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STATE OF NEVADA INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP)

INFORMATION
STUDENT/PARENT INFORMATION ELIGIBILITY CATEGORY MEETING INFORMATION
Student:Rita G Sex: F DATE OF MEETING10-21-18
Autism Spectrum Disorder DATE OF LAST IEP MEETINGNA
Birthdate Grade3.6 Student ID #
Student Primary LanguageEnglish 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:6941 Elm Street Hearing Impairment/Deaf IEP Following 3-Yr Reevaluation
Student Phone:702-5550000 Intellectual Disability Revision To IEP Dated

Multiple Impairment Exit Select Exit Code

Parent/Guardian/Surrogate:Mrs. G
Parent Phone (Home) 702-555-0000 (Work) Orthopedic Impairment IEP Revision Without A Meeting:
Specific Learning Disability At the request of : Parent or School District
Optional: Cell Email
Primary Language Spoken at HomeEnglish Speech/Language Impairment Other

Interpreter or Other Accommodations NeededSelect Y or N Traumatic Brain Injury IEP SERVICES WILL BEGIN10-21-18
Emergency Contact/Phone Number702-911-111 Visual Impairment/Blind ANTICIPATED
DURATION OF SERVICES3 yrs
Current School Hancock E.S. Zoned School Bruner E.S. ELIGIBILITY DATE
IEP REVIEW DATE10-21-19
ANTICIPATED 3-YR COMMENTS
REEVALUATION

IEP PARTICIPATION
Parent/Guardian/Surrogate* Mrs. G Speech/Language Therapist/Pathologist/Specialist
Student** School Nurse
LEA Representative* MRS.S InterpreterNA
Special Education Teacher* Mrs. P Other (name and role) Mr. S (Principal)
Regular Education Teacher*** Mr. Mild Other (name and role)
School Psychologist Mr. D 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 Mrs. G

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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PRESENT LEVELS OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE

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 ASSESSMENT RESULTS EFFECT ON STUDENT'S INVOLVEMENT AND PROGRESS IN GENERAL EDUCATION
CURRICULUM OR, FOR EARLY CHILDHOOD STUDENTS, INVOLVEMENT IN
DEVELOPMENTAL ACTIVITIES

Rita cannot work independently. She is unable to plan

TEACHER and organize when faced with a problem task. When
OBSERVATIONS doing a class assignment she quickly becomes Rita has difficulty visualizing objects in space, or plan and manipulate objects and in math.
distracted and does not complete the assignment. She has no system for attempting to solve challenging problems. She gives up easily.
Rita recognizes words but comprehension is
inconsistent. Rita never engages in conversation and
rarely asks questions.
A change in seating to be closer to the teacher and
modifying assignments were not successful. Rita’s
academic performance at school grew worse and she
was failing several subjects.

Rita’s Kindergarten teacher noted difficulty in fine

motor coordination. Students were given a 2 digit addition or subtraction word problem using place value.
First grade teacher noted lack of focus and incomplete They were expected to visualize the situation and then perform the calculations on paper
assignments. Second grade teacher noted lack of effort to find the answer. Rita did not volunteer the answer to any of the oral problemsa and she
and “sloppy” work did not write the calculations to find the answer to the problems. She attempted the first
problem but had difficulty staying on task. She made no attempt to solve the other 4
Auditory and visual acuity tests were given with no problems. She could not line up the numbers correctly during the addition problem and
difficulties noted. (Keystone Visual-Screening Service consequently, made errors. She had many erasures and cross outs.
for School)
During a 15 minute break none of her classmates interacted with Rita and she sat staring
WISC-111 Full Scale IQ: 109 out of the window.
Verbal IQ: 128
Performance IQ: 87

Verbal Subtest Scaled Scores

Information: 13
Similarities: 14
Arithmetic: 8
Vocabulary: 14
Comprehension: 11
Digit Span: 13

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Performance Subtest Scaled Scores

Picture Arrangement: 7
Coding: 6
Picture Completion: 8
Block Design: 8
Object Assembly: 7
Symbol Search: 7
Mazes: 5

There is a discrepancy between verbal and performance

abilities.

READING
Brigance Comprehensive Inventory of Basic Skills-
Revised
PIAT-R During observation Rita seemed to lose her place and had difficulty
The Woodcock Reading Mastery Tests-Revised focusing on the material. Difficulties occurred when she was required
Gray Oral Reading Tests to use higher level conceptual skills.

Independent reading comprehension level is at a

second grade level.
Word Recognition levels are at a fourth grade level.

Handwriting
Brigance comprehensive Inventory of Rita demonstrated an unusual pencil grasp. She begins many letters
Basic Skills-Revised from the bottom and tall letters are the same size as small letter.
Observation Written expression could not be assessed because of her extremely
poor handwriting skills.

SPELLING
PIAT-R Rita scored at the second grade level.
Brigance Comprehensive Inventory of Rita spelled words phonetically and showed poor visual memory for
Basic Skills-Revised irregular spelling.
The Woodcock Johnson Psycheducational
Battery-111 (WJ-111)
Wide Range Achievement Test-
111(WRAT-111)

ADAPTIVE BEHAVIOR
Vineland Adaptive Behavior Scales Lowest score were in the in the areas of daily living skills and
socialization. These scores support observations from Rita’s teacher
and her mother. At home Rita relies on others to tell her what to do,
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LEARNING WEAKNESSES

Developmental Test of Visual-Motor integration

Rita’s score was equivalent to a six year old. Rita could copy a circle but had difficulty with a triangle and
a diamond.

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R
STRENGTHS, CONCERNS, INTERESTS AND PREFERENCES

STATEMENT OF STUDENT STRENGTHS

Rita’s auditory discrimination skills were adequate on the Gold-Fristoe-Woodcock Test of Auditory Discrimination suggesting a strength in auditory discrimination.
Word recognition scores are at a fourth grade level...(Brigance, Woodcock and Gray)

STATEMENT OF PARENT EDUCATIONAL CONCERNS

Rita has described herself as “dumb” and hates school. She complains of stomach aches in the mornings. She has not made any friends.

STATEMENT OF STUDENT'S PREFERENCES AND INTERESTS (required if transition services will be discussed, beginning at age 14 or younger if appropriate)
Rita likes to watch TV and play with her younger sister. Her favorite subject is music.

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.

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.

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

Employment

Independent Living Skills (As Appropriate)

Other

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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

Any Other Agency Involvement (Optional):

Related Services

Any Other Agency Involvement (Optional):

Community Experiences

Any Other Agency Involvement (Optional):

Employment and Other Post-School Adult Living Objectives

Any Other Agency Involvement (Optional):

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

Any Other Agency Involvement (Optional):

Other

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)
By the end of the second semester of the 2018/19 school year Rita will solve math word problems 2 out of 5 times
#2)
By the end of the third semester Rita will solve math word problems 3 out of 5 times
#3)
By the annual review date Rita will solve math word problems 4 out of 5 times
# )

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) By the end of the third semester of the 2018/2019 school year, Rita will use word analysis skills to decode blends on 4 out of 5 attempts.

#2) By the end of the fourth semester of the 2018/2019 school year, Rita will use word analysis skills to decode diagraphs on 4 out of 5 attempts.

#3) Rita will use word analysis skills to decode consonant blends on 4 out of 5 attempts.

# )

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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) By the end of the second semester of the 2018/2019 school year, Rita will write legibly with the assistance of a pencil grip.

#2) By the end of the third semester of the 2018/2019 school year, Rita will differentiate between writing upper case and lower case letters.

#3) By the annual review date, Rita will write legibly 80% of the time.

# )

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) By the end of the second semester of the 2018/2019 school year, Rita will volunteer to answer questions in class 40% of the time.

#2) By the end of the third semester of the 2018/2019 school year, Rita will volunteer to answer questions in class 60% of the time.

#3) By the annual review date, Rita will volunteer to answer questions in class 80% of the time.

# )

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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

Math 10/21/2018 – 200 minutes per week Resource Classroom

10/21/2019
Language Arts 10/21/2018 – 200 minutes per week Resource Classroom
10/21/2019
Social Skills 10/21/2018 – 30 minutes per week Resource classroom
10/21/2019
-
-
-

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.
OT will provide adaptive equipment for educational access 10/21/2018 – Daily School
10/21/2019 Campus
-

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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

Occupational Therapy Direct 10/21/2018 – 120 minutes Resource

10/21/2019 per month Classroom
Select Related Service Select Service Type Description: -
Select Related Service Select Service Type Description: -
Select Related Service Select Service Type Description: -
Select Related Service Select Service Type Description: -
Select Related Service 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 Student will be provided a pencil grip No Yes

(CRT) Yes N/A Alternate If YES, list on "Accommodation(s) for the
prior to testing. 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)combination The student will spend 60 % of his or her school day in the
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.
The student needs a small group environment to address goals and objectives. The student will lose an opportunity with their non-
disabled peers while in the resource room.

*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 Mrs. G

A copy of this IEP was provided to the student’s parent on : _____10/21/2018___________byMr.

Mild___________________Classroomteacher_________________________ (date) (name)
(title)

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