Individualized Education Program Page 2
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8I N D I V I D U A L I Z E D E D U C A T I O N P R O G R A M
STUDENT’S NAME:
DOB:
SPECIAL INSTRUCTIONAL FACTORS
Items checked “YES” will be addressed in this IEP:
YES
NO
Does the student have behavior which impedes his/her learning or the learning of others?
[ ]
[ ]
Does the student have a Behavioral Intervention Plan?
[ ]
[ ]
Does the student have limited English proficiency?
[ ]
[ ]
Does the student need instruction in Braille and the use of Braille?
[ ]
[ ]
Does the student have communication needs?
[ ]
[ ]
Does the student need assistive technology devices and/or services?
[ ]
[ ]
Does the student require specially designed P.E.?
[ ]
[ ]
Is the student working toward alternate achievement standards and participating in the
Alabama Alternate Assessment?
[ ]
[ ]
Are transition services addressed in this IEP?
[ ]
[ ]
TRANSPORTATION
Student’s mode of transportation:
[ ] Regular bus
[ ] Bus for special needs
[ ] Parent contract
[ ] Other:
[ ] YES
[ ] NO
Does the student require transportation as a related service?
If yes, check any transportation needs:
[ ]
Bus assistance:
[ ] Adult support
[ ] Medical support
[ ]
Preferential seating
[ ]
Behavioral Intervention Plan
[ ]
Wheelchair lift and securement system
[ ]
Restraint system
Specify type:
[ ]
Other. Specify:
[ ]
Bus driver and support personnel are aware of the student’s behavioral and/or medical concerns.
NONACADEMIC and EXTRACURRICULAR ACTIVITIES
Will the student have the opportunity to participate in nonacademic/extracurricular activities with his/her nondisabled
peers?
[ ]
YES.
[ ]
YES, with supports. Describe:
[ ]
NO. Explanation must be provided:
METHOD/FREQUENCY FOR REPORTING PROGRESS OF ATTAINING GOALS TO PARENTS
Annual Goal Progress reports will be sent to parents each time report cards are issued (every
weeks).
Page
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ALSDE Approved Feb. 2016
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