IPP Assignment Template 1

Individualized Program Plan Assignment

Template

Group Assignment Confirmation Form: I confirm that I am aware of the entire contents
of this group assignment and that I have reviewed all group members’ contributions to
the assignment. I also acknowledge that each group member will be awarded the same
mark for this group assignment.

Group Member Names Laboratory Section Number

Christine Dang B17

IPP Template

Individualized Program Plan

Student Information *Entire section completed for Assignment Part 1.

Student Name: Dustin Johnson

Date of Birth: April 20, 2005
Current School: River Valley School
Current Grade: Grade 5
Name of Guardian 1: Mrs. Kate Johnson
Name of Guardian 2: Mr. Johnson

Administrative Information *Entire section completed for Assignment Part 1.

Alberta Special Education Code: 54 (Learning Disability) and 44 (Severe Medical Disability)
School Year Current IPP is Active For: September 2014 to June 2015
Primary/Homeroom Classroom Teacher for Current IPP: Mr. Hoppins
Special Education Coordinator: Mrs. Lesley

School History *Entire section completed for Assignment Part 1.

Fun Times Preschool (Preschool); Crescent Heights Elementary (Kindergarten to Grade 1); River Valley School
(Grade 2-4)

Medical Conditions that Impact Schooling *Entire section completed for Assignment Part 1.

Dustin is currently described as a happy and energetic boy. He received physical therapy for Torticollis up until last
year but currently doesn’t exist. Dustin also wears glasses for farsightedness (ie. close-up activities like reading).
Hearing has been evaluated and there are no concerns reported.
IPP Assignment Template 2

Assessment Data (Specialized Assessment Results) *Entire section completed for Assignment Part 1.

Date Tests/Assessment Results

2007 Speech Assessment  Reports indicate that Dustin’s receptive language abilities (ie. how
well he could understand) were in expected range; however, his
expressive language abilities (ie. how well he could communicate his
need and wants) were slightly delayed. Minor articulation difficulties
were also identified.
 He was discharged from the speech-language program in 2010-2011.

2013 Family Physician

Consultation  Doctor recommended that Dustin have a full psychological evaluation

May 6, 2014 Psychoeducational  Report affirms Average verbal comprehension; Low Average
Assessment (WISC-IV, working memory; Average perceptual reasoning; Average processing
Dr. Steven speed; Very Low visual motor skills; Confidence Index Low Average
VMI, NEPSY-II, WIAT-
Jones to Average
III, PICS-6)
 Reports affirm Low Average reading comprehension, Low Average
Oral Reading Fluency, Low Average word reading, Low Average
pseudoword decoding, Average math problem solving, Low Average
writing
 Reports provides a diagnoses of Specific Learning Disorder with
impairment in reading and written expression, Attention
Deficit/Hyperactivity Disorder (ADHD), and Persistent Motor Tic
Disorder.

Current Level of Performance and Achievement *Entire section completed for Assignment Part 1.

*List most recent report card information and informal assessments. If no informal assessments available, indicate
“none”.
Report Cards
Kindergarten report card indicate Good (3) in reading and math but difficulty following routine and expectations.
Grade 1 report card indicate that oral and reading fluency was Not Meeting (1) and there was difficulty demonstrating
appropriate listening behaviours. Grade 2 report card indicated Basic (2) reading and deriving meaning of text. Grade 3
report card indicated overall Basic (2) but writing still remained at Not Meeting (1) Grade 4 report card summarizes
that overall grade level expectations are met in all areas at the Basic (2) level with exception to English Language Arts.
His English Language Arts was Not Meeting (1) level with moderate levels of support required (eg. Writing
conventions such as capitalization and punctuation, organizing written work, writing stamina).

Curriculum-Based Measurement
He is currently at grade level in math and reading. His reading stamina has improved since the beginning of Grade 4.
Mrs. Foster reported that his reading stamina has improved considerably since the beginning of the grade. But there is
concern with his letter formation and spacing.
IPP Assignment Template 3

Student Strengths *Entire section completed for Assignment Part 1.

 Enjoys sports and being outdoors
 Sensitive to the needs of others and enjoys helping out
 Helps around classroom
 Typically follows classroom expectations and routines
 Good attention and effort on all tasks including those that were more challenging for him
 No difficulty with over activity
 Good verbal skills
 Interpreting and processing visual information not an area of difficulty
 More complicated and demanding task appeared to capture attention and resulted in more successful performance
 Gets along well with his peers and interacts with them both inside and outside of the school setting

Student Areas of Need *Entire section completed for Assignment Part 1.

*List student areas of need here.

 Specific reading intervention aimed at increasing his accuracy and fluency in decoding his reading
 Using phonological word decoding strategy to help with letter sounds and reading and use corrective feedback
 Breaking down large task into small to help with completion of tasks
 Strategies for letter formation and spacing development (handwriting)
 Strategies or tools to help with difficulty paying attention and remaining still for long periods of time
 Increase motor breaks to help with difficulties with attention and impulsivity in the classroom
 Checklist for editing his written work and ensuring the use of proper capitalization and punctuation

Required Classroom Accommodations *Entire section completed for Assignment Part 1.

 Motor breaks
 Reminders and cues to stay on task
 Breaking down tasks (especially written)
 Writer’s checklist or mnemonic for editing
 Multiple repetitions of instruction
 Increase opportunity for oral evaluation
 More time to complete written tasks
 Requiring fewer practice questions to be completed
 More time to copy from the board or a copy of teacher’s notes
 Have someone scribe for him
 Fidget toy to help with difficulty to remain still
 Frequent “check ins” for understanding

Long-Term Goal #1: *Entire section completed for Assignment Part 2.

Dustin will improve his writing skills by working on implementing letter formation strategies with 85% accuracy by
June 2015.
IPP Assignment Template 4

Short-Term Objectives Assessment Procedures Progress Review

*Complete short-term objective 1A
Dustin will select at least three
preferred letter formation strategies
that he can use for his written work
with 95% accuracy by November 1,
2014.
*Complete assessment procedures for Student has achieved short-term
short-term objective 1A objective 1A
Student interview conducted by the November 1, 2014
classroom teacher every week
tracking the strategies Dustin has
chosen.

*Complete short-term objective 1B
Dustin will select and use at least 1 of
3 preferred letter formation strategies
with cues from teacher on his written
work with 85% accuracy by February
1, 2015.
*Complete assessment procedures for Student has achieved short-term
short-term objective 1B objective 1B
Self-evaluating using a checklist and February 1, 2015
chart where Dustin will mark his own
work.
Teacher monitoring and tracking the
checklist and chart.

*Complete short-term objective 1C
Dustin will select and use at least 1 of
3 preferred letter formation strategies
without cues from teacher on his
written work with 85% accuracy by
June 1, 2015.
*Complete progress review for short- Student has achieved short-term
term objective 1C objective 1C
Self-evaluating using a checklist and June 1, 2015
chart where Dustin will mark his own
work.
Teacher monitoring and tracking the
checklist and chart.

Strategies to Support Objectives:

*List strategies to support the objectives for long-term goal #1 here.
1. Teacher will provide checklists for self-evaluation of work
2. Teacher support will be provided twice during writing task
3. Visual reminders in a binder and on the wall

Long-Term Goal #2: *Entire section completed for Assignment Part 2.

Due to Dustin’s hyperactivity/impulsivity, he will work on following routines and completing tasks in the classroom
for at least 20 minutes with minimal verbal cues and reminders from teacher during independent work time and/or
teacher instruction.
IPP Assignment Template
Short-Term Objective
*Complete short-term objective 2A
Dustin will be able to work on
assigned tasks independently at “quiet
corner” desk when asked by the
teacher for at least 10 minutes on 5
consecutive school days by
November 1, 2014.
*Complete short-term objective 2B
Dustin will be able to work on
assigned tasks independently at his
desk amongst students when asked by
the teacher for at least 10 minutes on
5 consecutive school days by
February 1, 2015.
*Complete short-term objective 2C
Dustin will be able to work on
assigned tasks independently at his
desk among students when asked by
the teacher for at least 20 minutes on
for two weeks by June 1, 2015.
Strategies to Support Objectives:
*List strategies to support the objectives for long-term goal #2 here.
1. Strategic seating arrangements
2. Provide fidget tools during activities to help increase focus (stress ball, coiled key chain, bean bags, putty, etc)
5
Assessment Procedure Progress Review
*Complete assessment procedures for Student has achieved short-term
short-term objective 2A objective 2A
Teacher will observe student using November 1, 2014
anecdotal recording once a day and
tracking the number of times Dustin
is on task on a chart.
Self-monitoring using a sticker
chart/calendar where Dustin will
place a sticker for every 10 minutes
he is on task.
*Complete assessment procedures for Student has achieved short-term
short-term objective 2B objective 2B
Teacher will observe student using February 1, 2015
anecdotal recording once every two
days and tracking the number of
times Dustin is on task on a chart.
Self-monitoring using a sticker
chart/calendar where Dustin will
place a sticker for every 10 minutes
he is on task.
*Complete progress review for short- Student has achieved short-term
term objective 2C objective 2C
Teacher will observe student using June 1, 2015
anecdotal recording once a week and
tracking the number of times Dustin
is on task on a chart.
Self-monitoring using a sticker
chart/calendar where Dustin will
place a sticker for every 10 minutes
he is on task.
IPP Assignment Template 6

Planning for Transition *Entire section completed for Assignment Part 1.

*List any skills that need to be developed or supports that need to be in place for future settings (e.g., future grades,
post high school) and any relevant notes related to transitions within the regular school day (e.g., between classes,
teachers, etc.).
Due to Dustin’s hyperactivity/impulsivity he has trouble following school rules and routines. He requires frequent
verbal cues and reminders from teachers. All future teachers working with Dustin should become familiar with the
aspect of his support plan that worked well this year. Mr. Hoppins will work on developing skills in order to help with
his difficulty paying attention and staying on task.

There is concern with Dustin’s writing skills (letter formation, capitalization, punctuation, spacing and spelling). Mr.
Hoppins will work on further developing these writing skills. Dustin would benefit from writing tools other than paper
and pencil like developing typing skills and allowing him to use a computer to type responses. Also as Dustin moves
through the grades, he can use more specific assistive technology (example: voice to text software). Dustin would also
benefit from day timers and electronic calendar.

Year-End Summary

*Not required for the assignment.

*IPP template modified from Alberta Education (2006). Alberta Education (2006).
Individualized program planning (IPP) ECS to grade 12: Working through the IPP
process.