UC - Denver 1380 Lawrence Street

Individualized Education Program Denver, CO 80204

(303) 555-1212

Antonio Brico 04/01/2005 April 26, 2019

Legal Name of Student DOB LASID SASID IEP Meeting Date

TYPE OF MEETING
Individualized Education Program
Initial IEP - School Age

DATES OF MEETINGS
Next eligibility meeting (on or before): Next review meeting (on or before): 4/24/2020
Initial eligibility: Initial consent for evaluation:
Initial evaluation completed: Initial consent for service:

STUDENT AND FAMILY INFORMATION

Prior to Meeting After Meeting
Home District UC - Denver UC - Denver
Home School UCD - Elementary UCD - Elementary
Service District UC - Denver UC - Denver
Service School UCD - Elementary
Primary Disability
Secondary Disability
Least Restrictive
Environment

Grade: 5th Age: 14y 0m Gender: Male

Race: Ethnicity: Not Hispanic/Latino

Primary Language Spoken in the Home: Student’s Primary Language:
Does the student have Limited English Proficiency? No

Parent Contact Information

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Antonio Brico 04/01/2005 April 26, 2019
Legal Name of Student DOB LASID SASID IEP Meeting Date

PROCEDURAL SAFEGUARDS
I have been provided the special education procedural safeguards in my native language or other mode of communication
on 4/16/2019.

Parent Signature IDEA 300.504(a) Date

Parent Signature IDEA 300.504(a) Date

IEP PARTICIPANTS

Student Parent 2nd Parent

IDEA 300.321(a)(7) and 300.321(b)(1) IDEA 300.321(a)(1) IDEA 300.321(a)(1)

Special Education Director or Designee General Education Teacher Special Education Teacher/Provider
IDEA 300.321(a)(4)(i)-(iii); ECEA 4.03(5)(a) IDEA 300.321(a)(2) IDEA 300.321(a)(3)

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Antonio Brico 04/01/2005 April 26, 2019
Legal Name of Student DOB LASID SASID IEP Meeting Date

PRESENT LEVELS OF ACADEMIC ACHIEVEMENT & FUNCTIONAL PERFORMANCE

INCLUDING INPUT FROM PARENT & STUDENT
Student Strengths, Preferences, Interests
What are the student’s education/developmental strengths, interest areas, significant personal attributes and personal
accomplishments as indicated by formal or informal assessment? Be sure to include specific feedback from the student.
IDEA 300.324(a)(i) strengths of child
IDEA 300.321(b)(2) preferences and interests
Ben is an active 5th grade boy. He loves to play with his friends and be outside whenever possible. From the conversations that we
have had together, I learned that he is an avid soccer player and fan. Not only does he play soccer at recess, but he is also on a
competitive team. Additionally, during the winter months, Ben and his family spend quality time in the mountains skiing. Ben is a
very genuinely kid student. He is social and welcoming to all other student. One of his strengths is the desire to do well at all activities
including academics. He advocates for himself for the support and resources he needs. Ben also advocates for other students if
necessary.

Present Levels of Educational Performance Summary

Include results of initial or most recent evaluation, including, if appropriate, the results of any interventions, progress
monitoring and gap analyses.
IDEA 300.320(a)(1) present levels of academic achievement and functional performance
IDEA 300.324(a)(iii) Results of initial or most recent evaluation
Ben is working hard within the general education classroom with respect to his reading comprehension. Grade level novels and
content material continue to be a struggle, and Ben requests and uses some necessary accommodations to access the curriculum.
According to an instruction level score of 28 on the DRA and an overall 10th percentile on the GORT-5, Ben is performing below
grade level.

Student Needs and Impact of Disability

How does the student’s disability affect his involvement and progress in the general curriculum and participation in
appropriate activities?
IDEA 300.324(a)(ii) concerns of parent
IDEA 300.324(a)(iv) communication needs
IDEA 300.320(a)(1)(i) How the child’s disability affects the child’s involvement and progress—in the general curriculum and participation
in appropriate activities

Parent/Student Input
IDEA 300.324(a)(1)(ii) concerns of parent

CONSIDERATION OF SPECIAL FACTORS

The student does not exhibit behavior that requires a Behavior Intervention Plan. 300.324(1)(2)(i)
The student is not deaf-blind. 300.324(1)(2)(iii) & 300.324(a)(2)(iv)
The student is not deaf or hard of hearing. 300.324(a)(2)(iv)
The student is not blind or visually impaired. 300.324(1)(2)(iii)
The student does not require a Health Care Plan.
The student does not have Limited English Proficiency. 300.324(a)(2)(ii)
The student does not need Assistive Technology devices or services. 300.324(a)(2)(v)
The student does not require Special Transportation. 300.34 Related Services (a); 300.34 (c)(16); 300.107(b)

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Antonio Brico 04/01/2005 April 26, 2019
Legal Name of Student DOB LASID SASID IEP Meeting Date

ANNUAL GOALS IDEA 300.320(a)(2)(i)

Progress Report (Describe how parents will be informed of Antonio’s progress towards goals and how frequently
this will occur.) IDEA 300.321(a)(3)(iii)
Parents will receive progress reports each trimester, three times a year typically when report cards are sent home.

Goal 1
Area of Need: Reading
Projected Achievement Date: 4/24/2020
ESY: No
Unit of Measurement: Percentage Correct
Baseline Data Point: 66%
Evaluation Method: Monitor and Chart Progress
Measurable Goal:
Given core, grade-level instruction in reading and small group intervention, Ben will answer questions about a text he read
from 66% on a grade 2 passage to a 100% on a grade 4 passage measured by a progress monitoring tool by the next annual
review.

Standards:
 2 Reading for All Purposes // 1 Literary texts are understood and interpreted using a range of strategies
// Evidence Outcomes // a Use pre-reading strategies, such as identifying a purpose for reading, generating
questions to answers while reading, previewing sections of texts and activating prior knowledge
 2 Reading for All Purposes // 1 Literary texts are understood and interpreted using a range of strategies
// Relevance and Application: // 1 Comprehension skills help us question the author’s purpose and view the
world with a critical eye (using persuasion to influence our decisions and choices).

ACCOMMODATIONS & MODIFICATIONS

Accommodations
What type(s) of accommodations(s) if any is (are) necessary for the student to access the general curriculum
and/or appropriate activities to make effective progress?

IDEA 300.320(a)(4)(i)-(iii)
IDEA 300.320(a)(6)(i)

 Oral presentation (text to speech)

 Extra time

 Adjust homework and class assignments as needed

 Frequent breaks

 Audiobooks to access grade level text

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Antonio Brico 04/01/2005 April 26, 2019
Legal Name of Student DOB LASID SASID IEP Meeting Date

Modifications
No curricular modifications were identified by the team.

EXTENDED SCHOOL YEAR DETERMINATION IDEA 300.106

Summarized findings based on completion of the ESY Predictive Factors.
The student did not experience severe regression on his IEP goals and objectives.

The student did not require an unreasonably long period of time to relearn previously learned skills.

Predictive factors do not indicate the need for ESY services.

It has been determined that the student is not eligible for extended school year services.

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Antonio Brico 04/01/2005 April 26, 2019
Legal Name of Student DOB LASID SASID IEP Meeting Date

STATE AND DISTRICT ASSESSMENTS

Accommodations and modifications must reflect those used in daily classroom instruction

District Assessments
Test Participation Accommodations 300.320(a)(6)(i)
Reading Regular

Writing Regular

Math Regular

Science Regular

Social Studies Regular

Other

State Assessments
Test Participation Accommodations 300.320(a)(6)(i)
CMAS: English Language Arts Yes  Unique: Auditory Presentation : Human
Reader/Text-to-Speech (Requires CO UAR)
 Extended time (time and a half)
 Speech to text (constructed/selected response)
 Word prediction external device
CMAS: Math Yes  Extended time (time and a half)
 Speech to text (constructed/selected response)
 Word prediction external device
CMAS Science and Social Studies Yes  Speech to text (constructed/selected response)
 Word prediction external device
PSAT 10

SAT

CoALT: Math No

CoALT: Science/Social Studies No

CSLA Reading No

ACCESS for ELLS (Online, Paper, No

Kindergarten)
ACCESS for ELLs Alternate No

If the IEP Team has determined that the student qualifies for alternate assessments, parents have been informed
about the differences between regular and the alternate assessments (both state and district) and the effects of

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Antonio Brico 04/01/2005 April 26, 2019
Legal Name of Student DOB LASID SASID IEP Meeting Date

these, if any (including that, for students taking alternate assessments, achievement will be measured based on
alternate achievement standards): Yes

SERVICE DELIVERY STATEMENT

Statement of types and anticipated location of services to be provided to and on behalf of the student:
Primary Service Provider:

Special
Specialized Instruction Education Service
Area and/or Related or Provider Role Start Date End Date
Services 300.320(a)(4) Related 300.18 & 300.320 300.320 Frequency of Special
Include ESY if applicable Location Services ECEA 3.04 (a)(7) (a)(7) Education/Related Services
Direct/
Minutes Frequency
Indirect

4/29/19 4/24/20

RECOMMENDED PLACEMENT IN THE LEAST RESTRICTIVE ENVIRONMENT (SPECIAL

EDUCATION SETTING) IDEA 300.320(a)(5)
Placement Options Considered
General education class at least 80% of the
time
Describe the possible advantages and
disadvantages of this placement option for the
Selected student and the modifications/supplementary
aids and services considered to reduce possible
disadvantages to the student.
Ben needs support within all to areas, but he is able to
access grade level material with supports and it is more
beneficial for Ben to continue access the grade level
curriculum. Ben will continue to receive support outside of
Yes
the classroom, but for the 5th grade school year it will be
three days a week for 40 minutes so it is a minimal amount
of time away from his peers.

Placement Date: 04/29/2019 Placement Type:Ages 6-21

LRE Setting:
 Time in general education environment: 100.0%
 Time outside general education environment: 0.0%

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Antonio Brico 04/01/2005 April 26, 2019
Legal Name of Student DOB LASID SASID IEP Meeting Date

PRIOR WRITTEN NOTICE IDEA 300.503

The IEP includes services to be provided to assist your child to make progress. The Present Level of Academic
Achievement and Functional Performance includes information about the data used as a basis for the decisions recorded
in the IEP.

Other options considered and reasons rejected:

Other factors considered:
Case Manager Contact Information

/
Name/Title Phone

Parents of a child with a disability have protection under the procedural safeguards. For a copy of the Procedural
Safeguards or assistance in understanding this information, please contact the person named above. IDEA
300.503(b)(4)

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