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STATE OF NEVADA INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP)

INFORMATION
STUDENT/PARENT INFORMATION ELIGIBILITY CATEGORY MEETING INFORMATION
Student: Rita G Sex: Female DATE OF MEETING 3/7/2018
Autism Spectrum Disorder DATE OF LAST IEP MEETING
Birthdate3/7/1999 Grade 3.6 Student ID #77777
Student Primary Language: English Deaf/Blind PURPOSE OF MEETING
Student English Proficiency Status: NLEP Developmental Delay Interim IEP

Federal Placement Code: B9 Emotional Disturbance x Initial

Federal Student Ethnicity Code: H7 Health Impairment IEP Annual

IEP
Address:742 Evergreen Terrace Hearing Impairment/Deaf
IEP Following 3-Yr Reevaluation
Student Phone:777-777-7777 Intellectual Disability
Revision To IEP Dated
Parent/Guardian/Surrogate: Mrs. G Multiple Impairment
Exit Select Exit Code
Parent Phone (Home) 777-777-7777 (Work) 777-777-7777 Orthopedic Impairment
IEP Revision Without A Meeting:
Optional: Cell Email x Specific Learning Disability
At the request of : Parent or School District
Primary Language Spoken at Home English Speech/Language Impairment
Other
Interpreter or Other Accommodations Needed N Traumatic Brain Injury
IEP SERVICES WILL BEGIN 3/28/2018
Emergency Contact/Phone Number777-7777 Visual Impairment/Blind
ANTICIPATED
Current Schoo lWatson Elementary Zoned School ELIGIBILITY DATE 3/28/2018 DURATION OF SERVICES 8 wks
ANTICIPATED 3-YR REEVALUATION IEP REVIEW DATE 8/22/2018
3/28/2021 COMMENTS

IEP PARTICIPATION
Parent/Guardian/Surrogate*Mrs G Speech/Language Therapist/Pathologist/Specialist N/A
Student**Rita G School Nurse N/A
LEA Representative* N/A Interpreter N/A
Special Education Teacher*Ms. S Other (name and role)
Regular Education Teacher***Mr. Mild Other (name and role)
School Psychologist Ms. Freud 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
X 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.

x 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

-Classroom observation
-Hearing Test
-Keystone Visual-Screening
Service for School
-Interview with student’s mother
- Wechsler Intelligence Scale for
Children-Third Edition (WISC-111
- Peabody Individual Achievement
Test-Revised (PIAT-R), the Key
Math-Revised, and the Brigance
Comprehensive Inventory of Basic
Skills-Revised (math assessment)
- Brigance Comprehensive
Inventory of Basic Skills-Revised,
the PIAT-R, the Woodcock
Reading Mastery Tests-Revised
and the Gray Oral Reading Tests,
Third Edition (reading assessment)
- Brigance Comprehensive
Inventory of Basic Skills-Revised,
observation (writing assessment)
- PIAT-R, the Brigance
Comprehensive Inventory of Basic
Skills-Revised, WJ-111, (WRAT-
111) (spelling assessment)
- Vineland Adaptive Behavior
Scales
-Developmental Test of Visual-
Motor Integration
- Goldman-Fristoe-Woodcock Test
of Auditory Discrimination
-Interest Inventory
-Rita was unwilling to participate during math class After a pre-referral request, accommodations were made for Rita such as:
assignment except for one of five problems during - The use of second-grade texts and workbooks and individual assignments based on
seatwork assignment these materials.
-Rita’s hearing is in normal range -A seat change to the front of the class so that Mr. Mild could have closer contact with
-Rita has no notable visual difficulties Rita.
-Normal medical history. Had difficulty learning to feed and -High interest-low vocabulary-level books from the library.
dress herself. Described by mother as “klutzy”. Regular -A daily check to see that she that Rita has her assignment book before she goes home.
language development. Disinterested in school from Rita objected to these accommodations on the grounds that she felt she was being forced
preschool age.. Kindergarten teacher reported Rita had to do “baby work”.
fine motor skills problems. Rita has no close friends. Rita has great difficulty staying on task, participates little in class discussions, frequently
-Average full-scale IQ (109), above-average verbal IQ leaves assignments unfinished, and doesn’t ask the teacher for further help nor interact
(128), below-average performance IQ (87). Strong in her classmates during free time.
language areas, weak in spatial reasoning and arithmetic.
-Rita’s test scores ranged between grades 1.8 and 2.5,
making her 1 1/2 to 2 years below her present grade (3.8)
in mathematics. Her most serious mathematical difficulties
were in the areas of numerical reasoning and word
problems. She also did poorly in addition, subtraction and
multiplication.
-Rita tested at the fourth grade level for word recognition
skills but at the second grade level for reading
comprehension.
-Rita has great difficulty performing the visual-motor task of
handwriting and is resistant to switching to cursive writing.
Written expression could not be tested due to extremely
poor handwriting.
-Tested at a second-grade spelling level.
-Rita scored low in daily living skills and socialization.
-Rita has visual-perception abilities equivalent to that of a
six-year old.
-Showed adequate results on a test of auditory
discrimination
-Rita likes watching television and eating; her favorite
subject is music and she dislikes math and gym.

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STRENGTHS, CONCERNS, INTERESTS AND PREFERENCES

STATEMENT OF STUDENT STRENGTHS

Rita shows potential in areas related to language, particularly indicated by her high test scores on verbal skills. Rita displays strong auditory discrimination and her favorite
subject is in a related area: music.

STATEMENT OF PARENT EDUCATIONAL CONCERNS

Mrs. G. is worried that her daughter might fail third grade if she continues to resist going to school. Rita calls herself ‘dumb’ and says she hates school, and often complains of stomach
aches in the morning before school, perhaps as an attempt to get out of school.

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

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

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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. x Yes.
If YES, IEP committee must provide positive behavioral strategies, supports and interventions, or other strategies, supports and interventions to address that
behavior.
x Addressed in IEP.

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

3. Does the student have limited English proficiency? x 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? x 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? x 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. X Yes.
If YES, the IEP committee must consider the following instructional approaches (check box if IEP committee considered the item):

X 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.
X 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.
X Meaning-based instruction directed at purposeful reading and writing, with an emphasis on comprehension and composition.
X 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)
By the end of eight weeks (the end of the school year), Rita will complete a minimum
of 3 of 5 grade 3.0 math problems 2. Unsatisfactory Progress Being Made
(need to review/revise)
Check here if this goal supports the student's postsecondary goal(s) and identify the goal(s) to which it relates:
3. Goal Met (note date)
Training/Education Employment Independent Living Skills Other
Date Date Date Date

Check here if this goal will be addressed during Extended School Year Services (ESY)
Progress Progress Progress Progress
#1) In two weeks, Rita will complete two of five grade 1.8-2.5 math problems during each class seatwork session. If she meets or exceeds this goal, she will move on to short-term goal
#2. In addition, Rita will take notes on how to solve problems using an assistive handwriting technology such as a touchpad.

#2)In four weeks, Rita will complete four grade 1.8 math problems or three grade 2.5 or higher math problems during each class seatwork session. If she meets or exceeds this goal, she
will move on to short-term goal # 2. In addition, Rita will take notes on how to solve problems using an assistive handwriting technology such as a touchpad.

#3)In six weeks, Rita will complete three or more grade 2.5 or higher math problems, or two grade 3.0 math problems. If she meets or exceeds this goal, she will move on to short-term
goal # 3. In addition, Rita will take notes on how to solve problems using an assistive handwriting technology such as a touchpad.

#4) In eight weeks, Rita will complete three or more grade 3.0 math problems.

MEASURABLE ANNUAL GOAL (including how progress toward the annual goal will be measured) PROGRESS REPORT
2. Satisfactory Progress Being Made (continue)
By the end of eight weeks (the end of the school year), Rita will spend an entire fifteen
minute “free” period interacting with other students, working on homework, or both. 2. Unsatisfactory Progress Being Made
(need to review/revise)
Check here if this goal supports the student's postsecondary goal(s) and identify the goal(s) to which it relates:
3. Goal Met (note date)
Training/Education Employment Independent Living Skills Other
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 two weeks, Rita will be observed, at least twice, interacting with other students and/or working on homework for at least 4 minutes of the “free” period. If she meets or
exceeds this goal, she will move on to short-term goal #2.

#2)By the end of four weeks, Rita will be observed, at least twice, interacting with other students and/or working on homework for at least 8 minutes of the “free” period. If she meets or
exceeds this goal, she will move on to short-term goal # 3.

#3)By the end of six weeks, Rita will be observed, at least twice, interacting with other students and/or working on homework for at least 12 minutes of the “free” period. If she meets or
exceeds this goal, she will move on to short term-goal # 4.

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#4) By the end of eight weeks, Rita will be observed, at least twice, interacting with other students and/or working on homework for the entirety of the 15 minute “free” period.

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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)
By the end of eight weeks (end of the school year), Rita will develop a regular
regimen of practicing cursive writing. 2. Unsatisfactory Progress Being Made
(need to review/revise)
Check here if this goal supports the student's postsecondary goal(s) and identify the goal(s) to which it relates:
3. Goal Met (note date)
Training/Education Employment Independent Living Skills Other
Date Date Date Date

Check here if this goal will be addressed during Extended School Year Services (ESY)
Progress Progress Progress Progress
#1) Over the space of two weeks, Rita will independently practice writing in cursive the letters ‘A-I’ and the numbers ‘0-3’ for 10 minutes every other day using a slant-board and wide-
lined paper in the library. If she meets this goal, she will move on to short-term goal #2. Rita will also practice her pencil grip.

#2)Over the space of weeks three and four, Rita will independently practice writing in cursive the letters ‘J-R’ and the numbers ‘4-6’ for 10 minutes every other day using a slant-board
and wide-lined paper in the library. If she meets this goal, she will move on to short-term goal #3. Rita will also practice her pencil grip.

#3)Over the space of weeks five and six, Rita will independently practice writing in cursive the letters ‘S-Z’ and the numbers ‘7-9’ for 10 minutes every other day using a slant-board and
wide-lined paper in the library. If she meets this goal, she will move on to short-term goal # 4. Rita will also practice her pencil grip.

#4)Over the space of weeks seven and eight, Rita will independently practice writing in cursive the letters ‘A-Z’ and the numbers ‘0-9’ for 10 minutes every other day using a slant-board
and wide-lined paper in the library. Rita will also practice her pencil grip.

MEASURABLE ANNUAL GOAL (including how progress toward the annual goal will be measured) PROGRESS REPORT
4. Satisfactory Progress Being Made (continue)
By the end of eight weeks (end of the school year), Rita will read a paragraph from a story at the third-
grade level. 2. Unsatisfactory Progress Being Made
(need to review/revise)
Check here if this goal supports the student's postsecondary goal(s) and identify the goal(s) to which it relates:
3. Goal Met (note date)
Training/Education Employment Independent Living Skills Other
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 two weeks, Rita will orally summarize a sentence from a paragraph of a third-grade level text read silently in the library. If she meets this goal, she will move on to
short-term goal # 2.

#2)By the end of four weeks, Rita will orally summarize two sentences from a paragraph of a third-grade level text read silently in the library. If she meets this goal, she will move on to
short-term goal # 3.

#3)By the end of six weeks, Rita will orally summarize three sentences from a paragraph of a third-grade level text read silently in the library. If she meets this goal, she will move on to
short-term goal # 4.

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#4) By the end of eight weeks, Rita will orally summarize four sentences (one paragraph) from a third-grade level text read silently in the library.

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)
x IEP Goals Pages District Report Card Quarterly Semester
Specialized Progress Report Parent Conferences Trimester x Other Biweekly for the remainder of
Other school year

SPECIAL EDUCATION SERVICES

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

Independent cursive practice 3/28 – 5/17 Every other day Library

Independent reading and oral summary 3/28 – 5/17 Daily Library
Progressive grade-specific math problems 3/28 – 5/17 Every seatwork Regular Classroom
session
-
-
-

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.

Touchscreen for handwriting assistance/notetaking 3/28 – 5/17 Daily General

Classroom
Slant board 3/28 – 5/17 Every other day Library

Wide-lined paper 3/28 – 5/17 Every other day Library

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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 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 No x Yes

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

End of Course Exams No Yes

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

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

Yes x N/A

EXTENDED SCHOOL YEAR SERVICES

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Does the student require extended school year services?

x 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
x Selected Rejected Regular class with supplementary aids and services (no removal)
x Selected Rejected Regular class and special education class (e.g., resource) The student will spend 80 % of his or her school day in the
combination x Selected Rejected Self-contained program regular education environment.
Selected x Rejected Special School
Selected x Rejected Residential
Selected x Rejected
Hospital
Selected x Rejected Home
Selected x 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.
Individualized instruction in a quiet setting (i.e. – the library) for cursive writing practice and reading comprehension goals
may prove more beneficial for Rita’s focus on these particular areas.

*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

x 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

x A copy of this IEP was provided to the student’s parent on : ________3/7/2018___________by____________________Prof. J. Meyers_________________ (date)
(name) (title)

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