Professional Documents
Culture Documents
Iepform
Iepform
STATE OF NEVADA
INFORMATION
STUDENT/PARENT INFORMATION ELIGIBILITY CATEGORY MEETING INFORMATION
Student Rita G. Sex Female Autism Spectrum Disorder DATE OF MEETING
DATE OF LAST IEP MEETING
Birthdate 09/27/2012 Grade 3.6 Student ID # 1127272 Deaf/Blind
Student Primary Language English PURPOSE OF MEETING
Developmental Delay
Student English Proficiency Code (optional) N/A Interim IEP
Emotional Disturbance
✔ Initial IEP
Address 5005 Bulldog Lane, 89101, Las Vegas, NV Health Impairment
Student Phone N/A Annual IEP
Hearing Impairment/Deaf
IEP Following 3-Yr Reevaluation
Intellectual Disability
Parent/Guardian/Surrogate Mrs. G Revision To IEP Dated
Multiple Impairment
Parent Phone (Home) (702) 321-7654 (Work) (702) 400-3303 Exit/Graduation
Orthopedic Impairment
Optional: Cell N/A Email Mrs.G@gmail.com
IEP Revision Without A Meeting:
✔ Specific Learning Disability
Primary Language Spoken at Home English At the request of : Parent or ✔ School District
Speech/Language Impairment
LEP Status N/A Other
Federal Placement Code N/A Traumatic Brain Injury
IEP SERVICES WILL BEGIN
Federal Student Ethnicity Code N/A Visual Impairment/Blind
ANTICIPATED
Interpreter or Other Accommodations Needed N/A ELIGIBILITY DATE DURATION OF SERVICES
Emergency Contact/Phone Number (702) 321-7654 ANTICIPATED IEP REVIEW DATE
3-YR REEVALUATION
Current School Blue Elementary School Zoned School Blue Elementary School COMMENTS
IEP PARTICIPATION
Parent/Guardian/Surrogate* Mrs. G Speech/Language Therapist/Pathologist/Specialist Ms. Henry (made up)
Student** Rita G. School Nurse N/A
LEA Representative* N/A Interpreter N/A
Special Education Teacher* Mr. Gomez (made up) Other (name and role) Ms. Jones Resource teacher (made up)
Regular Education Teacher*** Mr. Mild Other (name and role) N/A
School Psychologist Mrs. Flower( made up) Other (name and role) N/A
*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.
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.
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,
ASSESSMENTS CONDUCTED ASSESSMENT RESULTS EFFECT ON STUDENT'S INVOLVEMENT AND PROGRESS IN GENERAL EDUCATION
CURRICULUM OR, FOR EARLY CHILDHOOD STUDENTS, INVOLVEMENT IN
DEVELOPMENTAL ACTIVITIES
Auditory Normal range
Visual
Normal no difficulties
Wechsler Intelligence Scale for Full-Scale IQ score of 109 Strengths with her use language; her weaknesses were in
Children-Third Edition
(WISC-111) Verbal IQ score was 128 tests in which she had to visualize objects in space, or plan
Performance IQ score was 87 and manipulate objects, and in arithmetic.
Present levels of Academic
Functioning:
1. Mathamatics:
Peabody Individual
Achievement Test-Revised Scores ranged between 1.8 and 2.5 Rita is 1 1/2 to 2 years below her present grade in
(PIAT-R),
Key Math-Revised, mathematics. Did poorly in addition, subtraction and
Brigance Comprehensive multiplication. As well as stuggles with fractions and division,
Inventory of Basic numerical reasion and world problems.
Skills-Revised
2. Reading
Brigance Comprehensive Scored satisfactorily in tests of word recognition, performance
Inventory of Basic At a 2nd grade reading level dropped when reading comprehension was required. Loses
Skills-Revised, PIAT-R,
Woodcock Reading Mastery her place often, struggles with concentrating on the material.
Tests-Revised, Gray Oral phonics skills and reading vocabulary are okay.
Reading Tests, Third Edition
3. Handwriting:
Brigance Comprehensive Final product is usually illegible and has a very sloppy
Inventory of Basic Poor and often illegible appearance. Written expression could not be tested because
Skills-Revised and through of her extremely poor handwriting skills. Struggles with written
observation
4. Spelling: papers and switching from manuscript to cursive.
PIAT-R, Brigance
Comprehensive Inventory of At a 2nd grade spelling level Focuses on the phonics of the words and spells then based of
Basic Skills-Revised,
Woodcock-Johnson that. Many errors are present.
Psychoeducational
Battery-111 (WJ-111), Wide
Range Achievement Test-111
(WRAT-111)
STATEMENT OF STUDENT'S PREFERENCES AND INTERESTS (required if transition services will be discussed, beginning at age 14 or younger if appropriate)
Rita enjoys music and considers it her favorite subject. Rita does not like arithmetic or gym class. She enjoys eating and
watching tv as well as playing with her little sister and her friend.
If student was not in attendance, describe the steps taken to ensure that the student's preferences and interests were considered:
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.
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.
5. Does the student have communication needs that require IEP services? ✔ No. Yes.
Addressed in IEP.
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.
7. 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.
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 participate in a College and Career Readiness Assessment.
Alternative High School Diploma. Must complete all applicable credit requirements and participate in the Nevada Alternate Assessment.
Training/Education
Employment
Other
Instruction
Related Services
Community Experiences
Acquisition of Daily Living Skills and Functional Vocational Evaluation (if appropriate)
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)
✔
Check here if this goal will be addressed during Extended School Year Services (ESY) Date Date Date Date
#7
#8
Includes aids, services, and other supports provided in regular education classes, other education-related settings (including special education settings), and in
extracurricular and nonacademic settings to enable students with disabilities to be educated with nondisabled students to the maximum extent appropriate.
MODIFICATION, ACCOMMODATION, OR SUPPORT FOR STUDENT OR PERSONNEL BEGINNING AND FREQUENCY OF LOCATION OF
Provide specific description(s) below. ENDING DATES SERVICES SERVICES
Text to Speech Software: Where Rita can hear and listen to readings and be able to have assistance with identifying words, being able to work on her phonic skills. 10/01/21-01/30/22 Daily if necessary Blue Elementary School
Pencil Grips/Specialized Pencils: Used to help Rita work on her pencil grip and handwriting. 10/01/21-01/30/22 Daily Blue Elementary School
Calculator: to help Rita with her basic addition and subtraction and later on multiplication. 10/01/21-01/30/22 On tests/when instructor permits Blue Elementary School
Speech/Language
Physical Therapy
Occupational Therapy
Transportation
Counseling
Psychological Services
Orientation and Mobility
Audiology
School Health Services
and School Nurse Services
Medical Services for Diagnostic
or Evaluation Purposes
Recreation, including
Therapeutic Recreation
Parent Counseling and Training
Interpreting Services
Social Work Services
✔ Assistive Technology D 10/01/21-01/30/22 Daily Blue Elementary School
Other
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 100 % of his or her school day in
Selected ✔ Rejected Self-contained program the regular education environment.
Selected ✔ Rejected Special school
Selected ✔ Rejected Residential
Selected ✔ Rejected Hospital
Selected ✔ Rejected Home
Selected Rejected Other
*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