Professional Documents
Culture Documents
Iepform Nevada
Iepform Nevada
STATE OF NEVADA
INFORMATION
STUDENT/PARENT INFORMATION ELIGIBILITY CATEGORY MEETING INFORMATION
Student Chloenette Baker Sex Female ✔ Autism Spectrum Disorder DATE OF MEETING 02/05/2022
DATE OF LAST IEP MEETING 02/05/2021
Birthdate 08/15/2008 Grade 3 Student ID # 42424434 Deaf/Blind
Student Primary Language English PURPOSE OF MEETING
Developmental Delay
Student English Proficiency Code (optional) N/A Interim IEP
Emotional Disturbance
Address 111 Ocean Park, Oranfe, CA 92677 Initial IEP
Health Impairment
Student Phone (949) 212-1327 Annual IEP
Hearing Impairment/Deaf
✔ IEP Following 3-Yr Reevaluation
Intellectual Disability
Parent/Guardian/Surrogate Andy Baker, Alice Baker Revision To IEP Dated
Multiple Impairment
Parent Phone (Home) (949) 212-1327 (Work) (949) 321-5000 Exit/Graduation
Orthopedic Impairment
Optional: Cell (949) 212-1237 Email baker100@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 English (primary) Other
Federal Placement Code N/A Traumatic Brain Injury
IEP SERVICES WILL BEGIN 02/06/2022
Federal Student Ethnicity Code N/A Visual Impairment/Blind
ANTICIPATED
Interpreter or Other Accommodations Needed N/A ELIGIBILITY DATE DURATION OF SERVICES 08/15/2029
Emergency Contact/Phone Number (949) 312-2022 ANTICIPATED IEP REVIEW DATE 02/05/2023
3-YR REEVALUATION
Current School Martin Sunnydale E.S. Zoned School Sunnydale E.S. COMMENTS
IEP PARTICIPATION
Parent/Guardian/Surrogate* Andy Baker, Alice Baker Speech/Language Therapist/Pathologist/Specialist Kacy T, M.A. CCC-SLP
Student** Chloenette Baker School Nurse Cassandra Cole, RN
LEA Representative* Tammy Walker Interpreter N/A
Special Education Teacher* Sarah W, M.A.E.D. Other (name and role) Andy Baker (Father)
Regular Education Teacher*** Other (name and role) Alice Baker (Mother)
School Psychologist Megan R, M.S. Other (name and role) Dianna E, OTR/ (Occupational Therapist)
*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.
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
1) Eight minutes/day 1) Chloenette shows defficulti in 1) apply individual support for student daily activities such as
Chloenette particpates transitioning from one task to another. learning how to participate and learnibg how to trasition in a
in genreal education general education setting.
settings for recess and 2) Chloenette can attends to be
lunch. distracted or disregard directions. 2) provideing reinforcements with progression.
3) Speech and
language in a group
setting for 30 minutes
twice per week.
4) Ocupational therapy
in a group setting for
30 minutes one per
week.
Chloenette has good social skills with her peers teachers, and extended support staff. Academically she does well and succed on
certain curriculums. When assignments are presented she is willing to learn.
STATEMENT OF STUDENT'S PREFERENCES AND INTERESTS (required if transition services will be discussed, beginning at age 14 or younger if appropriate)
N/A
If student was not in attendance, describe the steps taken to ensure that the student's preferences and interests were considered:
Addressing the students's problems and coordinating plans and goals to help the student work on the tasks addressed. Also
making sure sure the student learn, understand and grow which will allow the student to apply daily activities and succeed.
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.
The studebt's IEP will give overall measurments and goals for students future success.
Please refer to the studen's IEP which will provide instructions, goals, and course of study for the student on an annually basis.
Training/Education
N/A
Employment
N/A
Other
Instruction
N/A
Related Services
N/A
Acquisition of Daily Living Skills and Functional Vocational Evaluation (if appropriate)
N/A
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
By 02/05/2023 Chloenette Baker will learn to recognize and print 7 lower case letters in 4 out of 5 presented opportunities:
# 2
By 02/05/2023 Chloenette Baker will learn to recognize and print 10 lower case letters in 4 out of 5 presented opportunities:
#
By 02/05/2023 Chloenette Baker will learn to recognize and print 26 lower case letters in 4 out of 5 presented opportunities:
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
By 02/05/2023 Chloenette Baker wil learn how to engage in a general classroom with her peers allowing 15minutes out of 40 minutes instructional time
# 2
By 02/05/2023 Chloenette Baker wil learn how to engage in a general classroom with her peers allowing 20 minutes out of 40 minutes instructional time
# 3
By 02/05/2023 Chloenette Baker wil learn how to engage in a general classroom with her peers allowing 30 minutes out of 40 minutes instructional time
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
Chloenettet will require support staff assistant to helpt her transition from one classroom to another. She will be giving therapy sessions such as
speech and occupational therpay for 30 minutes. Speech Therapy will be given two times a week for 30 minutes in a group setting and Occupational
therapy will be given once a week for 30 minutes in a group setting. She will learn how to engage with heer peers in each therapy session.
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
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 40 % 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
03/05/2022
A copy of this IEP was provided to the studentʼs parent on: _________________________ by _________________________________________________________
(date) (name) (title)