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STATEOFNEVADAINDIVIDUALIZEDEDUCATIONALPROGRAM(IEP)
INFORMATION
STUDENT/PARENTINFORMATION ELIGIBILITYCATEGORY MEETINGINFORMATION
Student:Rita G.Sex: Select Gender DATEOFMEETING10/22/2018
AutismSpectrumDisorder DATEOFLASTIEPMEETING
Birthdate10/22/09Grade3StudentID#
StudentPrimaryLanguage Deaf/Blind PURPOSEOFMEETING
StudentEnglishProficiencyStatus: Select LEP Status DevelopmentalDelay InterimIEP

Federal Placement Code: Select Placement Code EmotionalDisturbance InitialIEP

AnnualIEP
Federal Student Ethnicity Code: Select Ethnicity Code HealthImpairment
IEPFollowing3-YrReevaluation
Address: HearingImpairment/Deaf
RevisionToIEPDated
StudentPhone: IntellectualDisability
Exit Select Exit Code
Parent/Guardian/Surrogate: MultipleImpairment
IEPRevisionWithoutAMeeting:
ParentPhone(Home) (Work) OrthopedicImpairment
Attherequestof: Parentor SchoolDistrict
Optional:Cell Email SpecificLearningDisability
Other
PrimaryLanguageSpokenatHome Speech/LanguageImpairment
IEPSERVICESWILLBEGIN
InterpreterorOtherAccommodationsNeededSelect Y or N TraumaticBrainInjury
ANTICIPATED
EmergencyContact/PhoneNumber VisualImpairment/Blind DURATIONOFSERVICES
CurrentSchool ZonedSchool ELIGIBILITYDATE IEPREVIEWDATE
ANTICIPATED3-YRREEVALUATION COMMENTS

IEP PARTICIPATION
Parent/Guardian/Surrogate* Speech/LanguageTherapist/Pathologist/Specialist
Student** SchoolNurse
LEARepresentative* Interpreter
SpecialEducationTeacher* Other(nameandrole)
RegularEducationTeacher*** Other(nameandrole)
SchoolPsychologist Other(nameandrole)
*Requiredparticipant.
**Studentmustbeinvitedwhentransitionisdiscussed(beginningatage14oryoungerifappropriate).
***TheIEPteammustincludeatleastoneregulareducationteacherofthestudent(ifthestudentis,ormaybe,participatingintheregulareducationenvironment).

PROCEDURALSAFEGUARDS
IhavereceivedastatementofproceduralsafeguardsundertheIndividualswithDisabilitiesEducationAct(IDEA)andtheserightshavebeenexplainedtomeinmyprimarylanguage.

ParentSignature

ATLEASTONEYEARPRIORTOREACHINGAGE18,STUDENTSMUSTBEINFORMEDOFTHEIRRIGHTSUNDERIDEAANDADVISEDTHATTHESERIGHTSWILLTRANSFERTOTHEMATAGE18.

Notapplicable.Studentwillnotbe18withinoneyear,andthestudent'snextannualIEPmeetingwilloccurnolaterthanthestudent's17thbirthday.

Thestudenthasbeeninformedofhis/herrightsunderIDEAandadvisedofthetransferoftheserightsatage18.

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PRESENTLEVELSOFACADEMICACHIEVEMENTANDFUNCTIONALPERFORMANCE
Considerresultsoftheinitialevaluationormostrecentreevaluation,andtheacademic,developmental,andfunctionalneedsofthestudent,whichmayincludethefollowingareas:
academicachievement,language/communicationskills,social/emotional/behaviorskills,cognitiveabilities,health,motorskills,adaptiveskills,pre-
vocationalskills,vocationalskills,andotherskillsasappropriate.Forstudentswhoare16orolder,orwillturn16whenthisIEPisineffect,alsoconsidertheresultsofageappropriatetransitionassessmentsrelatedtotraini
ng/education,employment,andindependentlivingskills(asappropriate).

ASSESSMENTSCONDUCTED ASSESSMENTRESULTS EFFECTONSTUDENT'SINVOLVEMENTANDPROGRESSINGENERALEDUCATIONCUR

RICULUMOR,FOREARLYCHILDHOODSTUDENTS,INVOLVEMENTINDEVELOPMENTA
LACTIVITIES

• Mathematics, reading,
handwriting, spelling,
adaptive behavior,
learning strengths and
weaknesses, and
interest
• Mathematics assessment concluded that Rita Most of the developmental deficiencies will improve when Rita does more spelling
scored substantially below her grade level in activities including flashcards for the words that she misspells the most and most
all tests. frequently, handwriting can be improved by trying to give her a pencil grip so she can hold
• Reading assessment concluded that Rita was Her pencil easier and have her practice her handwriting on the worksheets that teach you
satisfactorily passing the words recognition, how to write each letter. To solve the spacing issue of her letters get a sacer and place
but her performance dropped considerably under each spot where you want her to write the words and have her follow along while
when reading comprehension was required. writing each letter and correct each one as it may appear worng as she writes it so she can
• Hadwriting skills concluded that her have the instruction on how to do it. Also try laminating a couple words on flashcards and
handwriting would appear sloppy and illegible hae her trace the letters on it with dry erase marker.
and all of her words are written the same size
including capital letters and lowercase letters,
her pencil grasp is unusual.
• Spelling assessment shows that she has
spelling errors that usually are spelled
according to the phonics rules, and she
showed poor visual memory for irregularly
spelled words.
•

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STRENGTHS,CONCERNS,INTERESTSANDPREFERENCES

STATEMENTOFSTUDENTSTRENGTHS

STATEMENTOFPARENTEDUCATIONALCONCERNS

STATEMENTOFSTUDENT'SPREFERENCESANDINTERESTS (requirediftransitionserviceswillbediscussed,beginningatage14oryoungerifappropriate)

Ifstudentwasnotinattendance,describethestepstakentoensurethatthestudent'spreferencesandinterestswereconsidered:

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CONSIDERATIONOFSPECIALFACTORS

1. Doesthestudent'sbehaviorimpedethestudent'slearningorthelearningofothers? No. Yes.

IfYES,IEP committeemustprovidepositivebehavioralstrategies,supportsandinterventions,orotherstrategies,supportsandinterventionstoaddressthatbehavior.
Addressed in IEP.

2. Doesthestudentrequireassistivetechnologydevicesandservices? No. Yes.

IfYES,IEP committeemustdeterminenatureandextentofdevicesandservices.
Addressed in IEP.

3. DoesthestudenthavelimitedEnglishproficiency? No. Yes.

IfYES,IEP committeemustconsider the following (check box if IEP committee considered the item):
Languageneedsofthestudentasthoseneedsrelatetothestudent'sIEP.

4. Isthestudentblindorvisuallyimpaired? 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. Isthestudentdeaforhardofhearing? No. Yes.

IfYES,IEP committeemustconsider the student’s language and communicationneeds 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 communication access.

6. Does the student have a Specific Learning Disability and Dyslexia? No. Yes.
IfYES, 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.

TRANSITION
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DIPLOMAOPTIONSELECTEDFORGRADUATION (Diplomaoptionmustbedeclaredatage14andreviewedannually.)
StandardorAdvancedHighSchoolDiploma.Must completeallapplicablecredit requirements AdjustedHighSchoolDiploma.Must completeIEPrequirements.
andpasstheHighSchool Proficiency Examination(withpermissibleaccommodations asneeded).

STUDENT'SVISIONFORTHEFUTURE
Ashortstatementthatdirectlyquoteswhatthestudentwantsforthefuture.

STATEMENTOFTRANSITIONSERVICES:COURSEOFSTUDY
Beginningatage14oryoungerifdeterminedappropriatebytheIEPteam,describethefocusofthestudent'scourseofstudy.

STATEMENTOFMEASURABLEPOSTSECONDARYGOALS
BeginningnotlaterthanthefirstIEPtobeineffectwhenthestudentis16,describemeasurablepostsecondarygoalsinthefollowingareas:

Training/Education

Employment

IndependentLivingSkills(AsAppropriate)

Other

TRANSITION(continued)

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STATEMENTOFTRANSITIONSERVICES:COORDINATEDACTIVITIES
BeginningnotlaterthanthefirstIEPtobeineffectwhenthestudentis16,developastatementofneededtransitionservices,includingstrategiesoractivities,forthestudent.

Instruction

AnyOtherAgencyInvolvement(Optional):

RelatedServices

AnyOtherAgencyInvolvement(Optional):

CommunityExperiences

AnyOtherAgencyInvolvement(Optional):

EmploymentandOtherPost-SchoolAdultLivingObjectives

AnyOtherAgencyInvolvement(Optional):

AcquisitionofDailyLivingSkillsandFunctionalVocationalEvaluation(ifappropriate)

AnyOtherAgencyInvolvement(Optional):

Other

AnyOtherAgencyInvolvement(Optional):

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IEPGOALS,INCLUDINGACADEMICANDFUNCTIONALGOALS,ANDBENCHMARKSORSHORT-TERMOBJECTIVES

MEASURABLEANNUALGOAL (includinghowprogresstowardtheannualgoalwillbemeasured) PROGRESSREPORT

1. SatisfactoryProgressBeingMade (continue)

Checkhereifthisgoalsupportsthestudent'spostsecondarygoal(s)andidentifythegoal(s)towhichitrelates: 2.UnsatisfactoryProgressBeingMade
(needtoreview/revise)

Training/Education Employment IndependentLivingSkills Other 3.GoalMet(notedate)

Date Date Date Date

CheckhereifthisgoalwillbeaddressedduringExtendedSchoolYearServices(ESY)

Progress Progress Progress Progress

# )

# )

# )

# )

MEASURABLEANNUALGOAL (includinghowprogresstowardtheannualgoalwillbemeasured) PROGRESSREPORT

2. SatisfactoryProgressBeingMade (continue)

Checkhereifthisgoalsupportsthestudent'spostsecondarygoal(s)andidentifythegoal(s)towhichitrelates: 2.UnsatisfactoryProgressBeingMade
(needtoreview/revise)

Training/Education Employment IndependentLivingSkills Other 3.GoalMet(notedate)

Date Date Date Date

CheckhereifthisgoalwillbeaddressedduringExtendedSchoolYearServices(ESY)

Progress Progress Progress Progress

# )

# )

# )

# )

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IEPGOALS,INCLUDINGACADEMICANDFUNCTIONALGOALS,ANDBENCHMARKSORSHORT-TERMOBJECTIVES

MEASURABLEANNUALGOAL (includinghowprogresstowardtheannualgoalwillbemeasured) PROGRESSREPORT

3. SatisfactoryProgressBeingMade (continue)

Checkhereifthisgoalsupportsthestudent'spostsecondarygoal(s)andidentifythegoal(s)towhichitrelates: 2.UnsatisfactoryProgressBeingMade
(needtoreview/revise)

Training/Education Employment IndependentLivingSkills Other 3.GoalMet(notedate)

Date Date Date Date

CheckhereifthisgoalwillbeaddressedduringExtendedSchoolYearServices(ESY)

Progress Progress Progress Progress

# )

# )

# )

# )

MEASURABLEANNUALGOAL (includinghowprogresstowardtheannualgoalwillbemeasured) PROGRESSREPORT

4. SatisfactoryProgressBeingMade (continue)

Checkhereifthisgoalsupportsthestudent'spostsecondarygoal(s)andidentifythegoal(s)towhichitrelates: 2.UnsatisfactoryProgressBeingMade
(needtoreview/revise)

Training/Education Employment IndependentLivingSkills Other 3.GoalMet(notedate)

Date Date Date Date

CheckhereifthisgoalwillbeaddressedduringExtendedSchoolYearServices(ESY)

Progress Progress Progress Progress

# )

# )

# )

# )

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METHODFORREPORTINGPROGRESS

METHODFORREPORTINGTHESTUDENT'SPROGRESSTOWARDMEETINGANNUALGOALS(checkallmethod PROJECTEDFREQUENCYOFREPORTS
sthatwillbeused)
IEPGoalsPages DistrictReportCard Quarterly Semester
SpecializedProgressReport ParentConferences Other Trimester Other

SPECIALEDUCATIONSERVICES
SPECIALLYDESIGNEDINSTRUCTION BEGINNING FREQUENCYO LOCATIONO
ANDENDING FSERVICES FSERVICES
DATES

-
-
-
-
-
-

SUPPLEMENTARYAIDSANDSERVICES
Includesaids,services,andothersupportsprovidedinregulareducationclasses,othereducation-
relatedsettings,andinextracurricularandnonacademicsettingstoenablestudentswithdisabilitiestobeeducatedwithnondisabledstudentstothemaximumextentappropriate.

BEGINNING AND FREQUENCY OF LOCATION OF

MODIFICATION,ACCOMMODATION,ORSUPPORTFORSTUDENTORPERSONNEL ENDING DATES SERVICES SERVICES
Provide specific description(s)below.
-

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RELATEDSERVICES
RELATEDSERVICE SERVICETYPEAND/ORDESCRIPTIO BEGINNING FREQUENCY LOCATION
N 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: -

PARTICIPATIONINSTATEWIDEAND/ORDISTRICT-WIDEASSESSMENTS
Indicatehowthestudentwillparticipateinst Ifthestudentwillparticipateinanalternateassessment,explainwhythe Ifthestudentwillparticipateinaregularas
atewideordistrict-wideassessments. studentcannotparticipateintheregularassessment,andwhythepartic sessment,doesthestudentrequireacco
ularalternateassessmentselectedisappropriate mmodations?

StateCriterion- No Yes
ReferencedTest(CRT) Yes IfYES,liston"Accommodation(s)fortheNevadaP
roficiencyExaminationProgram"(attachform).
N/A Alternate

End of Course Exams No Yes

Yes N/A IfYES,liston"Accommodation(s)fortheNevadaP
roficiencyExaminationProgram"(attachform).

College and Career Readiness Assessment No Yes

Yes N/A IfYES,liston"Accommodation(s)fortheNevadaP
roficiencyExaminationProgram"(attachform).

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

Yes N/A

EXTENDEDSCHOOLYEARSERVICES
Doesthestudentrequireextendedschoolyearservices?
No Yes IfYES,IEPgoalsandbenchmarks/short-termobjectivesand/orrelatedservicestobeimplementedinESYmustbeidentified.
IfneedforESYistobedeterminedatalaterdate,indicatedatebywhichIEPdecisionwillbemade:

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PLACEMENT
PLACEMENTCONSIDERATIONS PERCENTAGEOFTIME
INREGULAREDUCATIONENVIRONMENT
Selected RejectedRegularclasswithsupplementaryaidsandservices(noremoval)
Selected Rejected Thestudentwillspend %ofhisorherschooldayintheregulareducationenvironment.
Regularclassandspecialeducationclass(e.g.,resource)combination Selected RejectedSelf-
containedprogram
Selected RejectedSpecial School
Selected RejectedResidential
Selected
RejectedHospital
Selected RejectedHome
Selected RejectedOther

JUSTIFICATIONFORPLACEMENTINVOLVINGREMOVALFROMREGULAREDUCATIONENVIRONMENTS*
ExplainwhytheIEPgoalsandobjectivescannotbeimplementedinregulareducationenvironments,includingthereasonswhytheteamrejectedalessrestrictiveplacement.Includeanexplana
tionofanyharmfuleffectsonthelearningofthisorotherstudentswhichaffectedtheplacementselection.

*Regulareducationenvironmentsincludeacademicclasses(whichmightincludefieldtripslinkedtothecurriculum),nonacademicsettings(suchasrecess),andextracurricularactivities(forexample,sports,a
fter-schoolclubs,band,etc.).

IEPIMPLEMENTATION

Astheparent,IagreewiththecomponentsofthisIEP.IunderstandthatitsprovisionswillbeimplementedassoonaspossibleaftertheIEPgoesintoeffect.

Astheparent,IdisagreewithallorpartofthisIEP.IunderstandthattheschooldistrictmustprovidemewithwrittennoticeofanyintenttoimplementthisIEP.IfIwishtopreventtheimplementationofthisIEP,Imust
submitawrittenrequestforadueprocesshearingtothelocalschooldistrictsuperintendent.

ParentSignature

AcopyofthisIEPwasprovidedtothestudent’sparenton:________ ___________by_ ______________________________ _________________(date)

(name) (title)

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