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Sample IEP for a 7th
Grade Student with Chronic Fatigue Syndrome and Orthostatic Hypotension
Any Town Central School
Any Street
Any Town, State 12345
Individualized
Education Program
| Student: | "Student's Name" | Student ID: 111222345 |
| Date of Birth: ********* | Sex: M/F |
| Chronological Age: *** | Dominant Lang: English |
| Disability: Other Health Impaired |
| Current Grade: 7th Grade |
| Address: | First Avenue |
| Anytown, State 12345 |
| Telephone: | 123-456-7890 |
Parent/Guardian Information
| Name: | Smith, John | Relationship: Father |
| Smith, Jane | Relationship: Mother |
| Language: English | Interpreter Needed: No |
| Address: | First Avenue |
| Anytown, State 12345 |
| Telephone: | 123-456-7890 |
CSE Meeting Information
| Committee Name: Anytown CSE |
| Meeting Date: ******** | Projected Annual Review: *********
Author’s Note: must be within one year |
| Type of Meeting: New Referral | Next Triennial Review: ******** |
Least Restrictive Environment
This placement provides a program for
“Student’s Name” in the least restrictive environment.
Recommendations
The
committee has determined that “Student Name” is eligible to receive special
education services and recommends the following:
Objectives:
1. Apply properties of
irrational numbers to solve mathematical problems with 80% accuracy.
2. Apply concepts of percent to
solve mathematical problems with 80% accuracy.
3. Apply knowledge of fractions
to add, subtract and write in lowest terms with 80% accuracy.
Evaluation Procedures:
7th grade assignments and tests and
teacher/tutor tests and observations.
Science Goal: The student will develop knowledge, concepts
and skills related to the study of astronomy.
Objectives:
1. Explain how the tilt of the
Earth’s axis causes seasons with 80% accuracy based on teacher observation.
2. Explain why the length of
daylight changes throughout the year with 80% accuracy based on teacher
observation.
3. Identify the difference
between a meteor, meteorite, comet and asteroid with 80% accuracy based on
teacher observation.
4. Describe three principle
features of each planet with 80% accuracy.
5. Compare and contrast Mars and
Earth with 80% accuracy based on teacher observation.
6. Describe the size and colors
of stars and how they are born and die with 80% accuracy based on teacher
observation.
7. Describe the difference
between solar system, galaxy and universe with 80% accuracy based on teacher
observation.
Evaluation Procedures:
7th grade assignments and tests and
teacher/tutor tests and observations.
Individualized Education Program Comments
Modify
curriculum and workload
Meeting Attendees
| Name | Title |
|---|
| Dave Frank | SchoolPsychologist |
| Joe Doe | CSE Chairperson |
| Jane Smith | Mother |
| John Smith | Father |
| Student Smith | Self |
| Kate Jones | Special Education Teacher |
| Jane Doe | Voting CSE Parent |
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