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In this qualitative comparative case study, we drew from institutional theory and cultural historical activity theory to explore how educators wrote, implemented, and perceived the use of Individualized Education Programs (IEPs) for students with specific learning disabilities in secondary inclusive settings. We found that the students’ IEPs were tightly coupled with the general education curriculum, but loosely coupled to instruction. We also found that each of the schools had unique practices for implementing and monitoring IEPs, which were tightly coupled to the school’s organizational structures for providing inclusive education. So much so, the schools’ organizational models for providing inclusion essentially drove the educational supports students received, not the institutionalized structure of the students’ IEPs.