DATE: 10/20/2018 Page 1 of 13

STATE OF NEVADA INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP)

INFORMATION
STUDENT/PARENT INFORMATION ELIGIBILITY CATEGORY MEETING INFORMATION
Student: Rita Grande Sex: Female DATE OF MEETING
Autism Spectrum Disorder DATE OF LAST IEP MEETING NA
Birthdate: 10/20/2010 Grade3 Student ID #323330
Student Primary Language English Deaf/Blind PURPOSE OF MEETING
Student English Proficiency Status: Select LEP Status Developmental Delay Interim IEP

Federal Placement Code: Select Placement Code Emotional Disturbance Initial IEP

Federal Student Ethnicity Code: Select Ethnicity Code Health Impairment Annual IEP
Address: 2177 Smiley Road Henderson, NV 89014 Hearing Impairment/Deaf IEP Following 3-Yr Reevaluation
Student Phone:702-555-9523 Intellectual Disability Revision To IEP Dated

Multiple Impairment Exit Select Exit Code

Parent/Guardian/Surrogate: Maria Grande
Orthopedic Impairment IEP Revision Without A Meeting:
Parent Phone (Home) 702-555-9523 (Work) 702-555-8471
Specific Learning Disability At the request of : Parent or School District
Optional: Cell Email Mariag@noemail.com
Primary Language Spoken at Home English Speech/Language Impairment Other

Interpreter or Other Accommodations Needed No Traumatic Brain Injury IEP SERVICES WILL BEGIN
Emergency Contact/Phone Number702-555-5555 Visual Impairment/Blind ANTICIPATED
DURATION OF SERVICES
Current School Happy Smile Elementary School Zoned School 000 ELIGIBILITY DATE
IEP REVIEW DATE
ANTICIPATED 3-YR COMMENTS
REEVALUATION

IEP PARTICIPATION
Parent/Guardian/Surrogate* Speech/Language Therapist/Pathologist/Specialist
Student** School Nurse
LEA Representative* Interpreter
Special Education Teacher* Other (name and role)
Regular Education Teacher*** Other (name and role)
School Psychologist Other (name and role)

*Required participant.
** Student must be invited when transition is discussed (beginning at age 14 or younger if appropriate).
***The IEP team must include at least one regular education teacher of the student (if the student is, or may be, participating in the regular education environment).

PROCEDURAL SAFEGUARDS
I have received a statement of procedural safeguards under the Individuals with Disabilities Education Act (IDEA) and these rights have been explained to me in my primary language.

Parent Signature

AT LEAST ONE YEAR PRIOR TO REACHING AGE 18, STUDENTS MUST BE INFORMED OF THEIR RIGHTS UNDER IDEA AND ADVISED THAT THESE RIGHTS WILL TRANSFER TO THEM AT AGE 18.

Not applicable. Student will not be 18 within one year, and the student's next annual IEP meeting will occur no later than the student's 17th birthday.

The student has been informed of his/her rights under IDEA and advised of the transfer of these rights at age 18.

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Name Rita G DATE10/20/2018
Consider results of the initial evaluation or most recent reevaluation, and the academic, developmental, and functional needs of the student, which may include the following areas:
academic achievement, language/communication skills, social/emotional/behavior skills, cognitive abilities, health, motor skills, adaptive skills, pre-vocational skills, vocational skills, and other skills as
appropriate. For students who are 16 or older, or will turn 16 when this IEP is in effect, also consider the results of age appropriate transition assessments related to training/education, employment,
and independent living skills (as appropriate).
ASSESSMENTS CONDUCTED
Developmental Test of Visual-
Motor Integration
Vineland Adaptive Behavior
Scales
PIAT-R, the Brigance
Comprehensive Inventory of
Basic Skills-Revised, the
Woodcock-Johnson
Psychoeducational Battery-111
(WJ-111), and the Wide Range
Achievement Test-111
Brigance Comprehensive
Inventory of Basic Skills-Revised
and through observation
Brigance Comprehensive
Inventory of Basic Skills-
Revised, the PIAT-R, the
Woodcock Reading Mastery
Tests-Revised and the Gray Oral
Reading Tests, Third Edition
Peabody Individual Achievement
10/12/2015
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PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE
ASSESSMENT RESULTS EFFECT ON STUDENT'S INVOLVEMENT AND PROGRESS IN GENERAL EDUCATION
CURRICULUM OR, FOR EARLY CHILDHOOD STUDENTS, INVOLVEMENT IN
DEVELOPMENTAL ACTIVITIES
Equivalent to that of a 6 year old Although she could copy simple designs, such as the circle and plus sign, she had difficulty with
the triangle, diamond and other more complicated shapes. She appears to have a weakness in
visual perception abilities.
Lowest scores were in the areas of daily living skills She has made no friends and plays mostly with her younger sister. They also support Mr. Mild’s
and socialization. observation that Rita lacks the motivation to organize herself to complete school work and will
often "just sit there".
Analysis of her spelling errors showed that she usually spelled words according to phonics
Second grade level rules, for example, frend for friend, laf for laugh, and tok for talk. She showed poor visual
memory for irregularly spelled words.
The third-grade handwriting curriculum calls for shifting from manuscript to cursive writing.
Major Problem However, Rita has resisted making the change and asked Mr. Mild if she could continue using
manuscript writing. She is left-handed and has always had much difficulty performing this
visual-motor task. Her written papers are a painstaking task for her and to complete and require
much effort and time. Even then, the final product is usually illegible and has a very sloppy
appearance. She begins many letters from the bottom, moving to the top of a line. Tall letters
are the same size as small letters. Her pencil grasp is unusual, and she keeps her non-writing
right hand in a folded, tense position. Written expression could not be tested because of her
extremely poor handwriting skills.
Performance dropped considerably when reading comprehension was required. When she was
Satisfactorily observed during the reading, she seemed to lose her place and had difficulty concentrating on
the material. Her word identification, phonics skills and reading vocabulary are adequate.
Difficulties in reading appear when she is required to use higher conceptual skills in reading
comprehension. Her reading comprehension is at the independent reading level of second
grade. Her word recognition skills are at the fourth-grade level.
Her most serious mathematical difficulties were in the areas of numerical reasoning and word
Grade Placement 3.8 problems. She also did poorly in addition, subtraction and multiplication. Her scores were low in
IEP PAGE 2
Name Rita G DATE10/20/2018
Test-Revised (PIAT-R), the Key
Math-Revised, and the Brigance
Comprehensive Inventory of
Basic Skills-Revised
Wechsler Intelligence Scale for
Children-Third Edition (WISC-
111)
Auditory and Visual Acuity
The classroom observation
10/12/2015
Mathematics scores ranged between 1.8 and 2.5
WISC-111 Full Scale IQ: 109, Verbal IQ: 128,
Performance IQ: 87
Hearing Rita's hearing tested within the normal range.
Third grade observed an arithmetic lesson
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fractions and division, but she has not had instruction in these areas in the classroom
These WISC-111 scores suggest a discrepancy between Rita's verbal and performance
abilities. Her aptitude strengths were in areas that use language; her weaknesses were in tests
in which she had to visualize objects in space, or plan and manipulate objects, and in
arithmetic. The psychologist noted that Rita seemed to give up as soon as items became
difficult and did not seem to have any system for attacking challenging problems. When items
became hard for her, Rita seemed helpless and simply said, "I can't do that. It's too hard for
me."
Vision The Keystone Visual-Screening Service for School visual screening test was used to
screen Rita's vision. No visual difficulties were noted.
Rita did not volunteer the answer to any of the oral problems, and she did not write the
calculations to find the answer to the problems during the lesson. In the seatwork portion of the
lesson, Rita attempted the first problem but had difficulty staying on task. She did not even
attempt the other four problems. Inspection of her work showed she could not line up the
numbers in the addition problem and, consequently, made mistakes in addition. She had many
erasures and cross outs. During a fifteen-minute "free" period none of her classmates
interacted with Rita, and she just stared out the window for the entire period.
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STRENGTHS, CONCERNS, INTERESTS AND PREFERENCES

STATEMENT OF STUDENT STRENGTHS

Rita's auditory discrimination was tested with the Goldman-Fristoe-Woodcock Test of Auditory Discrimination. Her scores were adequate on this test, suggesting a strength in
auditory discrimination.

STATEMENT OF PARENT EDUCATIONAL CONCERNS

Her mother comments that Rita relies on other people to tell her what to do.

STATEMENT OF STUDENT'S PREFERENCES AND INTERESTS (required if transition services will be discussed, beginning at age 14 or younger if appropriate)

Rita indicated that she likes to watch television and eat. She said that her playmates include her younger sister and her sister's friend. Rita does not receive an allowance, but she
earns money by taking out the garbage. She spends the money she earns on candy. In response to the question, "Do you like school?" she said, "Sometimes and sometimes not."
After some prompting, she admitted that a good school day meant that the teacher had not yelled at her. Rita's favorite subject is music; she dislikes gym and arithmetic.

If student was not in attendance, describe the steps taken to ensure that the student's preferences and interests were considered:

The resource teacher gave Rita an informal interest inventory.

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CONSIDERATION OF SPECIAL FACTORS

1. Does the student's behavior impede the student's learning or the learning of others? No. Yes.
If YES, IEP committee must provide positive behavioral strategies, supports and interventions, or other strategies, supports and interventions to address that
behavior.
Addressed in IEP.

2. Does the student require assistive technology devices and services? No. Yes.
If YES, IEP committee must determine nature and extent of devices and services.
Addressed in IEP.

3. Does the student have limited English proficiency? No. Yes.

If YES, IEP committee must consider the following (check box if IEP committee considered the item):
Language needs of the student as those needs relate to the student's IEP.

4. Is the student blind or visually impaired? No. Yes.

If YES, IEP committee must evaluate reading and writing skills, needs, and appropriate reading and writing media (including an evaluation of the child’s future needs
for instruction in Braille or use of Braille) and must provide for instruction in Braille and use of Braille unless determined not appropriate for the student.
Braille instruction and use of Braille is not appropriate for student. Braille instruction and use of Braille is addressed in IEP.

5. Is the student deaf or hard of hearing? No. Yes.

If YES, IEP committee must consider the student’s language and communication needs and consider the following (check box if IEP committee considered the
item):

The related services and program options that provide the student with an appropriate and equal opportunity for communication access.
The student’s primary communication mode.
The availability to the student of a sufficient number of age, cognitive, academic and language peers of similar abilities.
The availability to the student of adult models who are deaf or hearing impaired and who use the student’s primary communication mode.
The availability of special education teachers, interpreters and other special education personnel who are proficient in the student’s primary communication
mode.
The provision of academic instruction, school services and direct access to all components of the educational process, including, without limitation, advanced
placement courses, career and technical education courses, recess, lunch, extracurricular activities and athletic activities.
The preferences of the parent or guardian of the student concerning the best feasible services, placement and content of the student’s IEP.
The appropriate assistive technology necessary to provide the student with an appropriate and equal opportunity for communica tion access.

6. Does the student have a Specific Learning Disability and Dyslexia? No. Yes.
If YES, the IEP committee must consider the following instructional approaches (check box if IEP committee considered the item):

Explicit, direct instruction that is systematic, sequential and cumulative and follows a logical plan of presenting the alphabetic principle that targets the specific needs
of the student.
Individualized instruction to meet the specific needs of the student in an appropriate setting that uses intensive, highly-concentrated instruction methods and
materials that maximize student engagement.
Meaning-based instruction directed at purposeful reading and writing, with an emphasis on comprehension and composition.
Multisensory instruction that incorporates the simultaneous use of two or more sensory pathways during teacher presentations and student practice.

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TRANSITION

DIPLOMA OPTION SELECTED FOR GRADUATION (Diploma option must be declared at age 14 and reviewed annually.)
Standard or Advanced High School Diploma. Must complete all applicable credit Adjusted High School Diploma. Must complete IEP requirements.
requirements and pass the High School Proficiency Examination (with permissible accommodations as needed).

STUDENT'S VISION FOR THE FUTURE

A short statement that directly quotes what the student wants for the future.
NA

STATEMENT OF TRANSITION SERVICES: COURSE OF STUDY

Beginning at age 14 or younger if determined appropriate by the IEP team, describe the focus of the student's course of study.
NA

STATEMENT OF MEASURABLE POSTSECONDARY GOALS

Beginning not later than the first IEP to be in effect when the student is 16, describe measurable postsecondary goals in the following areas:

Training/Education
NA

Employment
NA

Independent Living Skills (As Appropriate)

NA

Other
NA

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TRANSITION (continued)
STATEMENT OF TRANSITION SERVICES: COORDINATED ACTIVITIES
Beginning not later than the first IEP to be in effect when the student is 16, develop a statement of needed transition services, including strategies or activities, for the student.

Instruction
NA

Any Other Agency Involvement (Optional):

Related Services
NA

Any Other Agency Involvement (Optional):

Community Experiences
NA

Any Other Agency Involvement (Optional):

Employment and Other Post-School Adult Living Objectives

NA

Any Other Agency Involvement (Optional):

Acquisition of Daily Living Skills and Functional Vocational Evaluation (if appropriate)
NA

Any Other Agency Involvement (Optional):

Other
NA

Any Other Agency Involvement (Optional):

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IEP GOALS, INCLUDING ACADEMIC AND FUNCTIONAL GOALS, AND BENCHMARKS OR SHORT-TERM OBJECTIVES

MEASURABLE ANNUAL GOAL (including how progress toward the annual goal will be measured) PROGRESS REPORT
1. Satisfactory Progress Being Made (continue)

Check here if this goal supports the student's postsecondary goal(s) and identify the goal(s) to which it relates: 2. Unsatisfactory Progress Being Made
(need to review/revise)

Training/Education Employment Independent Living Skills Other 3. Goal Met (note date)

Date ____ Date ____ Date ____ Date ____

Check here if this goal will be addressed during Extended School Year Services (ESY)

Progress Progress Progress Progress

#1) Lower grade assignments for reading and comprehension.

#2) Read low level vocabulary books.

#3) Work on some reading comprehension.

#4) Review sounds for sounding our words.

MEASURABLE ANNUAL GOAL (including how progress toward the annual goal will be measured) PROGRESS REPORT
2. Satisfactory Progress Being Made (continue)

Check here if this goal supports the student's postsecondary goal(s) and identify the goal(s) to which it relates: 2. Unsatisfactory Progress Being Made
(need to review/revise)

Training/Education Employment Independent Living Skills Other 3. Goal Met (note date)

Date Date Date Date

Check here if this goal will be addressed during Extended School Year Services (ESY)

Progress Progress Progress Progress

#1) Numerical reasoning grade level 2.

#2) Adding one digit numbers.

#3) Word problems (addition).

#4) Subtracting one digit numbers.

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IEP GOALS, INCLUDING ACADEMIC AND FUNCTIONAL GOALS, AND BENCHMARKS OR SHORT-TERM OBJECTIVES

MEASURABLE ANNUAL GOAL (including how progress toward the annual goal will be measured) PROGRESS REPORT
3. Satisfactory Progress Being Made (continue)

Check here if this goal supports the student's postsecondary goal(s) and identify the goal(s) to which it relates: 2. Unsatisfactory Progress Being Made
(need to review/revise)

Training/Education Employment Independent Living Skills Other 3. Goal Met (note date)

Date Date Date Date

Check here if this goal will be addressed during Extended School Year Services (ESY)

Progress Progress Progress Progress

#1) Work on handwriting skill by going over the alphabet in capitalize letters.

#2) Work on handwriting skill by going over the alphabet in lower case letters.

#3) Gather left hand visual aid for writing.

#4) Practice writing short sentences.

MEASURABLE ANNUAL GOAL (including how progress toward the annual goal will be measured) PROGRESS REPORT
4. Satisfactory Progress Being Made (continue)

Check here if this goal supports the student's postsecondary goal(s) and identify the goal(s) to which it relates: 2. Unsatisfactory Progress Being Made
(need to review/revise)

Training/Education Employment Independent Living Skills Other 3. Goal Met (note date)

Date Date Date Date

Check here if this goal will be addressed during Extended School Year Services (ESY)

Progress Progress Progress Progress

#1) Work on spelling lower grade sight words.

#2) Work on vision memory for sight words.

#3) Work on phonics rules.

#4) Work on lower level spelling words.

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METHOD FOR REPORTING PROGRESS

METHOD FOR REPORTING THE STUDENT'S PROGRESS TOWARD MEETING ANNUAL GOALS (check all PROJECTED FREQUENCY OF REPORTS
methods that will be used)
IEP Goals Pages District Report Card Quarterly Semester
Specialized Progress Report Parent Conferences Trimester Other
Other

SPECIAL EDUCATION SERVICES

SPECIALLY DESIGNED INSTRUCTION BEGINNING FREQUENCY LOCATION
AND OF SERVICES OF
ENDING SERVICES
DATES

Resource teacher : Mrs. Hatt 10/21/18 – 10/21/19 90 minutes Happy Smile Elem
-
-
-
-
-

SUPPLEMENTARY AIDS AND SERVICES

Includes aids, services, and other supports provided in regular education classes, other education-related settings, and in extracurricular and nonacademic settings to enable
students with disabilities to be educated with nondisabled students to the maximum extent appropriate.

BEGINNING AND FREQUENCY OF LOCATION OF

MODIFICATION, ACCOMMODATION, OR SUPPORT FOR STUDENT OR PERSONNEL ENDING DATES SERVICES SERVICES
Provide specific description(s) below.
-

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RELATED SERVICES
RELATED SERVICE SERVICE TYPE AND/OR BEGINNING FREQUENCY LOCATION
DESCRIPTION AND ENDING OF SERVICES OF
A - Assessment DATES SERVICES
C - Consultative
D - Direct

Select Related Service Select Service Type Description: -

Select Related Service
Select Related Service
Select Related Service
Select Related Service
Select Related Service
Select Service Type Description: -
Select Service Type Description: -
Select Service Type Description: -
Select Service Type Description: -
Select Service Type Description: -

PARTICIPATION IN STATEWIDE AND/OR DISTRICT-WIDE ASSESSMENTS

Indicate how the student will participate If the student will participate in an alternate assessment, explain If the student will participate in a
in statewide or district-wide why the student cannot participate in the regular assessment, and regular assessment, does the student
assessments. why the particular alternate assessment selected is appropriate require accommodations?

State Criterion-Referenced Test No Yes

(CRT) Yes N/A Alternate If YES, list on "Accommodation(s) for the
Nevada Proficiency Examination Program"
(attach form).

End of Course Exams No Yes

Yes N/A If YES, list on "Accommodation(s) for the
Nevada Proficiency Examination Program"
(attach form).
College and Career Readiness Assessment No Yes
Yes N/A If YES, list on "Accommodation(s) for the
Nevada Proficiency Examination Program"
(attach form).

Other (List): No Yes List Accommodation(s):

Yes N/A

EXTENDED SCHOOL YEAR SERVICES

Does the student require extended school year services?

No Yes If YES, IEP goals and benchmarks/short-term objectives and/or related services to be implemented in ESY must be identified.
If need for ESY is to be determined at a later date, indicate date by which IEP decision will be made:

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PLACEMENT
PLACEMENT CONSIDERATIONS PERCENTAGE OF TIME
IN REGULAR EDUCATION ENVIRONMENT
Selected Rejected Regular class with supplementary aids and services (no removal)
Selected Rejected Regular class and special education class (e.g., resource) The student will spend 70 % of his or her school day in the
combination Selected Rejected Self-contained program regular education environment.
Selected Rejected Special School
Selected Rejected Residential
Selected Rejected
Hospital
Selected Rejected
Home
Selected Rejected Other

JUSTIFICATION FOR PLACEMENT INVOLVING REMOVAL FROM REGULAR EDUCATION ENVIRONMENTS*

Explain why the IEP goals and objectives cannot be implemented in regular education environments, including the reasons why the team rejected a less restrictive
placement. Include an explanation of any harmful effects on the learning of this or other students which affected the placement selection.

*Regular education environments include academic classes (which might include field trips linked to the curriculum), nonacademic settings (such as recess), and extracurricular activities
(for example, sports, after-school clubs, band, etc.).

IEP IMPLEMENTATION

As the parent, I agree with the components of this IEP. I understand that its provisions will be implemented as soon as possible after the IEP goes into effect.

As the parent, I disagree with all or part of this IEP. I understand that the school district must provide me with written notice of any intent to implement this IEP. If I wish to prevent the implementation of this IEP, I must
submit a written request for a due process hearing to the local school district superintendent.

Parent Signature

A copy of this IEP was provided to the student’s parent on : ___10/20/2018______by_____________Mrs. Smith__________ ____Evaluator_________________
(date) (name) (title)

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