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INDIVIDUALIZED EDUCATION PROGRAM: PRESENT LEVEL
OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Form I-4 (Rev. 10/06)
Name of Student Trina Forest
DOB 2/12/1999
Duration of IEP12/12/2012 to 12/11/2013
Describe the student’s strengths and the concerns of the parents about the student’s education.
Strengths:
 Very Cooperative
 Enthusiastic
 Friendly
 Participates in all team activities and warm ups
 Completed all tasks ask of her during her evaluation
 Works very well with peers and paraprofessional
 Knowledge of basic locomotor skills
 Can work independently
 Listens well to directions from classmates
 Eager to participate
 Have good relationships with her peers
 Responds well to reinforcement and praise
 Great stationary balance skills
Parental Concerns:
 Distracted easily
 Unmotivated in physical education
 Due to Fragile X, impacting her performance in sport and fitness skills
 Displays moderate motor deficit
 Uncomfortable with sport and fitness skills
 Continual development of balance such as shifting her weight
Describe the student’s present level of academic achievement and functional performance including how the
student’s disability affects his or her involvement and progress in the general education curriculum. For
preschool children, describe how the disability affects involvement in age-appropriate activities. (Note: Present
level of performance must include information that corresponds with each annual goal)
Trina is a student who works well with her peers and completes all tasks asked of her. Trina listens well
to her classmates instruction and always participates in team activities and warm ups. Trina listens well to
directions from her teacher and can work independently as well on her own. She is eager to participate and
responds well to positive reinforcement. She is an enthusiastic girl who is very friendly and cooperative.
After assessing Trina with the CTAPE, which is the Competency Test of Adapted Physical Education,
this measures Trina’s skills in sport and fitness commonly included in the physical education curriculum. This
evaluation was completed in one day and Trina was very cooperative throughout the assessment. However,
certain times during the assessment, the equipment and the people around her would distract Trina. Trina
required frequent verbal prompting, physical prompting and demonstration. Due to Trina’s Fragile X syndrome,
she displays autistic tendencies, which can pull her attention away from activities.
Trina has great understanding of basic locomotor movements but due to her Fragile X syndrome, she
needs improvement in the areas of sport skills and fitness skills. Trina displays moderate motor deficit and is
eligible for adapted physical education. Due to her need of improvement in sport and fitness skills, Trina is
uncomfortable in participating in these activities. In the overhead pass skill with a score ranging from a 0,
which is the lowest, to 24 the highest, Trina scored a 1. During the evaluation of the overhead pass, she was
distracted and did not begin in a ready position. Trina slapped at the ball instead of using her fingertips to
contact the ball. Her wrist and fingers did not flex on contact and there was no follow through at the end. With
Trina’s evaluation on the volleyball serve with a high score of 36, Trina scored a 2. Trina did keep her legs in
opposition and flexed. She also did not transfer her weight to the balls of her feet or extend her legs for power.
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Trina will need improvement on her catching skills as well. Due to Trina’s Fragile X syndrome, she
needs further development on balance while moving and shifting her weight in any direction. This resulted in
her continue development to catch a softball thrown from 40 feet scoring a 0 out of 5. Trina needs improvement
on catching a football at a stationary position as well as in motion. On both skills, she scores 0 out of 6 with the
stationary catch, and a 0 out of 5 on the moving catch. Trina would continually step away from the ball when a
it was thrown at her and can be due to a visual impairment.
Due to Trina’s Fragile X syndrome, Trina will need further development on her fitness skills such as
her sit and reach, which measure her flexibility. She was unable to keep her legs full extended for any length of
time. Trina scored of 5 out of 12 with her windmills, which also measures her flexibility. Trina was unable to
touch her hands to her opposite feet with verbal prompts. Moving to muscular strength, Trina was unable to
perform a push up scoring 2 out of 6.Trina would get into a prone position however could not hold herself there
for more than a second. Trina could not lower herself to the ground and lift herself back up. Trina also scored a
11 of her sit ups meaning she could perform 11 sit ups in a 1 minute span. Due to Trina’s reduced enjoyment in
fitness and sports skills, she struggles to participate in these activities for long periods.
Will the student be involved full-time in the general education curriculum or, for preschoolers, in ageappropriate activities? X Yes
□ No
Provide Trina with team-teaching with paraprofessional.
Establish peer tutoring program during activities that involve team work to further Trina’s interesting
working with her peers.
(If no, describe the extent to which the student will not be involved full-time in the general curriculum or,
for preschoolers, in age-appropriate activities)
The student will participate in an alternate or replacement curriculum that is aligned with alternate achievement
standards in: (check all that apply)
___ Reading ___ Math ___ Language Arts ____ Science ____ Social Studies
___ Other (specify):
SPECIAL FACTORS After consideration for special factors (behavior, limited English proficiency, Braille
needs, communication needs including deaf/hard of hearing, and assistive technology), is there a need in any of
the areas?
□ Yes □ No (If yes or student has a visual impairment, attach I-5, “Special Factors” page)
INDIVIDUALIZED EDUCATION PROGRAM
ANNUAL GOAL
Form I-6 (Rev. 10/06)
Name of Student Trina Forest
Measurable annual academic or functional goal to enable the student to be involved in and progress in the
general education curriculum, and to meet other educational needs that result from the student’s disability.
(Note: present levels of academic achievement and functional performance must include information that
corresponds with each annual goal)
Upon review: □ Goal met □ Goal not met
1. Trina will catch a beeped baseball thrown overhand from a partner with her hands only 10 feet away 3
out of 5 times.
a. Trina will catch a bounced basketball from a partner with her hand only from 10 feet away 3
out of 5 times.
b. Trina will catch a beach ball underhand thrown from a partner with her hands only 5 feet away
3 out of 5 times.
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2. Trina will perform 10 modified pushups on her knees in a 2 minute trial 3 out of 5 times.
a. Trina will hold herself in a barrel walk position with a partner holding her feet for 15 seconds 3
out 5 times.
b. Trina will hold herself in a plank position for 30 seconds 3 out of 5 times.
3. Trina will hold 4 inches increase on the sit and reach test for 5 seconds 3 out of 5 times.
a. Trina will complete 5 stretches off of a list of 10 choices holding each stretch for 20 seconds 3
out of 5 times.
b. Trina will complete 5 yoga poses off a list of 10 choices for a duration of 30 seconds each pose
3 out of 5 times
Procedures for measuring the student’s progress toward meeting the annual goal.
 Rubrics
 Checklists
 Digital Video
 Digital pictures
Will the student participate in an alternate assessment aligned with alternate achievement standards for students
with disabilities in any subject area? □ Yes
□ No
(If yes, include benchmarks or short-term objectives for the student)
When will reports about the student’s progress toward meeting the annual goal be provided to parents?
 Progress reports will be sent home every 9 weeks.
IEP Checklist:
X=Not Met
M=Mastered
12/26/2012 12/31/2012 1/02/2012
Student
Name/Objective
Trina Forest
Catching
beeping baseball
10 feet away
Fitness: 10
modified
pushups
Sit and Reach
I=In Progress
1/07/2013
1/21/2013
1/29/2013