Student Name: Ruta Begga Meeting Date: 28 February 2019

__________________SCHOOL SYSTEM
INDIVIDUALIZED EDUCATION PROGRAM (IEP)
IEP Meeting Date: 28 February 2019 Purpose of IEP Meeting : Initial  Annual Review  Amendment 
Student Name: Ruta Begga Date of Birth: GTID#
Eligibility Category(s): Learning Disability, Other Health Impairment (ADHD) Most Recent Eligibility Date(s): 27 February 2019
School: Grade: 4th School Year: 2018-2019
Parent(s): Mother
Address: Email:
Phone (home): (work): (cell phone):

TEAM MEMBERS IN ATTENDANCE

REQUIRED MEMBERS ADDITIONAL MEMBERS
Parent: Name/Title:

Parent: Name/Title:

Local Education Agency Representative (LEA): Name/Title:

Special Education Teacher: Name/Title:

Regular Education Teacher: Name/Title:

Student (age 18 or if transition is being discussed): Name/Title:

Agency representative (responsible for transition services): Name/Title:

I. PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

Results of initial or most recent evaluation and results of state and district assessments:
According to results from the WIAT-III Test, Ruta received a 92 on receptive language which is within the average range for her age group.
She received an 80, which is below average range, for Oral Discourse Comprehension. She also received an 80 on the WIAT-III Oral Expression
subtest.
Both her scores for assessment of expressive vocabulary (83) and measuring oral word fluency (75) were below average.
She received a 92 on the subtest that involves repetition of single sentences.
Results of the Core-Selective Evaluation Process indicate a strength in the area of fluid reasoning.
Weaknesses were evident in the area of short-term memory and working memory, as well as cognitive executive functions.
Ruta was tested for both dyslexia and dysgraphia, but she did not qualify for either of those categories.

Description of academic, developmental and/or functional strengths:

Her best mode of communication is oral expression.
According to her teachers, Ruta is pleasant, well-behaved, exhibits a positive attitude, and works well with others.
According to her teachers and her mother, Ruta’s adaptive behavior skills are within normal limits.
Both her scores for receptive language and repetition of single sentences fall in the average range.
In the assessment of Ruta’s cognitive and processes, a strength was identified in the area of fluid reasoning.
Description of academic, developmental and/or functional needs:
According to results of the WIAT-III subtests, her inferential reading comprehension level is below average (64%). Her teachers reported that her
reading comprehension level is between a 2nd and 3rd grade level.
Ruta’s reading teacher reported that she is slower in acquiring reading skills and producing written work.
Based on results of the WIAT-III test, her writing contained several punctuation errors, but it is suspected by her teachers that this is likely a result of
inattention and memory deficits rather than a disability in written expression.
According to the WIAT-III test, Ruta struggles in the area of mathematics. Her math calculation skills score (82) and the Math Problem Solving subtest
score (67) are below average. She does well with single-digit addition, subtraction, and multiplication but not with multi-digit numbers. She struggles
with problems involving time, money, and more complex graphs.
In the assessment of Ruta’s cognitive and processes, weaknesses were identified in her short-term and working memory and cognitive executive
functions.
Parental concerns regarding their child’s education:
Her mother reports that Ruta has had a hard time with her parents’ separation and the new baby. Her mother is concerned that Ruta is not going to
do well in school and may have to repeat the fourth grade.

Georgia Department of Education

Model Form July 2011
 Student Name: Ruta Begga Meeting Date: 28 February 2019

Impact of the disability on involvement and progress in the general education curriculum (for preschool, how the disability affects participation in
appropriate activities):
In the classroom setting, her teachers observe that she struggles with taking notes from readings and lectures.
Ruta’s Special Education teacher reports that her academic skill level regarding reading is below average based on observing her in the classroom.
She requires extra time to complete her assignments.
Her teachers report that she requires very specific instructions in order to complete tasks.
The multi-disciplinary assessment team has reported that there is an evident need for specialized instruction in the area of mathematics. It is possible
that she qualifies for Learning Disability in the areas of math calculation and math problem-solving.

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II. CONSIDERATION OF SPECIAL FACTORS
Georgia Department of Education
Model Form July 2011
 Student Name: Ruta Begga Meeting Date: 28 February 2019

a) Does the student have behavior which impedes his/her learning or the learning of others?  Yes  No
If yes, consider the appropriateness of developing a Behavior Intervention Plan.
Behavior Intervention Plan developed?  Yes  No
Refer to Behavior Intervention Plan for additional information.

b) Does the student have Limited English proficiency?  Yes  No

If yes, consider the language needs as related to the IEP and describe below.

c) Does the student have blindness/visual impairment?  Yes  No

If yes, provide for instruction in Braille and the use of Braille, unless the IEP Team determines that instruction in Braille is not appropriate for the student
after an evaluation of the student’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.

d) Does the student have communication needs?  Yes  No

If yes, consider the communication needs and describe below.

e) Is the student deaf or hard of hearing?  Yes  No

If yes, consider and describe the student’s language and communication needs, opportunities for direct communication 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. Describe communication needs below.

f) Does the student need assistive technology devices or services?  Yes  No

If yes, describe the type of assistive technology and how it is used. If no, describe how the student’s needs are being met in deficit areas.

g) Does the student require alternative format for instructional materials?  Yes  No
If yes, specify format(s) of materials required below.

 Braille  Large type  Auditory  Electronic text

III. TRANSITION SERVICE PLAN

A transition service plan must be completed no later than entry into 9th grade or by age 16, whichever comes first, or younger, if determined appropriate by the
IEP team and updated annually. If transition service plan is developed, attach to the IEP.

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Georgia Department of Education

Model Form July 2011
 Student Name: Ruta Begga Meeting Date: 28 February 2019

IV. MEASURABLE ANNUAL GOALS

Measurable Annual Goals: Academic and/or functional goals designed to meet the child’s Progress At Reporting Period
needs that result from the disability to enable the child to be involved in and make progress in Method of
Criteria for Mastery
the general education curriculum or to meet each of the child’s other educational needs that Evaluation
result from the disability. 1 2 3 4

(date) (date) (date) (date)

1. When given one-on-one support on in-class assignments in the areas of mathematics 75% Teacher will grade
calculation and problem-solving, Ruta will achieve scores of 75% or higher on her Ruta’s
assignments. assignments out
of 100%

2. When her teachers provide her with direct instruction in self-monitoring and being 75% Standardized test
able to identify relevant information within the given material, Ruta’s reading skills results (WIAT-III
and written expression abilities will increase. subtests
identifying reading
comprehension
level) will indicate
whether Ruta has
made progress in
these areas.

3. When given a brief review of vocabulary terms (reading/literature) and math terms 70% The teacher will
(mathematics) prior to instruction and testing, Ruta will have a better understanding monitor Ruta’s
of the material being taught or the content being assessed. progress/participa
tion in the
classroom; her
grades on
assessment will
also reflect her
improvement.

4. With the use of hands-on materials/manipulatives in the areas of counting money, 80% The teacher will
telling time, and graphing in mathematics, Ruta’s comprehension of and engagement observe Ruta’s
with these topics will increase. engagement with
the materials and
observe her
progress in class.

Georgia Department of Education

Model Form July 2011
 Student Name: Ruta Begga Meeting Date: 28 February 2019

REPORT OF STUDENT PROGRESS

When will the parents be informed of the child’s progress toward meeting the an nual goals?
Reporting period: Every nine weeks

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V. MEASURABLE ANNUAL GOALS & SHORT TERM OBJECTIVES/BENCHMARKS
Academic and/or functional goals designed to meet the child’s needs that result from the disability to enable the child to be involved in and make progress in the general education curriculum or to meet each of the
child’s other educational needs that result from the disability.

MEASURABLE ANNUAL GOAL: With the use of hands-on materials/manipulatives in the areas of counting money, telling time, and graphing in mathematics, Ruta’s comprehension of and engagement with these
topics will increase.

Progress At Reporting Period

Short term objectives/benchmarks: Measurable, intermediate steps or targeted sub-skills to Method of
Criteria for Mastery
enable student to reach annual goals. Evaluation
1 2 3 4

(date) (date) (date) (date)

1. By December 2018, when given play money, Ruta will be able to make real-world 40% Teacher observes
connections and understand coin and cash value. Ruta in class
(informal
assessment)

2. By December 2018, when practicing with a play clock with moveable hands, Ruta will 40% Teacher observes
be able to understand what the hour, minute, and second hand represent. Ruta in class
(informal
assessment)

3. By May 2019, when given play money, Ruta will be able to make real-world 80% Teacher observes
connections and understand coin and cash value. Ruta in class
(informal
assessment)

Georgia Department of Education

Model Form July 2011
 Student Name: Ruta Begga Meeting Date: 28 February 2019

4. By May 2019, when practicing with a play clock with moveable hands, Ruta will be 80% Teacher observes
able to understand what the hour, minute, and second hand represent. Ruta in class
(informal
assessment)

REPORT OF STUDENT PROGRESS

When will the parents be informed of the child’s progress toward meeting the annual goals?
Reporting period: Every nine weeks

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Georgia Department of Education

Model Form July 2011
Student Name: ____________________________________________________________Meeting Date: __________________________________________________

VI. STUDENT SUPPORTS

To advance appropriately toward attaining annual goals; to be involved and progress in the general curriculum; to be educated and participate with other
children in academic, nonacademic and extracurricular activities, the following accommodations, supplemental aids and services and/or supports for school
personnel will be provided:

Instructional Accommodations
Ruta may receive verbal attention-getting cues to help her focus when the teacher is speaking.
Ruta may be allowed up to 20 minutes of extra time to complete written assignments if needed.

Classroom Testing Accommodations

Ruta may be pulled out of class during testing time to take assessments in a distraction-free environment.
Ruta may be allowed the allotted time plus a half more to complete assessments.
Oral administration of tests may be provided for Ruta.

Supplemental Aids and Services

Graphic organizers may be provided and utilized by Ruta when taking notes on lectures or readings in class.
Ruta may receive one-on-one assistance on assignments by a paraprofessional.

Supports for School Personnel

All of Ruta’s teachers will have access to her IEP.

VII. ASSESSMENT DETERMINATION FOR DISTRICT AND STATEWIDE ASSESSMENTS FOR GRADES K-12
a) The student will participate in the following regular required assessments (Each state mandated test and subtest must be considered individually and
documented below).

Specific Testing Accommodations (Accommodations used for assessment must be consistent with accommodations used for classroom instruction/testing and
specified in the IEP. Some accommodations used for instruction may not be allowed for statewide assessment. Refer to the GaDOE Student Assessment
Handbook for the only allowable accommodations. Conditional accommodations are only allowable for students who meet eligibility criteria.) All subtests must
be considered individually. If the CRCT-M is considered, the Participation Guidelines for the CRCT-M must be completed and attached.

Test Subtest Setting Timing/Scheduling Presentation Response None, Standard or Conditional

Milestone Mathematics Small group The allotted time Read aloud Student will use a
environment plus a half more scantron
(Resource) will be allowed

Milestone ELA/Reading Small group The allotted time Read aloud Student will use a
environment plus a half more scantron
(Resource) will be allowed

b) The student will participate in the Georgia Alternate Assessment (GAA)  Yes  No

Georgia Department of Education

Model Form July 2011
Student Name: ____________________________________________________________Meeting Date: __________________________________________________
If yes, provide a statement of why the child cannot participate in regular required assessment.

Georgia Department of Education

Model Form July 2011
Student Name: ____________________________________________________________Meeting Date: __________________________________________________

VIII. SPECIAL EDUCATION: Instruction/Related Services in General Education Classroom/Early Childhood Setting
Options Anticipated
Initiation of Content/Specialty
Considered Frequency Duration Provider Title
Services Area(s)
 (mm/dd/yy
(mm/dd/yy)
)
X As needed 02/28/19 02/28/20 Special Education
Consultative
Teacher

X Collaborative

Co-teaching

Supportive Services

Related Services

IX. SPECIAL EDUCATION: Instruction/Related Services Outside of the General Education Classroom
Options Initiation of Anticipated
Content/Specialty
Considered Frequency Services Duration Provider Title
Area(s)
 (mm/dd/yy) (mm/dd/yy)
X Separate Class

Separate School

Home Instruction

Residential

Hospital/Homebound

Supportive Services

Related Services

X. The explanation of the extent, if any, to which the child will not participate with peers without disabilities in the regular
class and/or in nonacademic and extracurricular activities:

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Georgia Department of Education

Model Form July 2011
Student Name: ____________________________________________________________Meeting Date: __________________________________________________

XI. EXTENDED SCHOOL YEAR

a) Are extended school year services necessary?  Yes  No
If yes, complete the section below.

b) Goals to be extended or modified:

Initiation of Anticipated
Services Frequency Services Duration Provider Title Location
(mm/dd/yy) (mm/dd/yy)

XII. DOCUMENTATION OF NOTICE OF IEP MEETING

Date Method of Notification By Whom

1st Notification Invitation  Phone Call  In Person Reminder notice Other:

2nd Notification Invitation  Phone Call  In Person Reminder notice Other:

3rd Notification Invitation Phone Call  In Person Reminder notice Other:

XIII. PARENT PARTICIPATION IN THE IEP PROCESS

The following documents were provided to parent(s):
 Parental Rights in Special Education
 Individualized Education Program (IEP)
 Eligibility Report(s)
 Evaluation
 Other:________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________

If parent did not attend the meeting, complete below:

On _____________the documents were:  Mailed  Given In Person  Sent via Student  Other______________

Georgia Department of Education

Model Form July 2011
Student Name: ____________________________________________________________Meeting Date: __________________________________________________

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Georgia Department of Education

Model Form July 2011