Christopher Ries

EDUC 614
Case Study and IEP Max Fuentes
Educational Needs
The case study I chose was for a ninth grader named Max. The narrative is written by a history
teacher who will be teaching Max in the coming year. Max is a bright young man diagnosed with
PDD-NOS. Overall he is performing on grade level, but he has challenges in the areas of executive
functioning, social skills, and sensory integration.
Executive functioning:
While Max understands the academic material he is presented with, the Special Education team
describes that His weaknesses were in knowing what to study, remembering due dates, completing
assignments, and keeping track of his work and materials. These are typical of someone who has
poor executive functioning skills. The teachers reflection noted that they had an assignment
calendar and an electronic organizer on which teachers could record verbal directions. While these
are good tools to have, at present it is the responsibility of the teachers and staff to ensure that the
tools are being used. The goals I wrote are intended to help Max increase his independent use of
these tools instead of being reliant on others to organize his life for him. This will develop his
executive functioning skills in the areas of organizing, self-monitoring, and working memory.
For this IEP I would have liked to see an executive functioning specific assessment like the
Comprehensive Executive Functioning Inventory. The goals and interventions I wrote were based
on what was already available to Max. Using the CEFI would allow us to approach this issue from a
better angle. We would start by identifying the base skills that need developing and work up from
there, instead of guessing based on what tools are at hand.
Social Skills:
In this reflection, Maxs parents note that he has seemingly little interest in the people around him,
family or peers. There werent any inappropriate social behaviors listed, so it seems that there is
either a lack of social skills that is preventing him from forming bonds with others, or there is just a
lack of desire to do so. Given that PDD-NOS is part of the autism spectrum it is possible that one or
both are true. The goals I wrote are intended to help develop basic conversational skills on the
assumption that the desire to communicate is there, but knowledge of social conventions is missing.
As with the Executive Functioning, it would also have been helpful to have an assessment done in
this area, such as the TRIAD Social Skills Assessment. Identifying the specific skill gaps in social
communication would yield more productive goals and objectives.
Having typically developing peers as role models for appropriate social interactions is vital, so I have
kept Max in the regular education classroom for nearly all of his education. The only time I have
him pulled out is to do vocational planning with the schools career counselor.

Sensory:
The challenge continues in the area of sensory integration. Max has shown that he has sensory
needs, but there has only been anecdotal evidence as to exactly what those needs are. Parents noted
that as a youth Max had routines he needed to follow in new open spaces to feel comfortable there.
Perhaps Max was pinging and needed to physically walk the space to understand the size of the
places he was visiting. Whatever the issue may be, it is impacting his ability to navigate the school
as he will only follow one path through the building, regardless of destination.
Max also shows sensitivity to wearing socks and shoes he says that they are too hot. Again,
without a clear understanding of his needs it is challenging to create meaningful goals and objectives.
A sensory needs profile would help identify the issue so that more targeted interventions could be
implemented.
A Broader Look
The history teacher Gerry Calvin - who is describing Max seems overwhelmed at the potential time
and energy he would have to spend on Max. He is accustomed to making small changes in lesson
format as accommodations, and clearly hasnt dealt with teaching executive functioning skills. I
believe that having Max in his class will help this teacher improve how he teaches, as having
effective organizational skills is something that everyone can benefit from.
To address the teachers concerns about these interventions taking too much time, I have included
training time in the IEP. Gerry noted that in the past the district has provided a substitute for him
when he is in IEP meetings, so the intent is that the same thing will happen when he receives training
on the assistive technology as well as with executive functioning disorders.
In the description of the IEP meeting, the parents are described as hostile, but open to talking about
their sons diagnosis. Given that their son is higher functioning I could see this being a situation
where Maxs issues had been dismissed as occurring due to laziness or poor parenting. Hopefully
the dynamic between the school and family would improve with relevant training on Maxs
educational needs.

INVITATION TO A MEETING OF THE

INDIVIDUALIZED EDUCATION PROGRAM (IEP) TEAM
Form I-1 (Rev. 10/06)

Chileda Institute
[If you need this invitation in a different language or communicated in a different way, or have
questions about this invitation, please contact_Terri Knothe___ at _608-555-6480.]

Dear _Aaron Fuentes,

Date _11/1/15__

You are a participant on the IEP Team which will meet to address the educational needs of your child,
____Max Fuentes______________. IEP team meetings must be held at a mutually agreeable time and place.
An IEP team meeting has tentatively been scheduled for the following date __12/16/15___, time _1:00 PM_
and location _Chileda Institute 1825 Victory St, La Crosse, WI If these meeting arrangements are not
agreeable to you, please call _ Terri Knothe___ at __608-555-6480___. You may bring other people who you
believe have knowledge or special expertise about your child to the meeting with you. If your child is
transferring from a Birth to 3 Early Intervention Program we will, at your request, send to the Birth to 3
coordinator or other representative an invitation to the IEP meeting.
The purpose of this IEP team meeting is (check all that apply):
EVALUATION AND REEVALUATION
Determine initial eligibility for special education
Determine continuing eligibility for special education
INDIVIDUALIZED EDUCATION PROGRAM (IEP) (if student is eligible)
Develop an initial IEP
Develop an annual IEP
Review/revise IEP
Transition the consideration of postsecondary goals and transition services
(required for students beginning at age 14)

PLACEMENT (if student is eligible)

Determine initial placement
Determine continuing placement
OTHER
Review existing information to determine need for additional assessments or other evaluation
materials (meeting optional)
Conduct a manifestation determination (check appropriate boxes under IEP and placement if
changes in either are contemplated)
Determine setting for services during disciplinary change in placement (must also check
appropriate boxes under IEP & placement)
Specify: _______________________________________________________________
If transition is checked as one of the purposes of this meeting, your child will be invited to attend. Because
you provided your consent we are also inviting representatives from the following agencies who may assist in
the transition planning for your child:
None
________________________________________________________________________
Agency
Name (if known), and Title/Position
________________________________________________________________________
Agency
Name (if known), and Title/Position

If at any point during this meeting you or other IEP team participants believe that additional time is needed to
permit your meaningful involvement, additional time will be provided. Decisions related to the purpose(s)
checked above may be made in one meeting or may require more than one meeting, depending on individual
circumstances. In addition and upon request you may receive a copy of the IEP teams most recent evaluation
report.
The following individuals have been appointed as IEP team participants and will attend the meeting.

__Gerry Calvin_______________________
Name/Reg. Ed. Teacher

__Christopher Ries_______________________
Name/Sp. Ed. Teacher

__Rick Jones - Principal_________________

Name/LEA Representative

________________________________________
Name &Title

__Aaron Fuentes_______________________
Father

________________________________________
Name & Title

___Sylvia Swift________________________
Step-Mother

________________________________________
Name & Title

_____________________________________
Name & Title

________________________________________
Name & Title

You and your child have protection under the procedural safeguards (rights) of special education law. The
school district must provide you with a copy of your procedural safeguards once a year.

You received a copy of your procedural safeguard rights in a brochure about parent and child rights
earlier this year. If you would like another copy of this brochure, please contact the district at the
telephone number above.

A copy of the parent and child rights brochure is enclosed with this invitation.

In addition to district staff, you may also contact _Chris Neson- Student Rights Advocate__ at _608-555-6480
ext. 249____if you have questions about your rights.
Sincerely,
Scott Hahn Vice Principal 608-555-6480 ex. 222
Name and Title of District Contact Person

REQUEST TO INVITE OUTSIDE AGENCY REPRESENTATIVE(S)

TO THE INDIVIDUALIZED EDUCATION PROGRAM (IEP) MEETING
Form I-1-A (New 10/06)

Chileda Institute
[If you need this notice in a different language or communicated in a different way, or have
questions about this notice, please contact _Terri Knothe_________ at _608-555-6480___.]
Dear ___Aaron Fuentes_____________________________

Date _11/1/15_____________

A purpose of your childs upcoming individualized education program (IEP) meeting is to discuss his / her
post high school goals and the transition services needed to achieve those goals. We would like to invite
individuals or representatives from the following agencies who may assist with the transition planning
for your child.
Name, if known

Agency

___Aaron Rasch________________

__Independent Living Resources, La Crosse

________________________________

____________________________________

________________________________

____________________________________

Before we can invite these individuals or representatives the district needs your written consent
(permission).
Sincerely,
_ Scott Hahn Vice Principal 608-555-6480 ex. 222_____
Name and Title of District Contact Person
----------------------------------------------------------------------------------------------------------------------------- ------------------I understand the action proposed by the school district and
(Please check the appropriate box below, sign, date and return one copy of this request to the school
district)
I give my consent for all of the above identified individuals or representatives to be invited to
my childs IEP meeting. I understand that my consent is voluntary and may be revoked at
any time before the identified individuals or representatives have been invited.
I give my consent for the following above identified individuals or representatives to be invited
to my childs IEP meeting
_________________________________________________________________.
I do not give my consent for any of the above identified individuals or representatives to be
invited to my childs IEP meeting.
__Aaron Fuentes__________________________________
Signature of parent or legal guardian or adult student

__11/10/15__________
Date

You and your child have protection under the procedural safeguards (rights) of special education law. The school
district must provide you with a copy of your procedural safeguards once a year. Enclosed is a copy or earlier this
year you received a copy of your procedural safeguard rights in a brochure about parent and child rights. If you
would like another copy of this brochure, please contact the district at the telephone number above. In addition to
district staff, you may also contact _Chris Nelson Student Rights Advocate_ at _608-555-6480 ex.249_____ if you
have questions about your rights.

EVALUATION REPORT AND IEP COVER SHEET

Form I-3 (Rev. 10/06)

Name of Student
Max Fuentes

DOB
March 20, 2001

Sex
M

Parent or Legal Guardian

Aaron Fuentes, Father

Telephone (area/number)
608-577-6275

Grade
9

District of Residence
La Crosse

Current District of Placement

La Crosse

Race/Ethnic (if parent chooses to

identify)

Address
1500 Cass Street, La Crosse, WI

For students transferring between public agencies:

IEP reviewed and adopted by ________________________________________________
On _____________________________________________
For students transferring between public agencies:
Evaluation report reviewed and adopted by _____________________________________
On _____________________________________________

PURPOSE OF MEETING (Check all that apply):

Evaluation including determination of eligibility

Initial or annual IEP development

IEP review/revision

Develop a statement of transition goals and

services (required for students age 14 and older,
or younger if appropriate)

Placement

Manifestation determination

Alternate assessment

Determine setting for services during

disciplinary change in placement

Other: _____________________________

Other: _____________________________

If a purpose of this meeting is IEP development, review, and/or revision related to the academic,
developmental and functional needs of the child, the IEP team considered the results of:
Initial or most recent evaluation
Statewide assessments
District-wide assessments

Yes
Yes
Yes

Not applicable
Not applicable
Not applicable

Date of Meeting: ___December 16, 2015____________________________

(month/day/year)

IEP Team Participants Attending or Participating by Alternate Means in the Meeting:

Parent/Guardian

Regular education teacher/title:

Regular education teacher/title:

Student (if appropriate):

Special education teacher/title:

Special education teacher/title:

LEA Representative/Title:

Other:

Other:

Other:

Other:

Other:

If the parent did not attend or participate in the meeting by other means and did not agree to the time and place of the IEP
team meeting, document 3 efforts to involve the parents:

INDIVIDUALIZED EDUCATION PROGRAM: PRESENT LEVEL

OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
Form I-4 (Rev. 9/13)

Name of Student __Max Fuentes____________________

Describe the students strengths and the concerns of the parents about the students education.
Max is a ninth grade student who loves everything relating to history. He is a passionate learner when it
comes to historical wars and battles, and will independently learn about this topic when he has time to do so.
He has a strong memory when it comes to learning particular details, but he has difficulty with the executive
functioning skills of self-monitoring, organization, and planning and prioritizing. In this way Max often
seems like an aloof professor great at his content knowledge but lacking in organization.
Maxs parents are concerned about his lack of social bonds, both within the family and without. Max doesnt
seem to notice the absence of his family members and this apparent lack of concern has been difficult for both
parents and siblings. Max does not seem to have any strong peer bonds at school either.
Max has sensory issues that make navigating the world around him a challenge. He has a hard time
navigating through the school in novel ways, and will only retrace familiar routes to get to the places he needs
to go.
Describe the students present level of academic achievement and functional performance including how the
students 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)

Due to his diagnosis, Max is unable to use planning, self-monitoring, planning and prioritizing, and
organizational skills. This impacts his ability to learn independently and at the same pace of his peers.

Will the student be involved full-time in the general education curriculum or, for preschoolers, in ageappropriate activities? Yes
No
(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)

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

SPECIAL FACTORS
Form I-5 (Rev. 7/06)

Note: For any need(s) identified below, there must be a statement of the service(s) to meet that need (including
amount/frequency, location, and duration) on the Program Summary page (I-9).

Name of Student_Max Fuentes_____________________________

A. Does the students behavior impede his/her learning or that of others?
Yes No
(If yes, include the positive behavioral interventions, strategies, and supports to address that behavior)

B. Is the student an English Language Learner?

Yes No
(If yes, include the language needs that relate to this IEP)

C. If visually impaired, does the student need instruction in Braille or the use of Braille?
Yes
No
Cannot be determined at this time
(If yes, include Braille needs; if no or cannot be determined, attach ER-3, Determining Braille
Needs from the latest evaluation/reevaluation)

D. Does the student have communication needs that could impede his/her learning?
(If yes, include communication needs)

Yes

No

{If yes and the student is deaf or hard of hearing, identify the communication needs including (a) the students language;
(b) opportunities for direct communication with peers and professional personnel in the students language and
communication mode; and, (c) academic level and full range of needs including opportunities for direct instruction in the
students language and communicative mode}:

E. Does the student need assistive technology services or devices?

{If yes, specify particular device(s) and service(s)}

Yes

No

Audio recordings of textbooks, audio recorder for voice directions on assignments.

INDIVIDUALIZED EDUCATION PROGRAM

ANNUAL GOAL
Form I-6 (Rev. 10/06)

Name of Student _Max Fuentes________________________

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 students 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
Executive Functioning Goal:
Max will increase his organizational skills by completing his academic tasks on time from a current rate of
40% to a level of 70%
Benchmarks:
Max will fill his calendar out after each class from a current rate of 30% to a level of 70%
Max will use his calendar to identify academics that he needs to complete by the following day from a
current rate of 30% to a level of 70%
When prompted, Max will be able to locate his work and materials in his backpack from a current rate
of 30% to a level of 70%
Social Skills Goal:
Max will increase his social skills by interacting with peers on less preferred topics 50% of the time.
When given a written scenario, Max will be able to identify two topics of conversation 80% of the
time in 4 out of 5 attempts.
When shown a visual of a person, Max will identify two items to use as conversation starters 80% of
the time in 4 out of 5 attempts.
Sensory Goal:
In order to facilitate participation in his physical education class, Max will wear new socks in class 70% of the
time.
Benchmarks:
Max will wear a new pair of socks made of a novel material for 20 minutes 3x/week during Phy Ed
class with 80% compliance in 5 out of 6 attempts.
Max will identify the most comfortable pair of socks by rating them on a five point scale when
prompted in 4 out of 5 trials.
When Max has identified the socks he finds most comfortable (after trying a minimum of 4 kinds),
Max will wear those socks in class 80% of the time in 4 out of 5 attempts.
Transition Goal:
Max will increase his knowledge of potential career choices from a present level of none, to a number of five.
Max will take a career interest survey and identify 10 potential career options. From that he will
discuss the positives and negatives of each. Once he has done this he will narrow the list to five for
further investigation.
Procedures for measuring the students progress toward meeting the annual goal.
Teachers will be collecting data on all active benchmarks.

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 students progress toward meeting the annual goal be provided to parents?
Teacher will provide weekly updates via email about how Max has been using his organizational strategies and social
skills in class. Data collected will be provided quarterly.

INDIVIDUALIZED EDUCATION PROGRAM:

in
PARTICIPATION IN STATEWIDE ASSESSMENTS

To be completed for students participating

ACT Aspire Early High School

Form I-7 ACT Aspire Early High School (Rev. 9/15)

Name of Student__Max Fuentes_________________________

The student will be in (circle one) 9th or 10th grade when the ACT ASPIRE Early High School is given in
Reading, English, Writing, Mathematics, and Science. The student will be taking general education
assessments1 for all content areas required at this grade level.
Embedded Features are available to all students for computer administered ACT Aspire Early
High School Assessments. No advance request is needed.
Section A: Open Access Tools
Open Access Tools are also available for any student for whom the need has been indicated but
must be activated through the Personal Needs Profile (PNP), in advance of the assessment.
Please list any Open Access Tools that may be required for the student at the time of testing:

Section B: Accommodations (complete all 5 charts)

Accommodations must be entered into the Personal Needs Profile, in advance of the assessment. Disability
related documentation is not submitted for the ACT Aspire Early High School. Accommodations for the
ACT Aspire Early High School are specific to this assessment. Please check the Office of Student
Assessment website for the current accommodation policies.
Reading

Reading without
accommodations

Reading with accommodations (list):

English

English without
accommodations

English with accommodations (list):

Writing

Writing without
accommodations

Writing with accommodations (list):

Mathematics Mathematics
without
accommodations

Science

Science without
accommodations

Mathematics with accommodations (list):

Science with accommodations (list):

INDIVIDUALIZED EDUCATION PROGRAM:

To be completed for students participating

in
PARTICIPATION IN STATEWIDE ASSESSMENTS

district-wide assessments

Form I-7 District-wide Assessment (Rev. 9/15)

Name of Student__Max Fuentes_________________________

The student will be in (circle) K, or 1st, or 2nd, or3rd, or 4th, or 5th, or 6th, or 7th, or 8th, or 9th, or 10th, or 11th,
or 12th grade when the district-wide assessment is given.
PARTICIPATION IN DISTRICT-WIDE ASSESSMENTS
District-wide assessments given
District-wide assessments not given
Student will not be in the grade when a district-wide assessment is given
List district-wide assessment(s) student will take:
ACT Aspire Grade 9

Describe appropriate testing accommodations, if any:

Alternate Assessment* If the student does not take the regular district-wide assessment, describe why the
student cannot participate in the regular assessment and an alternate district-wide assessment is appropriate.

INDIVIDUALIZED EDUCATION PROGRAM:

participating
PARTICIPATION IN STATEWIDE ASSESSMENTS

To be completed for students

in Dynamic Learning Maps

Form I-7-DLM (Rev 9/15)

Name of Student__Max Fuentes_________________________

The student will be in (circle one) 3rd, 4th, 5th, 6th, 7th, 8th, 9th, 10th or 11th grade when the Dynamic Learning
Maps assessment is administered in English language arts, mathematics and/or science. The student will be taking
the alternate assessment1 for all content areas required at this grade level (the I-7-A Participation Guidelines for
Alternate Assessment must be included with the IEP).
Supports and accommodations for Dynamic Learning Maps are specific to this assessment. Please refer to the
Office of Student Assessment website for the current policies.
Section A: Supports
Supports are for all students, as needed; they do not alter the content being tested. Please list.

Section B: Accommodations (complete both charts):

English language
arts (for students
in grades 3-11)

ELA without
accommodations.

ELA with accommodations (list) :

Mathematics
(for students in
grades 3-11)

Mathematics without Mathematics with accommodations (list) :

accommodations.

Science
(for students in
grades 4 and
8-11)

Science without
accommodations.

Science with accommodations (list) :

INDIVIDUALIZED EDUCATION PROGRAM:

POSTSECONDARY TRANSITION PLAN WORKSHEET
FORM I-8 (Rev. 3/2014)

To be completed when online

Postsecondary Transition Plan (PTP)
application is unavailable
https://apps4.dpi.wi.gov/iep

Name of Student: Max Fuentes

Date of Birth: March 20, 2001

School: Chileda Institute

Date of IEP team meeting: 12/16/15
Date student was invited to the IEP team meeting: 11/1/15
Method of inviting the student to the IEP team meeting
Written

Verbal

Did the student attend the IEP team meeting?

Yes
No List the steps that were taken to ensure that the students preferences and
interests are considered:
Has an age-appropriate transition assessment been conducted?
Yes
No The IEP team must complete an age-appropriate transition assessment before
measurable postsecondary goals for the student can be identified or developed. The IEP Team
should not proceed until such assessment takes place. Depending on the type of transition
assessment to be used, it may be possible to complete such an assessment at the IEP Team
meeting.
Describe the results of the assessment (optional):
The Becker Work Adjustment Profile was completed on Max on 1/9/15. The items in the Becker
Work Adjustment Profile measure a workers vocational habits, attitudes and skills in the
performance of work and job related activities. The four domains represented on the profile are
work habits/attitudes, interpersonal relations, cognitive skills and work performance. A Broad
Work Adjustment is composited from all four domains. The scores from each domain place the
student in one of five work categories, day care, work activity, sheltered work (low or high),
transitional work and community-competitive work. Maxs broad work adjustment score place
her in the low sheltered work placement and benefiting from a moderate level of supports. The
focus in the low sheltered work placement is to improve the individuals personal habits, work
values, and social interactions to move to the next higher range. Work tasks generally include
collating, packaging, assembling, sorting, salvaging, folding, cutting, and making a variety of
light manufactured items from wood, plastics, metal and cloth by hand and or using special
equipment.

Postsecondary education or training goal

After high school the student will: (select one)
attend a 2-year technical college or school and earn an associate degree or certificate.
attend a 2-year college or community college.
attend a 4-year college or university and earn an undergraduate degree.
attend a vocational school or other short-term education program.
receive on-the-job training (including apprenticeship).
participate in a humanitarian program, e.g., Peace Corps, Vista, etc.
enlist in the military.
other:
(Other responses are subject to review by the Department of Public Instruction and may
result in identified noncompliance.)

Additional information the IEP team may wish to include related to the students
education or training goal:

Postsecondary employment goal (Please select from Appendix B of the PTP Manual. Responses
not selected from Appendix B are subject to review by the Department of Public Instruction and may result
in identified noncompliance.)

After completing or obtaining postsecondary education or training, the student will be

employed in the field of:
Museum Studies
Additional information the IEP team may wish to include related to the students
employment goal:
While it is early in the transition process, it is natural to include Maxs special
interest in history. As the transition planning progresses it is important to explore
options beyond those currently identified.
Does the student have a need for a postsecondary goal(s) related to independent living skills?
Yes

No

If yes, after high school the student will:

Does the students IEP contain at least one annual goal or short-term objective that will help
the student make progress toward meeting all of the stated postsecondary goals?
Yes
No - The IEP Team must develop an annual goal(s) to be included in the annual goals section
of the IEP that will help the student make progress toward meeting the stated postsecondary
goals.
Record the relevant annual goal(s) here (optional):

List at least one transition service that will assist the student in achieving their postsecondary
goals. (Please select from Appendix C of the PTP Manual. Other responses are subject to review by the
Department of Public Instruction and may result in identified noncompliance.)

Category

Transition Service

Instruction

Complete academic assessments

to determine academic strengths
and needs
Complete a learning styles
inventory to identify preferred
learning methods

Instruction

School
Year
2015

Person(s) responsible

2015

Max

Max

Will other agencies likely be involved in providing or paying for any transition services during
the term of this IEP?
Yes

No

If yes, did the local education agency obtain the written consent of the parents or the
adult student to invite a representative(s) of the outside participating agency(ies) to
attend the IEP Team meeting?
Yes
No
Parent or adult student refused consent, or the LEA was unable to obtain consent
after three good faith attempts.
If consent was obtained, was a representative(s) of the outside participating agency(ies) invited
to the IEP Team meeting?
Yes

No

Agencies invited to the meeting (optional)

List the classes the student will take while in high school focusing on the academic and
functional achievement needed to assist the student in reaching his or her postsecondary goals
(attach additional pages as needed).
Course Title

School Year

Will the student reach his/her 17th birthday during the timeframe of the IEP or has the student
reached the age of 18?
Yes
No
(If yes, specify how the student and parents have been informed of the rights which will
transfer or have transferred to the student at age 18 if no legal guardian has been
appointed)
Will the student be exiting school because of graduation or exceeding the age of eligibility for a
Free Appropriate Public Education (FAPE) at the conclusion of the current academic school
year?
Yes

No

If yes, eligibility for a Free Appropriate Public Education (FAPE) ends when a student is
granted a regular high school diploma, or at the end of the school term in which the
student turns age 21. Under these circumstances, the local education agency must
provide the child with a summary of the childs academic achievement and functional
performance, including recommendations on how to assist the child in meeting the
childs postsecondary goals. 34 CFR 300.305(e)(2) and (3), IDEA
The summary of performance must be provided at a reasonable point prior to
graduation. It is not necessary to conduct an IEP meeting to develop the summary of
performance.

INDIVIDUALIZED EDUCATION PROGRAM:

SUMMARY
Form I-9 (Rev. 10/06)

Name of Student _Max Fuentes_____________________

Projected beginning and ending date(s) of IEP services & modifications __12/16/15_____ to
__12/15/16_____
(month/day/year)
(month/day/year)

Physical education:
Regular
Vocational education: Regular

Specially designed
Specially designed

Include a statement for each of I, II, III and IV below to allow the student (1) to advance appropriately toward
attaining the annual goals; (2) to be involved and progress in the general education curriculum; (3) to be
educated and participate with other students with and without disabilities to the extent appropriate, and (4) to
participate in extracurricular and other nonacademic activities. Include frequency, location, & duration (if
different from IEP beginning and ending dates).

I. Special education
Vocational Planning
Social Skills development
Executive functioning instruction

Frequency/
Amount
30
min/week

Location
Career
counselors
office

Duration
Duration of
IEP

60
min/week
90 minutes/
week

Regular Ed
classroom
Regular Ed
classroom

Duration of
IEP
Duration of
IEP

II. Related services needed to benefit from special education including frequency, location, and
duration (if different from IEP beginning and ending dates).

None needed to benefit from special education

Assistive Technology

Audiology
Counseling
Educational Interpreting
Medical Services for Diagnosis and Evaluation
Occupational Therapy
Orientation and Mobility (VI only)
Physical Therapy
Psychological Services
Recreation
Rehabilitation Counseling Services
School Health Services
School Nurse Services
School Social Work Services
Speech / Language
Transportation
Other: specify

Freq / Amt
Location
30 min/week Classroom

Duration
Duration of
IEP

III. Supplementary aids and services: aids, services,

Freq / Amt
and other supports provided to or on behalf of
30the
student in regular education or other educational
min/week
settings.
Yes
No (If yes, describe)

Location
Regular
Education
classroom

Duration
Length of
IEP

Administration
offices

Length of
IEP

Audio recordings of textbooks, audio recorder for

voice directions on assignments.

IV. Program modifications or supports for school

6 hour/year
personnel that will be provided.
Yes No (If yes, describe)

Educational staff will be trained on how to use

audio recording device(s) used for giving verbal
directions, as well as training on executive
functioning disorders.

V. Participation in Regular Education Classes

The student will participate full-time with non-disabled peers in regular education
classes, or for preschoolers, in age-appropriate settings.

The student will not participate full-time with non-disabled peers in regular education
classes, or for preschoolers, in age-appropriate settings. (If you have indicated a
location other than regular education classes or age-appropriate settings in the case of a
preschooler in I, II, or III above, you must check this box and explain why full-time
participation with non-disabled peers is not appropriate.)

VI. Participation in Extracurricular and Nonacademic Activities

Will the student be able to participate in extracurricular and nonacademic activities with
nondisabled students?
Yes No
(If yes, include under I., II., III., and IV. any special education, related services, supplementary
aids and services, and program modifications or supports necessary to assist the student. If no,
describe the extent to which the student will not be involved in extracurricular and nonacademic
activities with nondisabled students)