Individual Educational Plan - Secondary

Catholic Independent Schools Vancouver Archdiocese

School Year: IEP Meeting Date: Review Date:

PERSONAL INFORMATION

Given Name: / Student Surname: / Grade/Prog./ H.Rm.: / School: /

School Phone / FAX:

Birthdate (yy/mm/dd): / Gender: / PEN #: / School History:
Address:
Home Phone:
Work Phone: / Parent(s) / Guardian:
E-mail Address: / Assessment / Diagnostic Information (most recent):
Language(s) of the Home:
Pertinent Family /Health Information:
Funding Category (if applicable) Category ___
IEP TEAM / ADDITIONAL SUPPORT SERVICES
Role/Title
Case Manager /
IEP Co-ordinator:
Classroom Teacher(s):
Parent(s) / Guardian: /
Name
/
Role / Title
Others /
Name
STRENGTHS
(abilities / interests / motivators) /
CHALLENGES

Student:

PRIORITY GOALS / Academic / Intellectual / Social / Emotional / Behavioural / Physical / Health / Communication / Functional / Self-Help / Self Determin. / Indep.
1.
2.
3.
4.
5.
6.
Priority Goal:
Curriculum Area: / Entry Level:
Objectives:
·  / Strategies / Resources / Personnel:
·  / Date / Evaluation of Progress:
· 

Student:

Priority Goal:
Curriculum Area: / Entry Level:
Objectives:
·  / Strategies / Resources / Personnel:
·  / Date / Evaluation of Progress:
· 
Priority Goal:
Curriculum Area: / Entry Level:
Objectives:
·  / Strategies / Resources / Personnel:
·  / Date / Evaluation of Progress:
· 

Student:

CLASS ASSIGNMENT

Term/Semester

/

Subject/Course

/

Teacher

/

Regular

/

With adaptations[1]

/

With modifications[2]

1. / o / o / o
2. / o / o / o
3. / o / o / o
4. / o / o / o
5. / o / o / o
6. / o / o / o
7. / o / o / o
8. / o / o / o
9. / o / o / o
10. / o / o / o

ASSIGNMENT ADAPTATIONS

Adaptations

/

Subject by #

1. / 2. / 3. / 4. / 5. / 6. / 7. / 8. / 9. / 10.


Student:

Adaptations for the Classroom
Classroom Organization / ¨  Student-directed / ¨  Ongoing feedback / dialogue
¨  Preferential Seating / ¨  Provide concrete examples / Modify test format
¨  Short answer
¨  Fill-in blanks
¨  Multiple choice
¨  Grouping of concepts
¨  Vary grouping / Teach to learning style of student
¨  Visual
¨  Auditory
¨  Kinesthetic
¨  Learning centres
¨  Reduce/Minimize distractions
¨  Review classroom and school rules / ¨  Use manipulatives / ¨  Other
¨  Vary seating plan / ¨  Pre-teach vocabulary / Classroom Management
¨  Other / ¨  Reduce language complexity
Assignments / ¨  Adjust reading level of materials / ¨  Reminders about expected behaviour when problems are likely to occur
¨  Use visual cues / visual supports
¨  Reduce work load / ¨  Simplified / repeated instruction
¨  Provide extra time to complete assignments / ¨  Break information into small chunks / ¨  Review class/school rules and expectations
¨  Proximity to student
¨  Adaptations to assignments to match the student’s needs / ¨  Vary amount to be learned / ¨  Reward program for desired behaviours
¨  Graphic organizers
¨  Give extra cues/prompts / ¨  Assistive technology / ¨  Individual written contract with student
¨  Provide a scribe / ¨  Other
¨  Allow word processing of assignments / Methods of Assessment / ¨  Meeting with student and parents to provide structured feedback about behaviour
¨  Avoid penalizing for spelling errors / Vary type of assessment:
¨  Verbal
¨  Written
¨  Demonstration
¨  Avoid penalizing for poor printing skills / ¨  Practice of expected behaviour
¨  Progress chart
¨  Role Play/Act out answers / Vary structure of assessment:
¨  Time / Frequency
¨  Individual
¨  Amount
¨  Visual presentation / ¨  Office referrals
¨  Alternative assignments to demonstrate learning/understanding / ¨  Classroom / individual behaviour plan
¨  Class meetings
¨  Ongoing communication with parents and students
¨  Other / ¨  Allow for practice/sample questions
Instruction / ¨  Provide a study guide relevant to assessment / ¨  Teach coping strategies
¨  Provide breaks
¨  Small group instruction / ¨  Allow for assessment in alternative setting / ¨  Positive notes sent home
¨  Individual instruction / ¨  Communication book/agenda checked daily to communicate with parents/guardians
¨  Peer tutoring / ¨  Open book
¨  Teacher directed / ¨  Have instructions and questions read to student
¨  Edit written work / spell check / ¨  Other


Student:

TERM COMMENTS

Successes:
· 
Challenges:
· 

TERM RECOMMENDATIONS

· 

YEAR END RECOMMENDATIONS / TRANSITION PLANS

Step-by-Step Plan:
2. 
5.  / Personnel Responsible:
1. 
2. 
5. 

Student:

Parent / Guardian Involvement

q  Parent(s) / Guardian was/were invited to participate in the IEP meeting. Date: ______(Documentation on file.)
q  Parent(s) / Guardian declined the opportunity to participate in the development of the IEP. Date: ______(Documentation on file.)
q  Parent(s) / guardian has/have received a copy of this IEP. Date: ______

Additional Notes:

2016-09-12 IEP Template-High School-Revised

[1] Adaptations only change the way the student receives information and instruction, participates in class activities, and/or represents their learning. The learning outcomes of the prescribed curriculum do not change. They stay the same.

[2] Modifications are designed for a student whose learning outcomes and instruction differ significantly from the learning outcomes of the prescribed curriculum. They are documented as IEP goals and objectives.