INDIVIDUALIZED EDUCATION PROGRAM (IEP)
SAU or CDS Site: Sampaguita Integrated School
Date IEP Sent to Parent: 02/15/2025
1. CHILD INFORMATION
Child’s Name: Student A Age: 12 Annual Date of IEP: 02/10/2025
Date of Birth: 03/07/2013 Grade: 5th Effective Date of IEP: 02/19/2025
School/ Program: Sampaguita Integrated School – SPED Date of Next Annual IEP Meeting:
Program 02/10/2026
Parent/ Guardian name: Jamie A. Date of Re-Evaluation: 02/10/2028
Child’s Address: 124 Mabini Street Date(s) of Amended IEP: N/A
City, State, ZIP: Quezon City, Metro Manila, 1100 Case Manager: Ma’am Faith R.
State Agency Client? ☐ YES ☒ NO
2. DISABILITY
☐Autism ☐Deaf- blindness Deafness ☐Developmental delay (3-5)
☐Developmental delay (kindergarten) ☐Emotional disturbance ☐Hearing impairment ☐Intellectual disability
☐Visual impairment (including blindness) ☐Other health impairment ☐Orthopedic impairment ☐Speech or language disability
☐Specific learning disability ☐Traumatic brain injury ☐Multiple disability (list concomitant
disabilities)
3. CONSIDERATIONS – INCLUDING SPECIAL FACTORS
A. Concerns of the parents for enhancing the education of their child (MUSER IX.3.C.(1)(b)):
Student A’s parents are concerned about social interaction, communication, and mathematical concerns. They want support for building
independence and communication skills.
B. Does the child exhibit behavior that impedes the ☒Yes ☐No C. Does the child have limited English Yes ☐No
child’s learning or that of others? proficiency? (MUSER IX.3.C.(2)(b))
(MUSER IX.3.C.(2)(a))
Does the child have language needs due to limited ☒Yes ☐No
Does the child need positive behavioral ☒Yes ☐No English proficiency which must be addressed in the
Interventions and supports and other IEP?
Strategies to address the behavior?
If yes, where is this addressed in the IEP?
If yes, where is this addressed in the IEP? Learning goals, Teaching Strategies, Communication
Section 7: Behavioral supports, accommodations, goals accommodation
D. If the child is blind or visually impaired, does the ☐Yes ☒No E. Does the child have communication needs? ☒Yes ☐No
child require instruction in Braille and the use of (MUSER IX.3.C.(2)(d))
braille? (MUSER IX.3.C.(2)(c))
Is the child deaf or hard of hearing? ☒Yes ☐ No
Does the child have a print disability that require. ☐ Yes ☒No
accessible educational materials (AEM) to If yes, where is this addressed in the IEP?
access the curriculum? (MUSER IX.3.C.(2)(c)) Speech therapy goals, visual supports, communication
accommodations, teaching strategies
If yes, what type of accessible educational
materials (AEM) does the child require?
Visual schedules, simplified text, graphic organizers, audio supports
If yes, where is this addressed in the IEP?
Section 7: Accommodations
F. Does the child need assistive technology devices ☒Yes ☐No G. Does the child have academic needs? ☒Yes ☐No
and services? (MUSER Ix.3.C.(2)(e))
If yes, where is this addressed in the IEP?
If yes, where is this addressed in the IEP? writing goals; support in math problem-solving; curriculum
Assistive communication device (AAC), iPad for visuals — listed in modifications
accommodations
Does the child have functional/developmental ☒Yes ☐No
needs?
If yes, where is this addressed in the IEP?
Daily living skills, communication goals, social skills training.
SECONDARY TRANSITION
Is the child in 9th grade or above? ☐Yes ☒No If yes, Section 10 should be completed before completing the
remainder of the IEP.
Is the child 16 or older? ☐Yes ☒No If yes, Section 10 should be completed before completing the
remainder of the IEP.
4. RESULTS OF ALL INITIAL EVALUATION OR MOST RECENT EVALUATION OF THE CHILD.
Results of evaluations:
KTEA Kaufman Test of Educational Achievement – January 2025 (85–115 is average range)
Standard Scores 95% Confidence Interval Percentile Rank
Reading Composite
Reading Comprehension 80 71-85 9th
Letter/Word Recognition 79 71-84 7th
Reading Fluency 78 70-83 7th
Writing Composite
Written Expression 70 71-83 6th
Spelling 81 73-82 9th
Math Composite
Math Concepts & Applications 90 81-93 21st
Math Computation 92 81-95 22nd
Hearing Assessment Summary:
Diagnosis: Bilateral Profound Sensorineural Hearing Loss (Deaf)
Audiometric Evaluation Results:
Frequency (Hz) Right Ear (dB HL) Left Ear (dB HL)
250 90 95
500 100 100
1000 110 110
2000 110 115
4000 105 110
8000 100 105
Overall Hearing Loss Percentage:
Right Ear: 98%
Left Ear: 99%
(Based on standard hearing loss calculation models)
Teaching Strategies:
-Use visual aids (charts, images, videos with captions)
-Incorporate sign language (ASL or local sign systems)
-Provide written instructions for clarity
-Use assistive technologies (e.g., captioning tools, hearing devices)
-Create a quiet, distraction-free environment
-Pair with interpreters or note-takers if needed
-Encourage peer support and collaboration
