Annex 6- Individualized Education Plan
Department of Education
Region V (Bicol)
Division of Albay
Daraga South District
ANISLAG ELEMENTARY SCHOOL
INDIVIDUALIZED EDUCATION PLAN (IEP)
Overview- This IEP has been designed in accordance with the World Health Organization International Classification of
Functioning Disability and Health. In accordance with this approach Disability is defined as an impairment in interaction
with a wide range of environmental barriers. In this IEP, teachers are asked to identify the learner’s impairment in
combination with their school environment. The learning barriers should be documented alongside accommodations
designed to remove the participation barriers and improve educational success.
SECTION A: PERSONAL INFORMATION
LEARNER/PARENT INFORMATION: DIFFICULTIES (select most relevant): MEETING INFORMATION
___ Difficulty in Seeing DATE OF MEETING ___________________
Learner__________________________Sex____ DATE OF LAST IEP ___________________
Birth Date_________________ Grade/Level____ ___ Difficulty in Hearing
LRN____________________________________ PURPOSE OF MEETING:
___ Difficulty in Communicating
Current School ___________________________ ____ Interim IEP***
Address of School ________________________ ___ Difficulty in Mobility/Walking
Mother Tongue Spoken ____________________ ____ Initial IEP
___ Difficulty in Displaying Interpersonal ____ Team IEP
Address ________________________________ Behaviors
_______________________________________ ____ IEP Following 3-Yr Reevaluation***
Learner´s Phone (if there is) _________________ ___ Difficulty in Performing Adaptive Skills
____ Revision to IEP Date_____
Parent/Guardian/Caregiver _________________ ___ Difficulty in Basic Skills and Applying ____ Exit/Graduation_________
Work & Workplace________________________ Knowledge
Landline/Mobile/ Cellphone No. ______________ ____Revision Without a Meeting:
Email __________________________________ ___Difficulty in Remembering/Concentrating At the request of ______ Parent
Mother Tongue Spoken ____________________ ______ School
Interpreter or Other Accommodations Needed ___ Others (please specify)
_______________________________________ IEP Review Date _____________________
_ ___ Medical Diagnosis (if yes, please specify) COMMENTS:
___________________________________
___________________________________
___________________________________
IEP TEAM MEMBERS IN ATTENDANCE
Parent/ Guardian/Caregiver ________________________________________ School Psychologist**______________________________________
*Learner________________________________________________________ Guidance Counselor/Designate _____________________________
Principal/School Head _____________________________________________ School Nurse ___________________________________________
Other (name and role) _____________________________________________ Therapist/Pathologist/Specialist _____________________________
Special Education Teacher _________________________________________ Speech/Language Interpreter _______________________________
** Regular Education/Receiving Teacher___________________________ Other (name and role)
** Learner must be invited when transition is discussed.
** The EIP team must include at least one regular education teacher of the learner (if the learner is or may be participating in the regular education
environment)
___________________________________________________
Signature over Printed Name of Parent/Guardian/Caregiver
AT LEAST ONE YEAR PRIOR TO REACHING AGE 18, LEARNER MUST BE INFORMED OF THEIR RIGHTS UNDER THE LAW AND ADVISED
THAT THESE RIGHTS WILL BE ENJOYED AT AGE18.
______ Not Applicable (learner will not be 18 within a year
______ The learner has been informed of his/her rights under law and advised of the transfer rights of age 18.
Distribution: ____Learner´s Folder
____Parent/Guardian/Caregiver Ed Special Education/Receiving Teacher
LEARNER: _____________________________________________________________________________________________________________
DATE: ________________________________________________________________________________________________________________
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Annex 6- Individualized Education Plan
Department of Education
Region V (Bicol)
Division of Albay
Daraga South District
ANISLAG ELEMENTARY SCHOOL
2|Page
Annex 6- Individualized Education Plan
Department of Education
Region V (Bicol)
Division of Albay
Daraga South District
ANISLAG ELEMENTARY SCHOOL
I. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Results of initial or most recent evaluation and results of school and division assessments:
Description of academic, developmental and/or functional strengths:
Description of academic, developmental and/or functional needs:
Parental concerns regarding their child´s education:
Impact of the disability on involvement and progress in the general education curriculum (for preschool, how the disability affects
participation in appropriate activities):
II. CONSIDERATION OF SPECIAL FACTORS
a. Does the learner have difficulty relating with people which impedes his/her learning or the learning of others? No Yes
b. If yes, consider the appropriateness of developing a Behavior Intervention Plan.
Behavior Intervention Plan developed? No Yes
Refer to Behavior Intervention Plan for additional information.
Does the learner have difficulty in Moving/Walking? No Yes
If yes, consider the mobility needs as related to the IEP and describe below.
Does the learner have difficulty in seeing or with blindness/visual impairment?
If yes, provide for instruction in Braille and the use of Braille, unless the IEP Team determines that instruction in Braille No Yes
is not appropriate for the learner after an evaluation of the learner´s reading and writing skills, needs, and appropriate
reading and writing media, including evaluation of future needs for instruction in Braille or the use of Braille. Describe
below.
No Yes
Does the learner have difficulty in communicating?
If yes, consider the communication needs and describe below.
No Yes
Does the learner have difficulty in concentrating/paying attention?
If yes, consider the attention span needs and describe below.
Does the learner have difficulty in remembering/understanding? No Yes
If yes, consider the understanding needs and describe below.
Does the learner have difficulty in hearing or is the learner deaf or hard of hearing?
If yes, consider and describe the learner´s language and communication needs, opportunities for direct communication with
Peers and professional personnel in the learner´s language and communication mode, academic level and full range of No Yes
needs, including opportunities for direct instruction in the learner´s language and communication mode. Describe
communication needs below.
Does the learner need assistive technology devices or services?
If yes, describe the type of assistive technology and how it is used. If no, describe how the learner´s needs are being No Yes
met in deficit areas.
Does the learner require alternative format for instructional materials?
If yes, specify format(s) of materials required below. No Yes
Braille Large type Auditory Electronic text
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
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Annex 6- Individualized Education Plan
Department of Education
Region V (Bicol)
Division of Albay
Daraga South District
ANISLAG ELEMENTARY SCHOOL
DIFFICULTY (enter all ENVIRONMENTAL ENVIRONMENTAL ACCOMMODATIONS (list items,
areas of difficulty) BARRIERS (describe each FACILITIES (describe each staff resources and infrastructure
factor restricting participation) factor enabling participation in changes required to enable
response to barriers) participation)
SECTION B: DIFFICULTIES, BARRIERS AND ENABLING SUPPORTS
DIFFICULTY (enter ENVIRONMENTAL ENVIRONMENTAL FACILITIES ACCOMMODATIONS (list items, staff
all areas of difficulty) BARRIERS (describe each factor enabling participation resources and infrastructure changes
(describe each factor in response to barriers) required to enable participation)
restricting participation)
Difficulty Seeing 1. Printed text 1. Braille text books (+4). All text books to be transcribed into Braille
books (4).
2. Printed exam 2. Braille exam paper and use of All exam papers to be transcribed into Braille
papers (4). computer with screen reader (+4). School desktop computer with screen reader
Separate exam room
Exam supervisor
3. Writing with 3. Laptop computer with screen reader Laptop computer
pen/pencil (+4). Screen reader
and paper (4). Headphones
Adaptive technology training
Difficulty 2. Travelling 1. Buddy to provide sighted guide each day
moving/walking between to and from school. School Buddy
home and
school (3).
1. Unmarked 2a. Tactile indicators on school grounds
paths on 2b. Orientation and Mobility training to Tactile indicators
school support independent movement Orientation and Mobility training
grounds.
2. Team Sport 3. Provision of modified team sport School Buddy
(4) activities and classmate training to support
participation (+4)
Selection of Barriers and Qualifiers for Environmental Barriers and Facilitators (taken from ICF)
DIFFICULTIES (select all relevant categories) Qualifier for Environment Barriers Qualifier for Environment Facilitators
Seeing .0 No barrier +1 Mild facilitator
Hearing .1 Mild barrier +2 Moderate facilitator
Communicating .2 Moderate barrier +3 Substantial facilitator
Moving/Walking .3 Severe barrier +4 Complete facilitator
Concentrating/Paying Attention .4 Complete barrier +8 Facilitator, not specified
Remembering/Understanding .8 Barrier, not specified +9 Not applicable
.9 Not applicable
Sample
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Annex 6- Individualized Education Plan
Department of Education
Region V (Bicol)
Division of Albay
Daraga South District
ANISLAG ELEMENTARY SCHOOL
INTEREST GOAL INTERVENTIONS TIMELIN INDIVIDUALS REMARKS PROGRESS/NEXT
E RESPONSIBLE STEPS
SECTION C: LEARNER GOALS
To support identification of learner goals, also confirm:
What opportunities are available at the school to support learner goals?
What are the student interest areas?
What disability-specific skills does the learner need to develop to support their participation/attainment of goals?
Goals (eg-Skills to improve participation in education or daily living skills. Goals should be SMART (Strategic, Measurable, Achievable, Realistic and
Tiem-bound).
INTEREST GOAL INTERVENTIONS TIMELIN INDIVIDUALS REMARKS PROGRESS/NEXT
E RESPONSIBLE STEPS
Sample
INTERES GOAL INTERVENTIONS TIMELINE INDIVIDUALS REMARKS PROGRESS/NEXT
T RESPONSIBLE STEPS
Independent Independent travel Weekly mobility 3 months
mobility from home to school training
Reading Reading Braille Braille training 6 months
SECTION D: LEARNER TRANSITION
This section is for learners exiting the school environment and transitioning into work.
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