DATE:_18 Feb 2019___ Page 1 of 12

STATE OF NEVADA INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP)

INFORMATION
STUDENT/PARENT INFORMATION ELIGIBILITY CATEGORY MEETING INFORMATION
Student: Rita G Sex: Female DATE OF MEETING18 Feb 2019
Autism Spectrum Disorder DATE OF LAST IEP MEETING N/A
Birthdate N/A Grade 3 Student ID #N/A
Student Primary Language English Deaf/Blind PURPOSE OF MEETING
Student English Proficiency Status: Proficient Developmental Delay Interim IEP

Federal Placement Code: N/A Emotional Disturbance Initial IEP

Federal Student Ethnicity Code: N/A Health Impairment Annual IEP

Address: N/A Hearing Impairment/Deaf IEP Following 3-Yr Reevaluation
Student Phone: N/A Intellectual Disability Revision To IEP Dated N/A

Multiple Impairment Exit Select Exit Code

Parent/Guardian/Surrogate: N/A
Parent Phone (Home) N/A (Work) N/A Orthopedic Impairment IEP Revision Without A Meeting:
Specific Learning Disability At the request of : Parent or School District
Optional: Cell N/A Email N/A
Primary Language Spoken at Home English Speech/Language Impairment Other N/A

Interpreter or Other Accommodations Needed N/A Traumatic Brain Injury IEP SERVICES WILL BEGIN N/A
Emergency Contact/Phone Number N/A Visual Impairment/Blind ANTICIPATED
DURATION OF SERVICES N/A
Current School N/A Zoned School N/A ELIGIBILITY DATE N/A
IEP REVIEW DATE N/A
ANTICIPATED 3-YR REEVALUATION N/A COMMENTS N/A

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* Resource Teacher Other (name and role) N/A
Regular Education Teacher*** Other (name and role) N/A
School Psychologist School Psychologist 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.

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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Name:_____Rita G______ DATE:____18 Feb 2019_____ Page 2 of 12

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

 Wechsler Intelligence Scale  Average IQ score of 109  Gives up on tasks when items become more difficult, has no system for attacking challenging
for Children-Third Edition  Verbal IQ score of 128 problems. Becomes helpless and says, “I cannot do that.”
(WISC-111)  Performance IQ score of 87

 Peabody Individual
Achievement Test-Revised  Below grade level with scores ranged between 1.8  Currently placed at 3.8, which makes her 1-2 years below present mathematical placement.
(PIAT-R), the Key Math- and 2.5 Has difficulties with numerical reasoning and word problems. Placement will continue to
Revised, and the Brigance restrict her abilities to learn.
Comprehensive Inventory
of Basic Skills-Revised

 Brigance Comprehensive  Satisfactory in word recognition, unsatisfactory with  Performance drops considerably when reading comprehension is required.
Inventory of Basic Skills- reading comprehension  Loses her place while reading has difficulty concentrating on material.
Revised, the PIAT-R, the  Reading comprehension level – 2nd grade
Woodcock Reading  Word recognition level – 4th grade
Mastery Tests-Revised and
the Gray Oral Reading
Tests, Third Edition

 Brigance Comprehensive  Unsatisfactory in arithmetic.  Resists attempting cursive. Left handed and has difficulty performing this visual motor task.
Inventory of Basic Skills-  Satisfactory in manuscript Spends much time writing but the result is sloppy. Does not distinguish between tall and
Revised  Refuses cursive small letters. Unusual pencil grasp.

 PIAT-R, the Brigance  2nd grade level  Usually spells words according to phonics rules. Shows poor visual memory for irregularly
Comprehensive Inventory spelled words.
of Basic Skills-Revised, the
Woodcock-Johnson
Psychoeducational Battery-
111 (WJ-111)

 Vineland Adaptive  Low tests score in daily living skills and socialization  Relies on other people to tell her what to do. Has made no friends and plays mostly with her
Behavior Scales younger sister. If not instructed to do something, Rita will “just sit there.”

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Name:_____Rita G______ DATE:____18 Feb 2019_____ Page 3 of 12

 Developmental Test of  Equivalent to 6-year-old  Can copy simple designs but has difficulty with triangle, diamond and complicated shapes.
Visual-Motor Integration  Weakness in visual perception abilities
 Strength in auditory discrimination
 Goldman-Fristoe-  Adequate
Woodcock Test of Auditory
Discrimination
 No hearing difficulties were noted
 Hearing Test  Normal range
 No visual difficulties were noted
 The Keystone Visual-  Normal range
Screening Service for
School visual screening
test

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Name:_____Rita G______ DATE:____18 Feb 2019_____ Page 4 of 12

STRENGTHS, CONCERNS, INTERESTS AND PREFERENCES

STATEMENT OF STUDENT STRENGTHS

Excels with word recognition. Satisfactory with word identification, phonics skills and reading vocab. Strengths in auditory discrimination.

STATEMENT OF PARENT EDUCATIONAL CONCERNS

 Mrs. G is concerned that Rita would be restricted from learning with her peers. While Rita gets along well with her younger sister, Mrs. G is concerned that Rita is not
making friends or choosing to be social, and that this might restrict her in life. Mrs. G is concerned that Rita might have a learning disability that is keeping her from
excelling; she says that Rita was an average baby that developed childhood skills at the age appropriate time.

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 eat. She likes hanging out with her little sister and her little sisters friend. She likes going to school when the teacher does not yell at her. She
enjoys music class and hates gym and arithmetic. When she takes out the garbage at home, her mother gives her money and she likes to spend it on candy.

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

 Interviewed with school psychologist.

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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.
 Rita hopes to improve her writing skills so that she may be able to excel and not be hindered by her writing. She hopes to improve her reading comprehension by
reading more books and practicing flashcards at home. Rita hopes to make a friend that is the same age as her.

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.
 More focus on arithmetic. More focus on reading comprehension. More us of shapes in the classroom. Better disciplinary tool from the teacher, so
as to keep the student on track with daily tasks.

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
 Attend college or equivalent at a school for performing arts.

Employment
 To become employed in a music profession. She prefers either soundtrack creator or jingle writer.

Independent Living Skills (As Appropriate)

 Cook and clean for herself. Acquire her own apartment near the theater that she pays rent for herself.

Other
 When she grows up, she wants to get a cat and name it puppy.

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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
 Rita needs to be placed in a desk at the front of the class. This will help her with direct instruction, and restrict the distractions of the classroom.
She must have access to a text-to-speech product that will help her hear the words that she is reading. This will help her with her reading
comprehension. Teacher must incorporate a musically activity to attract the attention of the student.

Any Other Agency Involvement (Optional): N/A

Related Services
 Text-To-Speech program

Any Other Agency Involvement (Optional): N/A

Community Experiences
 Enrichment program designed to inspire the student and show her that she can do the things that she tells herself that she cannot.

Any Other Agency Involvement (Optional): N/A

Employment and Other Post-School Adult Living Objectives

 Audio Visual Technician
 Record Producer

Any Other Agency Involvement (Optional): N/A

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

Any Other Agency Involvement (Optional): N/A

Other
N/A

Any Other Agency Involvement (Optional): N/A

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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)

Check here if this goal will be addressed during Extended School Year Services (ESY) Date N/A Date N/A Date N/A Date N/A

# 1) N/A

# 2) N/A

#3) N/A

#4) N/A

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)

Check here if this goal will be addressed during Extended School Year Services (ESY) Date N/A Date N/A Date N/A Date N/A

#1) N/A
#2) N/A
#3) N/A
#4) N/A

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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)

Check here if this goal will be addressed during Extended School Year Services (ESY) Date N/A Date N/A Date N/A Date N/A

#1) N/A

#2) N/A

#3) N/A

#4) N/A

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)

Check here if this goal will be addressed during Extended School Year Services (ESY) Date N/A Date N/A Date N/A Date N/A

#1) N/A
#2) N/A
#3) N/A
#4) N/A

METHOD FOR REPORTING PROGRESS

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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

Text-To-Speech 2/18/2019 – Daily In the classroom

6/5/2019
Reading Room 2/18/2019 – Weekly Outside Instruction
6/5/2019
N/A -
N/A -
N/A -
N/A -

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.
Reading Teacher 2/18/2019- Weekly Outside
6/5/2019 Instruction
-

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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

Speech/Language Consultative Description: Discuss reading comprehension 2/18/2019 – Weekly Outside

6/5/2019 source
Psychologist Direct Description: Discuss Learning Behaviors 2/18/2019 – Monthly Outside
6/5/2019 Source
-
Description: N/A
-
Description: N/A
-
Description: N/A
-
Description: N/A

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 participate in State Reference Test, however, No Yes
(CRT) Yes N/A Alternate she will test in a separate room, free of noise and If YES, list on "Accommodation(s) for the
distractions. Reading section allows use of text-to-speech. Nevada Proficiency Examination Program"
(attach form).

End of Course Exams Student will participate in State End of Course Exams, however, No Yes
Yes N/A she will test in a separate room, free of noise and distractions. If YES, list on "Accommodation(s) for the
Reading section allows use of text-to-speech. Nevada Proficiency Examination Program"
(attach form).
College and Career Readiness Assessment Student will participate in College and Career No Yes
Yes N/A Readiness Assessment, however, she will test in a If YES, list on "Accommodation(s) for the
separate room, free of noise and distractions. Reading Nevada Proficiency Examination Program"
section allows use of text-to-speech. (attach form).

Other (List): N/A 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: N/A

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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 95 % 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 N/A

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.

 Student requires specialized reading instruction in a one-on-one setting that the general education teacher cannot provide. This will help the
student focus on improving their reading comprehension in an environment that is not as distractive as the regular classroom. Student also
required to attend therapy with a physiologist to restrict feelings of “can’t do” attitude. Team has rejected specialized classroom separate from
general education classroom so the student can learn with their peers and improve their social skills.

*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: ___18 Feb 2019________by_Erin Quinn__________ __________Educator_________________
(date) (name) (title)

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