DATE:___________ Page 1 of

15
STATE OF NEVADA INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP)
INFORMATION
STUDENT/PARENT INFORMATION ELIGIBILITY CATEGORY MEETING INFORMATION
Student:Penelope Waver Sex: F Autism Spectrum Disorder DATE OF MEETING11/15/16
Birthdate5/30/10 Grade1 Student ID #284461 DATE OF LAST IEP MEETING11/15/16
Deaf/Blind PURPOSE OF MEETING
Student Primary LanguageEnglish Developmental Delay Interim IEP
Student English Proficiency Status: LEP Emotional Disturbance Initial IEP
Federal Placement Code: E2 Reg. EC Prog 10 hrs wk/srvcs in in other loca Annual IEP
Health Impairment
Federal Student Ethnicity Code: A7 Asian IEP Following 3-Yr Reevaluation
Hearing Impairment/Deaf
Address:1994 Bronze Ave. Revision To IEP Dated
Intellectual Disability
Student Phone:-0 Exit Select Exit Code
Multiple Impairment
IEP Revision Without A Meeting:
Parent/Guardian/Surrogate:Stacy Waver Orthopedic Impairment
At the request of : Parent or School District
Specific Learning Disability
Parent Phone (Home) 5 (Work) Other
Optional: Cell Email123h Speech/Language Impairment
IEP SERVICES WILL BEGIN12/1/16
Traumatic Brain Injury
Primary Language Spoken at HomeEnglish ANTICIPATED
Visual Impairment/Blind
Interpreter or Other Accommodations NeededNo DURATION OF SERVICES12/1/17
Emergency Contact/Phone Number-6598956 ELIGIBILITY DATE11/1/16
IEP REVIEW DATE12/1/17
ANTICIPATED 3-YR
Current School81 Zoned School81 REEVALUATION COMMENTSnone

IEP PARTICIPATION
Parent/Guardian/Surrogate* Speech/Language Therapist/Pathologist/Specialist
Student** School Nurse
LEA Representative* Interpreter
Special Education Teacher* Other (name and role)
Regular Education Teacher*** Other (name and role)
School Psychologist Other (name and role)

10/12/2015 IEP PAGE 1

DATE PAGE OF

*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.

Revised 9/20/15
Name:___________ DATE:___________________ Page 3 of 15

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

-District Performance -Tested well below average on Penelope is falling further and further behind her classmates
tests standardized tests. daily.
-Reading -Is not able to read or recognize Her language skills are quite underdeveloped.
Comphrension many words in grade level story Because of this, she is not able to make progress
evaluation books. academically, socially, or otherwise.
-Social interactions -Is not able to communicate Due to Penelope not being able to express herself, she has
within and out of the effectively and therefore is not able often acted outduring instructional time.
classroom to make any meaningful social Action must be taken now in order for her to be ablet o catch
interactions with her classmates. up.
-When other students have reached
out to her to partake in activities with
them, she was extremely hestitant
and ultimately did not participate.
Very distracted during instruction.
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Name:___________ DATE:___________________ Page 5 of 15

STRENGTHS, CONCERNS, INTERESTS AND PREFERENCES

STATEMENT OF STUDENT STRENGTHS

Other than being an incredibly caring young girl, Penelope is quite the gifted artist for someone her age. her ability to
remember visual details is remarkable. She is precisive and detial oriented in her art work.

STATEMENT OF PARENT EDUCATIONAL CONCERNS

Mr. and Mrs. Waver have expressed great concern with her lack of ability to communicate more than a few words per
sentence. It is more than just Penelope being "shy" as she communicates the same way to her parents.

STATEMENT OF STUDENT'S PREFERENCES AND INTERESTS (required if transition services will be discussed, beginning at age 14 or younger if appropriate)
Penelope is a visual learner. Bright pictures with bold lines aide in her education best. She shows improvement with one-
on-one attention. But in a group setting she becomes lost quickly and loses interest.

If student was not in attendance, describe the steps taken to ensure that the student's preferences and interests were considered:
We, as a group,, discussed how we saw Penelope learn. Her parents' observations from the home and my perspective
coming from the classroom.
Name:___________ DATE:___________________ Page 6 of 15

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 childs 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 students 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 students 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 students primary communication mode.
The availability of special education teachers, interpreters and other special education personnel who are proficient in the students 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 students 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.
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
Name:___________ DATE:___________________ Page 7 of 15

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.
Penelope has expressed wanting to be able to complete a full book by herself.

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

TRANSITION (continued)
STATEMENT OF TRANSITION SERVICES: COORDINATED ACTIVITIES
Name:___________ DATE:___________________ Page 8 of 15

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):

Name:___________ DATE:___________________ Page 9 of 15

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)

Date11/15/ Date Date Date

Check here if this goal will be addressed during Extended School Year Services (ESY) 16

Progr Progr Progre Progress

ess ess ss
#1) Penelope will be able to read a full, level-approved book by this time next year. her progress will be measured by how
many pages she is able to read at one time until the book is complete.

#)

#)

#)

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)

Date11/15/ Date Date Date

Check here if this goal will be addressed during Extended School Year Services (ESY) 16

Progr Progr Progre Progress

ess ess ss
#2) Penelope will have made at least one friend that she interacts with on a daily basis by this time next year. I will
encourage her and her classmates by adding more group work and general observation.

#)

#)

#)
Name:___________ DATE:___________________ Page 10 of 15
Name:___________ DATE:___________________ Page 11 of 15

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)

Date11/15/ Date Date Date

Check here if this goal will be addressed during Extended School Year Services (ESY) 16

Progr Progr Progre Progress

ess ess ss
#3) Penelope will take a math test, by herself, along side her peers. this will be measured by how long she will be able to sit
through the test and also completion of such.

#)

#)

#)

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)

Date11/15/ Date Date Date

Check here if this goal will be addressed during Extended School Year Services (ESY) 16

Progr Progr Progre Progress

ess ess ss
#)

#)

#)

#)
Name:___________ DATE:___________________ Page 12 of 15
 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)
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

Therpeutic Recreation 12/1/16 - 2x weekly Private Room

12/1/17
Extra tutoring on each subject taught 12/1/16 - everyday Gen. Ed
12/1/17 Classroom
-
-
-
-

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.
assistive technology will be used to further language comprehension 12/1/16 - when Gen. Ed
12/1/17 needed class
Group work for social encouragment 12/1/16 - New Gen. Edu
12/1/17 Subject Class
Adding more visual aides for her benefit 12/1/16 - Everyday Gen. Ed
12/1/17 Class
-

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 Direct Description: Pathology for further linguistic skills 12/1/16 - 3x weekly Private
12/1/17 Room
Psychological Direct Description: To help with feelings of self doubt 12/1/16 - 1x weekly Private
Services and discouragment 12/1/17 Room
Assistive Technology Direct Description: to further comprehension 12/1/16 - when Gen. Ed
12/1/17 needed Classroo
m
Select Related Select Service Type Description: -
Service
Select Related Select Service Type Description: -
Service
Select Related Select Service Type Description: -
Service

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 Due to her level of reading No Yes

(CRT) Yes N/A Alternate
comprehension, a vocalized test If YES, list on "Accommodation(s) for the
Nevada Proficiency Examination Program"
(attach form).
will be best suited for her success.
End of Course Exams This is necessary to compare her No Yes
Yes N/A level with ther peers If YES, list on "Accommodation(s) for the
Nevada Proficiency Examination Program"
(attach form).
College and Career Readiness Assessment No Yes
Yes N/A If YES, list on "Accommodation(s) for the
Nevada Proficiency Examination Program"
(attach form).

Other (List): 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:
 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 8000% % 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

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.
Penelope requires one on one attention in order for the concepts to truly be understood. the removal from the classroom is
necessary to ensure that Penelope is able to learn and remember the information.

*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

A copy of this IEP was provided to the students parent on : ________11/15/16___________by_Yasmin Reyes______________________________
_________________ (date) (name) (title)