Educators and families develop individualized education programs (IEPs) to address unique needs of individual students with disabilities. Addressing all student needs is critical to ensuring students receive a free and appropriate public education. To understand how IEP teams address the needs of students with complex support needs, we examined the alignment of IEP goals and supplementary aids and services with the stated needs of 112 elementary students with complex support needs as reported in their present levels of academic achievement and functional performance. We found there was a large amount of variation in alignment, but that 32.76% of stated student needs were not addressed by goals or supplementary aids and services. Neither educational placement nor type of student need was statistically significant in terms of whether a student need was addressed in the IEP. These findings suggest a serious threat to a student's right to a free and appropriate public education. Implications for practice and research are discussed.