterns are especially challenging.  He successfully identifies shorter words in isolation and context, but is less successful with multi-syllabic words, as he does not always analyze the whole word. 
• He has mastered most of the second grade Dolch word list, and is able to identify several from the third grade list.  He is able to identify “chunk” compound words and identify their segments.

Writing:  Damien demonstrates slow writing speed, difficulty with writing out math problems, difficulty taking notes and poor spelling and handwriting.

Math: Given Damien’s grade level math probes, his fluency/accuracy average in math facts is 7 digits per minute.  Word problems above the second grade level are frustrating for Damien both in reading content and computation. He is working on computational and problem-solving skills in addition and subtraction, while his classmates are currently working on developing multiplication skills.

Organization:  Damien comes to classes without the appropriate books on the average of 4 times per week.  He rarely turns in homework, even when his parents report assignments were completed.  Last month he turned in 12 out of 20 homework assignments. 

Attention: Damien is easily distracted.  His average time for attention to task is 10 minutes for instruction in reading and math.  His average time for attention to task for science when engaged in hands on experiments is 15 minutes.

Student strengths, preferences, interests: 
Good memory for details from information that he has either read or heard
Enjoys computers
Likes sports, animals and music
Responds well to hands-on work

Academic, developmental and functional needs of the student, including consideration of student needs that are of concern to the parent:
Damien needs to:

• develop decoding strategies which will enable him to read grade level materials more independently.
• practice fluent reading in challenging texts to build his “sight vocabulary” (words he recognizes on sight). 
• employ self-correction strategies when he makes an error in reading, especially when the miscue interrupts meaning.
• build fine motor skills stamina and learn strategies to use assistive technology.
• master multiplication and division concepts and reliance on key word strategies for math word problems.
• learn how to create a schedule and use self-regulatory skills to deal with distractions.
• learn techniques for coping with frustration and reducing worry so he can focus on the task and not on anxiety.

Parents are concerned about how frustrated he gets doing homework and how this is affecting his behavior at home and motivation in school.

Social Development
The degree (extent) and quality of the student's relationships with peers and adults; feelings about self; and social adjustment to school and community environments:

When presented with a change in routine, or a novel situation, Damien frequently demonstrates confusion and anxiety (e.g., asks repeated questions, stands up, tenses his muscles, pinches himself). These behaviors occur on the average of five times per academic class period.  Often makes negative comments about himself or his work (e.g., "I am not smart."  "I cannot do this."  "Oh, this is not good work.")  These statements occur on the average of 10-15 times per class period, and primarily for any work involving writing. He maintains a long term friendship with one classmate. His peer group rarely initiates conversations/activities with Damien. Damien’s comments and actions are often off topic/task from the group.

Student strengths:
Participates willingly in individual sports activities, such as wrestling, that are not team sports
Rarely makes negative comments about himself or his performance during sports activities
Initiates interaction with adults and peers
Responds appropriately to authority figures

Social development needs of the student, including consideration of student needs that are of concern to the parent: 
Damien needs to:

• engage in activities and reinforcement strategies which encourage peer interaction and emphasize his role as a successful group member; and
• develop strategies to transition between activities.

Parents are also concerned about his difficulty with transitions from activity to activity that are increasingly resulting in resistive behaviors (refusal to change activities) and the impact of his low self-esteem on his academic and social engagement. 

Physical Development
The degree (extent) and quality of the student’s motor and sensory development, health, vitality and physical skills or limitations which pertain to the learning process:

Damien's physical growth, hearing and vision are within normal development.  His fine motor skills are delayed.  He has a history of seizures, for which he takes medication.  He has reported side effects from medication such as fatigue and these affect his ability to learn.  His parents report that he is often tired and falling asleep during afterschool homework. His sleep patterns make it difficult for him to get up in the morning.  He shows fatigue as the school day progresses.  He puts his head down on the desk 10-15 times during class periods scheduled after lunch.  He tends to be most alert in the morning before lunch. 

Student strengths: 
Damien is physically strong and likes to exercise and work out with weights.

Physical development needs of the student, including consideration of student needs that are of concern to the parent: 
Damien's fatigue level needs to be monitored, particularly as it impacts his ability to concentrate on his school work.  Parents ask that, when possible, his academic classes be scheduled in the morning to accommodate for his fatigue.

Management Needs
The nature (type) and degree (extent) to which environmental and human or material resources are needed to address needs identified above: 
Scheduled rest periods
Assistance with transitions as he develops self-regulatory strategies
Activities and reinforcement to build and encourage peer interaction
Frequent monitoring when completing independent assignments
Assistive technology for content area reading and activities that include extensive physical writing
Monitoring and adjusting of student class work and homework requiring extensive fine motor skills and/or extensive time (due to fatigue issues)
Alternate formats of assessments that require less fine motor skill activity 

Involvement and Progress in the General Curriculum / Appropriate Activities

The following section is used to document how the student’s disability affects involvement and progress in the general education curriculum; or for preschool students, as appropriate, how the disability affects the student’s participation in appropriate activities.  Consider the affect of the student’s disability needs as they relate to each of the following: instructional content, instructional method, method of assessment, instructional materials and physical environment.

For example:  Student with Traumatic Brain Injury - age 13

Effect of Student Needs on Involvement and Progress in the General Education Curriculum or, for a Preschool Student, Effect of Student Needs on Participation in Appropriate Activities

Craig’s short attention span and his difficulties applying organization strategies affect his ability to complete homework and class assignments in a timely manner.  He forgets to take home materials and assignments and often forgets to turn in completed homework.

His decoding skills and physical difficulties with written work affect his ability to keep pace with his peers in activities which require independent reading and manual writing. As a result, he is falling behind in learning and does not always get credit for completed work or assessed knowledge. 

His behavior when frustrated is distancing him from his peer group and taking time from instruction.

Special Considerations

Present levels of performance statements must also include documentation that the Committee considered special factors in the development of the student’s IEP as noted below. If any of the following special considerations are checked ‘Yes‘, then the Committee must ensure that a device or service, including an intervention, accommodation or other program modification needed for the student to receive a free appropriate public education is indicated in the IEP under the applicable section of the IEP.

‘Yes’, ‘No’ or ‘Not Applicable’ must be indicated for each consideration.  If ‘Yes’ is indicated, then the IEP must identify the specific supports or other strategies (e.g., counseling, special seating, speech and language therapy) under the ‘Recommended Special Education Programs and Services’ section of the IEP.  If 'Yes‘ is checked indicating the need for a behavioral intervention plan, there is a text field provided in this section where additional information, as applicable, could be inserted (see example below).

For example:  Student with Autism – age 8

Student Needs Relating to Special Factors

Based on the identification of the student's needs, the Committee must consider whether the student needs a particular device or service to address the special factors as indicated below, and if so, the appropriate section of the IEP must identify the particular device or service(s) needed.

Does the student need strategies, including positive behavioral interventions, supports and other strategies to address behaviors that impede the student's learning or that of others?   X Yes   No
Does the student need a behavioral intervention plan?    No   X Yes:   To address self-abusive behaviors. 

For a student with limited English proficiency, does he/she need a special education service to address his/her language needs as they relate to the IEP?
Yes   No   X Not Applicable

For a student who is blind or visually impaired, does he/she need instruction in Braille and the use of Braille?   Yes   No   X Not Applicable

Does the student need a particular device or service to address his/her communication needs?   X Yes   No
In the case of a student who is deaf or hard of hearing, does the student need a particular device or service in consideration of the student's language and communication needs, opportunities for direct communications with peers and professional personnel in the student's language and communication mode, academic level, and full range of needs, including opportunities for direct instruction in the student's language and communication mode?
Yes   No   X Not Applicable

Does the student need an assistive technology device and/or service?   X Yes   No
If yes, does the Committee recommend that the device(s) be used in the student's home?   X Yes   No

Measurable Postsecondary Goals and Transition Needs

For students beginning with the first IEP to be in effect when the student is age 15 (and at a younger age, if determined appropriate) and updated each year, the IEP must include measurable postsecondary goals (the student’s long-term goals for living, working and learning as an adult) based on the student’s preferences and interests, as they relate to transition from school to post-school activities. The IEP must document measurable postsecondary goals in the areas of education and training (e.g., career and technical education and training, continuing and adult education, college), employment (e.g., integrated competitive employment), and community living (e.g., adult services, independent living or community participation). 

For example:  Student with Other Health Impairment - age 16

Beginning not later than the first IEP to be in effect when the student is age 15 (and at a younger age if determined appropriate)

Measurable Postsecondary Goals

long-term goals for living, working and learning as an adult

Education/Training:  Lisa will attend a two year college to take courses in animal care.

Employment:  Lisa will work as a dog groomer as she pursues courses in veterinary science.

Independent Living Skills (when appropriate):  Lisa will obtain her driving license.  She will live in an apartment assisted by friends and family. 

In addition, the IEP for these students must include a statement of the transition service needs of the student that focuses on the student’s courses of study, taking into account the student’s strengths, preferences and interests, as they relate to transition from school to post-school activities. The Committee identifies the coursework (e.g., Regents classes, career and technical education courses) the student will be enrolled in to achieve the student’s desired post-school goals. 

Transition Needs

In consideration of present levels of performance, transition service needs of the student that focus on the student's courses of study, taking into account the student’s strengths, preferences and interests as they relate to transition from school to post-school activities: 

Needs

Lisa needs to:

• develop self-advocacy, time management, computer and independent travel skills.
• be able to complete job application forms independently.
• learn appropriate work habits when supervisor is not present.
• develop community leisure skills.

Courses of study
Lisa plans to go to college for animal care.  Beyond the required curriculum for a regular diploma, she needs to take courses that include animal biology and computer word processing. To provide job exploration and skill development, her courses of study should include career and technical education courses in veterinary science.

Measurable Annual Goals

The IEP must list measurable annual goals, consistent with the student’s needs and abilities, to be followed during the period in which the IEP will be in effect.  For each annual goal, the IEP must indicate the evaluative criteria (the measure used to determine if the goal has been achieved), evaluation procedures (how progress will be measured) and schedules (when progress will be measured) to be used to measure progress toward meeting the annual goal. 

For example:  Student with Multiple Disabilities - age 9

Measurable Annual Goals

The following goals are recommended to enable the student to be involved in and progress in the general education curriculum, address other educational needs that result from the student's disability, and prepare the student to meet his/her postsecondary goals.

Annual Goals What the student will be expected to achieve by the end of the year in which the IEP is in effect	Criteria Measure to determine if goal has been achieved	Method How progress will be measured	Schedule When progress will be measured
Dawn will solve math word problems that involve addition and subtraction of two-, three- and four-digit numbers.	90% accuracy on 8/10 classroom assessments or worksheets	Classroom assessments and worksheets	Every two weeks
Dawn will complete actions in response to 3-step verbal requests.	5 out of 5 times on 4 consecutive weekly trials	Charting of student responses	Weekly
Dawn will remain in class for 45/50 minute periods, requesting a ‘break’ from class work not more than three times per class period.	5 out of 7 class periods per day over 5 week period	Daily charting of time in class	Monthly

For students who meet the eligibility criteria to take the New York State Alternate Assessment (NYSAA) and for preschool students with disabilities, the IEP must include a description of the short-term instructional objectives and/or benchmarks that are the measurable intermediate steps between the student’s present levels of performance and the measurable annual goals.  A district may establish policy to include short-term instructional objectives and/or benchmarks in other students’ IEPs (e.g., all elementary age students; all students recommended for special classes).

Alternate Section for Students Whose IEPs will Include Short-term Instructional Objectives and/or Benchmarks

(required for preschool students and for school-age students who meet eligibility criteria to take the New York State alternate assessment)

For example:  Student with Learning Disability - age 10

Measurable Annual Goals

The following goals are recommended to enable the student to be involved in and progress in the general education curriculum or, for a preschool child, in appropriate activities, address other educational needs that result from the student's disability, and, for a school-age student, prepare the student to meet his/her postsecondary goals.

Annual Goal What the student will be expected to achieve by the end of the year in which the IEP is in effect	Criteria Measure to determine if goal has been achieved	Method How progress will be measured	Schedule When progress will be measured
Given reading passage at the 2nd grade level, Mike will orally read 100 words per minute with no more than 6 errors.	8 out of 10 trials over 3 consecutive weeks.	Reading curriculum based oral reading fluency probes	Every two weeks
Short-term Instructional Objectives and/or Benchmarks (intermediate steps between the student’s present level of performance and the measurable annual goal): By November, Mike will orally read 70 – 80 words per minute  By February, Mike will orally read 80 – 90 words per minute  By April, Mike will orally read 90 – 100 words per minute

If needed, additional rows may be inserted into each of the annual goal charts. 

Reporting Progress to Parents

The IEP must identify when periodic reports on the progress the student is making toward the annual goals will be provided to the student’s parent(s).  The method or combination of methods to inform the parents of their child’s progress is left to local discretion. Based on the unique needs of the student, the manner selected to inform parent(s) might vary from student to student.

Reporting Progress to Parents

Identify when periodic reports on the student's progress toward meeting the annual goals will be provided to the student's parents: 

Quarterly (November, February, April and June) at the same time school report cards are issued.

Recommended Special Education Programs and Services

The IEP must indicate the recommended program and services, including related services, as defined in law and regulation from the options set forth in sections 200.6 and 200.16 of the Regulations of the Commissioner of Education that will be provided for the student.  These options are provided in a drop-down format in the IEP form for both preschool and school-age students to ensure the recommendations are stated based on the State’s special education program and services options.  Any information typed into the text box that is  also provided in this section must be consistent with this requirement. 

For special education programs and services, the options are as follows:

• For preschool students, the drop-down options include: 
  • Special education itinerant teacher services
  • Special class in an integrated setting
  • Special class
• For school-age students, the drop-down options include:
  • Consultant teacher services
  • Integrated co-teaching services
  • Resource room program
  • Special class
  • Travel training
  • Adapted physical education

The form also includes a text box following each drop-down option so that clarifying information may be provided by the Committee, as appropriate (e.g., identifying another term by which the special education service is known by in the school district). 

Example: Integrated co-teaching services   - (Collaborative Team Teaching)  In this example, another term used by a particular school district meaning the same as integrated co-teaching services is identified in the IEP.

The drop-down list of related service options is not a finite list.  These options include: Speech-Language Therapy; Audiology Services; Interpreting Services; Psychological Services; Physical Therapy; Occupational Therapy; Counseling Services; Orientation and Mobility Services; Medical Services; Parent Counseling and Training; School Health Services; School Nurse Services;  and School Social Work.

In addition to the drop-down options, text boxes on the form should be used to identify any recommended related service(s) not included in the drop-down options.  The form allows a Committee to recommend multiple programs/services/related services by utilizing multiple drop-down boxes.

The State form allows documentation of other clarifying information related to a recommended program/service under the column “Applicable Service Delivery Recommendations.”  A Committee should use this section of the IEP to document recommendations including special class size (required), group or individual service, program/service provided in a language other than English or direct or indirect consultant teacher services for school age students, as applicable to the recommended service and the student’s needs. 

For example: 

Applicable Service Delivery Recommendations

Bilingual - Spanish

The IEP must indicate the anticipated frequency, duration, location and initiation date of each recommended special education program, related service, supplementary aid and service, program modification or accommodation, use of an assistive technology device and/or service and, if applicable, support for school personnel.

The IEP must also indicate the projected beginning date of each recommended program/service. In addition, because the Committee may recommend a program/service for a limited time period, an end date of service may be documented if appropriate.  

For example: Student with Other Health Impairment

Recommended Special Education Programs and Services
Special Education Program/Services	Service Delivery Recommendations*	Frequency How often provided	Duration Length of session	Location Where service will be provided	Projected Beginning/Service Date(s)
Special Education Program:
Integrated co-teaching		4 days/ week	40 minutes	English class	9/7/10
Consultant teacher services	Direct	2 days/ week	40 minutes	Math class	9/7/10
Resource room program	Instruction on use of assistive technology, organization and self-regulation strategies	3 days/ week	40 minutes	Resource Room	9/7/10
Related Services:
Speech-Language Therapy	Individual	Once weekly	30 minutes	Therapy Room	9/7/10
Speech-Language Therapy	Small group	Once weekly	40 minutes	Therapy Room	9/7/10
Supplementary Aids and Services/Program Modifications/Accommodations:
One to one aide	For transitions in hall during class	Daily	Duration of transition	Hallways	9/7/10
Individualized daily visual schedule	Pictures accompanied with written words	Daily - all classes	Duration of class instruction	Student's academic classes	9/7/10
Preferential seating in regular classes	Away from window, front of the room, near teacher.	Daily - all classes	Duration of class (except for small group work)	All general education classes	9/7/10
Assistive Technology Devices and/or Services:
Text to speech software and speech to text software		Daily	Duration of academic and resource room class periods	English and Resource Room classes (Device will also be used in the student’s home)	9/7/10
Computer with headphones and microphone		As above	As above	As above	9/7/10
Supports for School Personnel on Behalf of the Student:
Instruction on use of text to speech and speech to text software	For Resource Room teacher	3 sessions	1 hour each session	Conference Room	9/7/10 - 9/15/10
*Identify (if applicable) class size (maximum student-to-staff ratio), language if other than English, group or individual services, direct and/or indirect consultant teacher services or other service delivery recommendations.

12-Month Service and/or Program

The IEP form must identify if the Committee recommends that the student receive special education services during the months of July and August.  If so, the IEP must include:

• the identity of the provider of services during the months of July and August; and
• for a preschool student, the reason(s) the student requires special education programs and services during July and August.

If the program/services recommended for July and August are not the same as recommended for the 10-month school year, the July and August recommendations must be documented in the following section of the IEP. 

For example:

12-Month Service and/or Program

Student is eligible to receive special education services and/or program during July/August: No    X Yes 
If yes:    Student will receive the same special education program/services as recommended above. 
OR X Student will receive the following special education program/services:

Special Education Program/Services	Applicable Service Delivery Recommendations	Frequency	Duration	Location	Projected Beginning/ Service Date(s)
Speech and Language Therapy	Bilingual - Spanish Individual	2 times weekly	30 minutes	Therapy Room	7/5/10 - 8/14/10
Name of school/agency provider of services during July and August:   Related Services Only - ABC School For a preschool student, reason(s) the child requires services during July and August:  N/A

Testing Accommodations

The IEP must indicate the individual testing accommodations needed by the student, if any, to be used consistently by the student in his or her recommended education program, in the administration of district-wide assessments of student achievement and consistent with Department policy, in State assessments of student achievement that are needed by the student to participate in the assessment.  This section would only be completed for preschool students if there is an assessment program for nondisabled preschool students.

The State form provides testing accommodation drop-down options.   These options include the following:  extended time; breaks; multiple day administration; revised test format; revised test directions; use of aids/assistive technology device; separate location/room; adaptive or special equipment; special lighting; special acoustics; location with minimal distractions; preferential seating; additional paper for math calculations; use of scribe; on-task focusing prompts; waive spelling requirements; waive paragraphing requirements; waive punctuation requirements; use of calculator; use of abacus; use of arithmetic tables; use of spell check device; and use of grammar check device.

However, since the list of testing accommodations is not finite, text boxes allow entry of other testing accommodation recommendations as appropriate. For each recommended testing accommodation, the Committee must, as applicable, identify the conditions or types of tests that will require testing accommodations (e.g., type, length, purpose of test) as well as any implementation recommendations (e.g., amount of extended time, duration and interval of breaks).

For example:

Testing Accommodations (to be completed for preschool children only if there is an assessment program for nondisabled preschool children): Individual testing accommodations, specific to the student’s disability and needs, to be used consistently by the student in the recommended educational program and in the administration of district-wide assessments of student achievement and, in accordance with Department policy, State assessments of student achievement 

Testing Accommodation	Conditions*	Implementation Recommendations**
None
Extended time	For tests requiring written essays	Time and a half
*Conditions – Test Characteristics:  Describe the type, length, purpose of the test upon which the use of testing accommodations is conditioned, if applicable. **Implementation Recommendations:  Identify the amount of extended time, type of setting, etc., specific to the testing accommodations, if applicable.

Coordinated Set of Transition Activities

Beginning with the first IEP to be in effect when the student is age 15 (and at a younger age, if determined appropriate) and updated annually, the IEP must include a statement of needed transition services.  These services focus on improving the academic and functional achievement of the student with a disability to facilitate the student’s movement from school to post-school activities.

All recommended transition services and activities are documented here to show the coordinated nature of the services and activities that are designed to promote movement from school to post-school opportunities before the student leaves the school setting.  For each activity, the IEP must include a statement of the responsibilities of the school district and, when applicable, participating agencies for the provision of transition services.

For example:  Student with Learning Disability - age 16

Beginning not later than the first IEP to be in effect when the student is age 15 (and at a younger age, if determined appropriate).

Coordinated Set of Transition Activities

Needed activities to facilitate the student’s movement from school to post-school activities	Service/Activity	School District/ Agency Responsible
Instruction	Instruction in problem solving	ABC Public School
Instruction	CTE Courses in Culinary Arts	BOCES
Instruction	Instruction in computer word processing skills	ABC Public School
Related Services	Counseling to work on self-advocacy skills	ABC Public School
Community Experiences	Visits to community agencies to develop an understanding of the location of services and their functions.	Independent Living Center
Community Experiences	Practice banking in the community	ABC Public School
Development of Employment and Other Post-school Adult Living Objectives	Facilitate meeting of student with Independent Living Center to explore post-school supports available	ABC Public School and Independent Living Center
Development of Employment and Other Post-school Adult Living Objectives	Complete sample college and job applications	ABC Public School
Development of Employment and Other Post-school Adult Living Objectives	Explore summer job opportunities	ABC PublicSchool
Development of Employment and Other Post-school Adult Living Objectives	Apply for local transportation pass and discount card if available	Independent Living Center
Development of Employment and Other Post-school Adult Living Objectives	Initiate application to VESID Vocational Rehabilitation (VR)	ABC Public School and VESID VR
Acquisition of Daily Living Skills (if applicable)	Considered, but not needed	N/A
Functional Vocational Assessment (if applicable)	Considered, but not needed	N/A

Participation in State and District-Wide Assessments

All students with disabilities must be included in State or district-wide assessment programs. If the Committee determines that the student will participate in an alternate assessment on a particular State or district-wide assessment of student achievement, the IEP must provide a statement of why the student cannot participate in the regular assessment, and why the particular alternate assessment selected is appropriate for the student.

For example:

Participation in State and District-Wide Assessments

(To be completed for preschool students only if there is an assessment program for nondisabled preschool students)

The student will participate in the same State and district-wide assessments of student achievement that are administered to general education students.

X The student will participate in an alternate assessment on a particular State or district-wide assessment of student achievement.
Identify the alternate assessment:    New York State Alternate Assessment  (NYSAA) 
Statement of why the student cannot participate in the regular assessment and why the particular alternate assessment selected is appropriate for the student:    The student meets the eligibility criteria for the NYSAA because of her limited cognitive abilities combined with physical limitations.  She is nonverbal and uses a picture communication device to communicate basic needs.  She requires direct care for personal needs.   Her chronological age is 12 but her instructional levels are at the Kindergarten level.   

Participation with Students without Disabilities

The following section of the IEP is used to document the extent to which a student’s disability precludes his/her participation with students without disabilities, including:

• an explanation of the extent, if any, to which a student will not participate in regular class and/or extracurricular and nonacademic activities, or, for preschool students, in appropriate activities, with age-appropriate nondisabled peers. This may be indicated as the percent of the school day or by identifying particular activities that the student will not participate in with his/her nondisabled peers. 
• the extent to which the student will participate in specially-designed physical education; and
• when the Committee recommends that a student be exempt from the World Languages requirement because the student's disability affects his/her ability to learn a language. 

For example:

Participation with Students Without Disabilities

Removal from the general education environment occurs only when the nature or severity of the disability is such that, even with the use of supplementary aids and services, education cannot be satisfactorily achieved.

For the preschool student:
Explain the extent, if any, to which the student will not participate in appropriate activities with age-appropriate nondisabled peers (e.g., percent of the school day and/or specify particular activities):  N/A

For the school-age student:
Explain the extent, if any, to which the student will not participate in regular class, extracurricular and other nonacademic activities (e.g., percent of the school day and/or specify particular activities):  Student will not participate in regular classes for English or Math - 100 minutes per day.
If the student is not participating in a regular physical education program, identify the extent to which the student will participate in specially-designed instruction in physical education, including adapted physical education:  Adapted physical education - 30 minutes per day - 3 days per week.  
Exemption from the World Languages diploma requirement:
X No
Yes.  The Committee has determined that the student's disability adversely affects his/her ability to learn a language and recommends the student be exempt from the World Languages requirement.

Special Transportation

The IEP must include recommendations to address each of the student’s disability-related special transportation needs, as appropriate. The IEP must specify any special transportation, including any specialized transportation equipment (e.g., special or adapted buses, lifts and ramps), needed by the student based on his or her unique needs related to the student’s disability to travel to and from school (including such school-related programs as work programs and settings other than the school where the student receives education or special education services); and, as appropriate, in and around the school. 

The State form provides the following drop-down options for documenting a student’s special transportation needs:

• Special seating;
• Vehicle and/or equipment needs;
• Adult supervision;
• Type of transportation; and
• Other accommodations.

Text boxes are provided after each of the above options to document the specific transportation recommendation to address each of the student’s needs (e.g., seating away from the bus window, car seat, bus with bus attendant).

In addition, the IEP must indicate if the student needs transportation to and from special education services to be provided at another site.

For example:

Special Transportation

Transportation recommendation to address needs of the student relating to his/her disability

None.
Student needs special transportation accommodations/services as follows: 
Vehicle and/or equipment needs - Wheel chair ramp
Adult supervision - to assist the student on and off the bus 
Student needs transportation to and from special classes or programs at another site:  To and from BOCES to receive related services.

Placement Recommendation

The IEP must indicate the recommended placement of the student. The student’s placement is the educational setting in which the student’s IEP will be implemented.  Placement should indicate the type of setting where the student will receive special education services (e.g., public school district, BOCES class, approved private school).

For example:

Placement Recommendation

Approved private day school

For additional guidance on IEP development, see the Guide to Quality IEP Development and Implementation.