Student Name: KY IEP, Page 1
DOB: Date of ARC:
Individual Education Program (IEP)
Plan Information
Meeting Date: Start Date: End Date:
Special Ed Status: Special Ed Setting:
Primary Disability:
Student Information
Student Name: DOB: Student Number:
Address: District of Residence:
School of Attendance: Grade: Gender: Race (Ethnicity Code):
Present Level of Academic Achievement and Functional Performance
Present Levels of Academic Achievement and Functional Performance, including how the disability affects the student's
involvement and progress in the general curriculum:
(For preschool children include the effect on participation in appropriate activities. Beginning in the child's 8th grade year or when the child has
reached the age of 14, a statement of transition needs is included.)
Communication Status
☑ Performance commensurate with similar age peers
Academic Performance
☑ Performance commensurate with similar age peers
Health, Vision, Hearing, Motor Abilities
☑ Not an area of concern at this time
Social and Emotional Status
☑ Performance commensurate with similar age peers
General Intelligence
☑ Performance commensurate with similar age peers
Functional Vision/Learning Media Assessment
☑ Not an area of concern at this time
Functional Hearing, Listening, & Communication Assessment
☑ Not an area of concern at this time
KY IEP (Revised 6/2016)
,Student Name: KY IEP, Page 4
DOB: Date of ARC:
Present Level of Academic Achievement and Functional Performance
Transition Needs
☑ Not an area of concern at this time (Checking this box is not an option when the student is in the 8th Grade
or 14 years or older because transition must be addressed for these students)
☑ Instruction
☑ Related Services
☑ Community Experiences
☑ Employment
☑ Daily Living Skills
☑ Post School Adult Living Objectives
☑ Functional Vocational Evaluation
Transition Services Needs
(Beginning in the child's 8th grade year or when the child has reached the age of 14 and thereafter)
What transition assessments were used to determine the child's preference and interests?
☑ Student Interview
☑ Student Survey
☑ Interest Inventory
Needs Related to The Course of Study - See Present Levels of Performance
☑ The Multi Year Course of Study is included with this IEP.
☑ The Multi Year Course of Study has been uploaded and attached.
Do transition service needs focus on the child's course of study and are they addressed in the Present
Levels?
☑ Yes
☐ No
Postsecondary Goal(s)
(By age 16, or younger if appropriate, and thereafter)
Postsecondary Goal(s) Related to Education/Training & Employment
After high school, the goal is to enroll in a vocational training program to be able to work as a medical technician.
Transition Service Agency Responsible
Vocational Training Vocational Rehabilitation
Career Counseling School Counselor
KY IEP (Revised 6/2016)
, Student Name: KY IEP, Page 5
DOB: Date of ARC:
Job Shadowing Local Business / Mentorship Program
Internships Workforce Development Agency
College/University Enrollment Assistance College/University Disability Services
Course of Study
Proposed courses of study to assist the student in reaching the measurable postsecondary goals.
Grade: Grade: Grade: Grade:
9th Grade Introduction to Healthcare Basic healthcare skills, Supports career goal of
anatomy, medical becoming a medical
terminology technician
10th Grade Computer Science for Introduction to medical Helps with technical skills for
Healthcare software and data medical technician role
management
11th Grade Vocational Skills Training Hands-on training in Provides real-world
healthcare settings (e.g., experience for employment
medical office) goal
12th Grade Advanced Medical Study of medical devices, lab Prepares for postsecondary
Technology procedures, and safety training in medical
protocols technology
12th Grade Career Preparation and Job Resume building, job search Ensures readiness for
Readiness techniques, and interview employment in medical field
skills
12th Grade Health Occupations Clinical placements or Direct experience for career
Education internships in local healthcare goal as a medical technician
facilities
Transfer of Rights at Age of Majority
If applicable, one year before the student reaches age 18 the student and parent have been informed of the student's rights under Part B of the
Individuals with Disabilities Education Act, if any, that will transfer on reaching the age of majority.
Date student was first informed of the transfer of rights:
Consideration of Special Factors for IEP Development
(The ARC MUST address each question below and consider these issues in the review and revision of the IEP.)
Does the child's behavior impede his/her learning or that of others?
☑ Yes
☐ No
Description of strategies to address behavior:
A Behavior Intervention Plan (BIP) will be implemented, focusing on reinforcing positive behaviors
such as active participation in classroom activities and respectful communication.
Positive reinforcement, such as praise and reward systems, will be used to motivate and reward desired
KY IEP (Revised 6/2016)
DOB: Date of ARC:
Individual Education Program (IEP)
Plan Information
Meeting Date: Start Date: End Date:
Special Ed Status: Special Ed Setting:
Primary Disability:
Student Information
Student Name: DOB: Student Number:
Address: District of Residence:
School of Attendance: Grade: Gender: Race (Ethnicity Code):
Present Level of Academic Achievement and Functional Performance
Present Levels of Academic Achievement and Functional Performance, including how the disability affects the student's
involvement and progress in the general curriculum:
(For preschool children include the effect on participation in appropriate activities. Beginning in the child's 8th grade year or when the child has
reached the age of 14, a statement of transition needs is included.)
Communication Status
☑ Performance commensurate with similar age peers
Academic Performance
☑ Performance commensurate with similar age peers
Health, Vision, Hearing, Motor Abilities
☑ Not an area of concern at this time
Social and Emotional Status
☑ Performance commensurate with similar age peers
General Intelligence
☑ Performance commensurate with similar age peers
Functional Vision/Learning Media Assessment
☑ Not an area of concern at this time
Functional Hearing, Listening, & Communication Assessment
☑ Not an area of concern at this time
KY IEP (Revised 6/2016)
,Student Name: KY IEP, Page 4
DOB: Date of ARC:
Present Level of Academic Achievement and Functional Performance
Transition Needs
☑ Not an area of concern at this time (Checking this box is not an option when the student is in the 8th Grade
or 14 years or older because transition must be addressed for these students)
☑ Instruction
☑ Related Services
☑ Community Experiences
☑ Employment
☑ Daily Living Skills
☑ Post School Adult Living Objectives
☑ Functional Vocational Evaluation
Transition Services Needs
(Beginning in the child's 8th grade year or when the child has reached the age of 14 and thereafter)
What transition assessments were used to determine the child's preference and interests?
☑ Student Interview
☑ Student Survey
☑ Interest Inventory
Needs Related to The Course of Study - See Present Levels of Performance
☑ The Multi Year Course of Study is included with this IEP.
☑ The Multi Year Course of Study has been uploaded and attached.
Do transition service needs focus on the child's course of study and are they addressed in the Present
Levels?
☑ Yes
☐ No
Postsecondary Goal(s)
(By age 16, or younger if appropriate, and thereafter)
Postsecondary Goal(s) Related to Education/Training & Employment
After high school, the goal is to enroll in a vocational training program to be able to work as a medical technician.
Transition Service Agency Responsible
Vocational Training Vocational Rehabilitation
Career Counseling School Counselor
KY IEP (Revised 6/2016)
, Student Name: KY IEP, Page 5
DOB: Date of ARC:
Job Shadowing Local Business / Mentorship Program
Internships Workforce Development Agency
College/University Enrollment Assistance College/University Disability Services
Course of Study
Proposed courses of study to assist the student in reaching the measurable postsecondary goals.
Grade: Grade: Grade: Grade:
9th Grade Introduction to Healthcare Basic healthcare skills, Supports career goal of
anatomy, medical becoming a medical
terminology technician
10th Grade Computer Science for Introduction to medical Helps with technical skills for
Healthcare software and data medical technician role
management
11th Grade Vocational Skills Training Hands-on training in Provides real-world
healthcare settings (e.g., experience for employment
medical office) goal
12th Grade Advanced Medical Study of medical devices, lab Prepares for postsecondary
Technology procedures, and safety training in medical
protocols technology
12th Grade Career Preparation and Job Resume building, job search Ensures readiness for
Readiness techniques, and interview employment in medical field
skills
12th Grade Health Occupations Clinical placements or Direct experience for career
Education internships in local healthcare goal as a medical technician
facilities
Transfer of Rights at Age of Majority
If applicable, one year before the student reaches age 18 the student and parent have been informed of the student's rights under Part B of the
Individuals with Disabilities Education Act, if any, that will transfer on reaching the age of majority.
Date student was first informed of the transfer of rights:
Consideration of Special Factors for IEP Development
(The ARC MUST address each question below and consider these issues in the review and revision of the IEP.)
Does the child's behavior impede his/her learning or that of others?
☑ Yes
☐ No
Description of strategies to address behavior:
A Behavior Intervention Plan (BIP) will be implemented, focusing on reinforcing positive behaviors
such as active participation in classroom activities and respectful communication.
Positive reinforcement, such as praise and reward systems, will be used to motivate and reward desired
KY IEP (Revised 6/2016)
