Roxana Loya

Education 203
Mock IEP
Professor Vicki Rieger
 PARENTAL PRIOR NOTICE- PROPOSED MEETING ARRANGMENTS
StudePnt Name: Marlyne Montez Grade: 1 DOB: 08/05/09 ID#555111 Date Sent: 03/17/16
Dear Parent/Guardian/Student:

We have tentatively scheduled a meeting with you to discuss the information noted on the attached Parental Prior Notice
Form. If this meeting time is not convenient for you, please review the options at the bottom of this sheet and return to the
school at your earliest convenience. You have the right to invite persons who have knowledge or special expertise
regarding your child to the meeting. (If your child is transitioning from Nevada Early Intervention Services (Part C) at age
three, you may ask that the District invite a service provider or coordinator from that agency to participate in your childs
initial IEP meeting. Please contact the person listed below if you would like the district to invite a Part C representative in
your childs IEP meeting).

The tentative meeting date is: April 30, 2016 at 1:00 pm at 1323 Red St Las Vegas, NV 89111
The following additional persons have been notified about the meeting and may be in attendance:
Title: Mr. Name: Ricardo Montez Title: Ms. Name: Chelsea Brown

Title: Mrs. Name: Rebecca Gold Title: Mrs. Name: Maria Gomez

Title: Ms. Name: Stacy Montez Title: Ms. Name: Sofia Montez

Please refer to the Parental Prior Notice for information about procedural safeguards available under IDEA.
Sincerely,
Designee: Gabriella Sanchez Location: 4578 Yellow Ave Las Vegas, NV 89751 Phone: (702)-123-4567

PLEASE DETACH HERE AND RETURN TO SCHOOL

Student Name: Marlyne Montez Proposed Meeting Date: 04/30/16 Proposed Meeting time: 1:00 PM
Proposed meeting location: 1323 Red St Las Vegas, NV 89111
CHECK THE ITEMS THAT APPLY:
I give consent to the District to invite the following person(s): Gabriella Sanchez from Kids Elementary School
to attend the IEP meeting for transition services.
I will attend the meeting at the time and place specified.
I will bring the following person(s): Jorge Montez (Dad) to the meeting.
I would prefer a telephone conference and am available from ______ at ___________.
I wish to attend but cannot meet the date specified; however, I can meet on _____at______ if this date is
mutually accepted.
Please call the school to confirm this appointment. If there is a scheduling conflict, an alternative meeting date
and/or time may be needed.
Date: ________ Parent/Guardian Signature: ___________________
 PARENTAL PRIOR NOTICE OF DISTRICT PROPOSAL
Student Name: Marlyne Montez Grade: 1 DOB: 08/05/09 ID#555111 Date Sent: 03/17/16
Date of Telephone Notice: 03/17/16

Dear Parental/Guardian/Student:

Federal regulations require that parents/guardians or legally recognized adult students be provided with prior notice
written notice each time the District proposes to initiate or change the identification, evaluation, educational
placement of the provision of a free appropriate public education (FAPE) for your child. The district proposes
action(s) described below:
1. Proposed Action(s):
Evaluate and identify students special education needs

Determine student eligibility for special education programming

Develop an Initial/Annual Individualized Education Program (IEP) and Educational Placement

Review/revise Individualized Education Program (IEP)

RE-EVALUATE students special education needs and continued eligibility for special education services

Develop transition services and/or postsecondary goals beginning at age 14

Conduct a manifestation determination and propose a disciplinary change of placement

Other: _______________________________________________
2. The reason this action is proposed:

Academic Concerns Health Concerns Behavior Concerns

IEP Development Review Speech/Language Concerns Teacher Concerns

Evaluation/Reevaluation Results Parent/Guardian Concerns Student Concerns

3. Other options considered by the District before proposing the above were:

The influences and environment in which the student is living in. Background information on parents and family
members.

4. The above options were rejected because:

The mother is a nurse and the father is a lawyer. Family doesnt show to have any medical records or disabilities arent
inherited from past generations.

5. The following evaluation procedure, assessment, record or report was relied upon when proposing the action:

Relied on people living in Marlynes household and her teachers and classmates.
 PRESENT LEVELS OF ACADEMIC ACHIEVMENT AND FUNCTIONAL
PERFORMANCE
Student Name: Marlyne Montez Grade: 1 DOB: 08/05/09 ID#555111
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, Pro-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)
 ASSESMENTS ASSESSMENT RESULTS EFFECT ON STUDENTS
INDIVIDUALIZED
CONDUCTED EDUCATIONAL PROGRAM
INVOLVMENT(IEP)
AND PROGRESS IN
GENERAL EDUCATION
INFORMATION CURRICULUM OR, FOR EARLY
CHILDHOOD STUDENTS,
INVOLVEMENT IN
STUDENT/PARENT INFORMATION DEVELOPMENTAL ACTIVITIES
1. Verbal
Student: Alphabet
Marlyne Montez
1. Mixes up the letters inSex: F Birth Date:1.
08/05/09 Grade: can1____
different Other students recite their
2. Writing
Student Alphabet
ID: 555111 Language: Spanish___________________________ alphabet accordingly.
order.
Student Primary

Address: 1812 Rising Flower Rd_________________________________________________

3. Reading Short 2. Switches letters around. Ex: b, d, 2. The students in general Ed can
stories
City/State/Zip: andStudent
Las Vegas, Nevada 89758 q. Phone: (702) 999-7788_________________ write out their alphabet correctly,
Parent/Guardian/Surrogate: Selena Montez Parent Phone (Home): (702) 123-7432 causing Marlyne to be a little
4. Writing simple 3. Understands the basic words with behind.
sentences
Parent Phone (Work): (702)458- 6622few
Ext: letters
848 EmailinAddress:Selenamontez@gmail.com___
them. Ex: am, do, is, it,
3. In an ordinary day, the students
etc. Language Spoken at Home: Spanish________________________________
Optional (Cell): (702) 333-4454 Primary
5. Sitting still for 5 read stories together and Marlyne is
minutesor Other Accommodations4.needed:
Interpreter Has _________________________________________________________________________
a hard time putting simple left behind.
sentences together.
Emergency Contact/Phone Number: (702)888-8989___________________________________________________
6. Playing with 4. Marlyne takes a lot of extra time
Current School: Red Rock Elementary School_________________________________________________________________________
classmates 5. Cant stay still and wants to to write her sentences when other
ELIGIBILITY CATEGORY constantly be playing or running students finish fairly quickly.
7. Sharing Toys with
around.
others
Primary: Selena Montez Other: ______________________________________________
5. Marlyne seems to interrupt her
ELIGIBILITY DATE: March 2016 and 6.onVery aggressive and impulsive
ANTICIPATED when classmates
3-YR REEVALUATION: 2019________
each time she decides to
8. Recognition of
IEP PARTICICIPATION
around other students or kids. run around or cannot maintain
Images
7. Refuses to share anything that is in sitting in her seat.
Selena Montez, mother of Marlyne Montez, Jorge Montez, father of Marlyne Montez, Ricardo, Stacy, and Sofia Montez, siblings of
Marlyne Montez, each attended the herIEP.
possession.
The siblings are each older than Marlyne and have stated they participate to help improve
6. Marlynes classmates seem to be
Marlynes education and behavior at school as well as out of school. The family stated that Marlyne enjoys to play and have the
family present, but will not allow8.
them to join in on her fun. The parents
She is able to recognize almost all stated they scared
would likeofa monthly
her reactions
report ofbecause she
Marlynes
progress and would like to be present in her classes at least once a week.
images shown to her. gets aggressive outrages while
playing.
7. Marlyne doesnt let her
*Required Participant
classmates or family members play
with anything in her possession,
**Student must be invited when transition is discussed (beginning at the age of 14 or younger if appropriate).
which ends up making her quite
***The IEP team must include at least one regular condition teacher of the student (if the student is, orviolent.
may be, participating in the regular education env).

PROCEDURAL SAFEGUARDS
8. Shows she is a visual learner.
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.

I received the Middle/High School Graduate Profile.

N/A prior to 14 years of age.

Parental/Guardian Signature: ____________________________________________________________

 INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP) STREGNTHS,
CONCERNS, INTERESTS AND PREFERENCES
Student Name: Marlyne Montez Grade: 1 DOB: 08/05/09 ID#555111
STATEMTNF OF STUDENT STRENGTHS
Student presents to have a lot of talent playing sports and any outdoor activity. She has a lot of energy and had a
higher level in math. Her strengths involve anything that does not require her staying still.

STATEMENT OF PARENT EDUCATIONAL CONCERNS

Parents are concerned with her educational delays, in comparison with their other children, Marlyne has been
struggling the most in school and out of school. They notice she has very violent and aggressive bursts in situations
that arent that extreme. One second shes happy and the other shes angry and everything bothers her. They dont
think its normal since shes at such a young age.

STATEMENT OF STUDENTS PREERENCES AND INTERESTS

Student does not like to read or write because she focuses on images rather than the words. She prefers to look at
pictures and draw different things. She is interested in playing games or watching TV. She is interested in dolls and
her favorite part of school is recess.

CONSIDERATION OF SPECIAL FACTORS

1. Does the students behavior impede the students learning or the learning of others?

If YES, team must provide positive behavioral strategies, supports and interventions, or other strategies,
supports and interventions to address that behavior.
No action needed Yes, addressed in IEP

2. Does the student have limited English Proficiency? No action needed

Yes, addressed in IEP

If YES, team must consider language needs pf the students as those needs relate to the students IEP.

No action
needed Yes, addressed in IEP

3. Is the student blind or visually impaired?

If YES, tram must evaluate reading and writing needs and provide for instruction in Braille unless determined
not appropriate for student.

4. Is the student deaf or hard of hearing? No action needed

Yes, addressed in IEP

If YES, team must consider communication needs.

5. Does the student require assistive technology devices and services? No action needed
Yes, addressed in IEP
 INDIVIDUALIZED EDUACTIONAL PROGRAM (IEP) TRANSITION
Student Name: Marlyne Montez Grade: 1 DOB: 08/05/09 ID#555111 Date Sent: 03/17/16

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 requirements and
Adjusted High School Diploma.

STUDENTS VISION FOR THE FUTURE A short statement that directly quotes what the student wants for the future.

The student wants to be at the same pace as the students around her and wants to learn to share her things with everyone.
She is still too young to be able to set goals in her life. Her mother wants her to stable her attitude and anger problems.

STATEMENT OF TRANSITION SERVICES: COURSE STUDY beginning at age 14 or younger if determined

appropriate by IEP team, describe the focus of students course study.

Not at age 14 yet.

IEP GOALS, INCLUDING ACADEMIC AND FUNCTIONAL GOALS, AND
BENCHMARKS OR SHORT-TERM OBJECTIVES
Student Name: Marlyne Montez Grade: 1 DOB: 08/05/09 ID#555111

MEASURABLE ANNUAL GOAL (including how progress toward the annual goal will be measured)

The annual goal is to improve reading and writing skills. Math skills are already meeting standards
therefore that just needs to keep improving at the correct pace. This will be measure at a monthly rate,
by doing small evaluation to see where to student is improving in.

Check here if this annual goal supports the students postsecondary goal(s) and identify the goal(s) to which is relates:

Training Education Employment Independent living skills other ______________

Check here if this goal will be addressed during extended year services (ESY)

BENCHMARK OR SHORT-TERM OBJECTIVE

1. Maintain seated or calm at least 10 minutes a day for every day.

2. Recite and write the alphabet weekly in order to improve comprehension of the letters.
 INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP) SERVICES (SDI)
Student Name: Marlyne Montez Grade: 1 DOB: 08/05/09 ID#555111
SPECIAL EDUCATION SERVICES

SPECIALLY DESIGNED SERVICE TYPE BEGINNING&ENDING DATES

FREQUENCY LOCATION OF SERVICES
INSTRUCTION OF
SERVICES
Student must spend
Half the day in general 08/29/16-06/06/17
Everyday Attending School
Education class.
An aid must supervise
Every other day Attending School
The student. 08/26/16-06/06/17
 INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP) SERVICES (RS)
Student Name: Marlyne Montez Grade: 1 DOB: 08/05/09 ID#:555111
SPECIAL EDUCATION SERVICES

SPECIALLY DESIGNED SERVICE TYPE BEGINNING&ENDING DATES

FREQUENCY LOCATION OF SERVICES
INSTRUCTION OF
SERVICES

EXTENDED SCHOOL YEAR SERVICES

Does the student require extended school year services? YES NO DEFFERED

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 or at a later date, indicate date by which IEP decision will be made: ____________________

METHOD FOR REPORTING YEAR SERVICES

METHOD FOR REPORTING OF THE STUDENTS PROGRESS TOWARDD MEETING ANNUAL PROJECTED FREQUENCY

GOALS (check all methods that will be used) OF REPORTING

IEP Goals District Report Card Specialized Progress Report Parent Conferences Quarterly Semester Trimester

Other: Other: Monthly

 INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP)
TRANSPORTATION- RELATED SERVICES 1
Student Name: Marlyne Montez Grade: 1 DOB: 08/05/09 ID#: 555111_____________________

Parent/Guardian Name: Selena Montez Cell Phone: (702) 333-4454________

Home Address: 1812 Rising Flower Rd Home Phone: (702) 123-7432________

Bldg./Apt/Space#: __________________________________________________________________________

City/State/Zip: Las Vegas, Nevada 89578________________________________________________________

Zoned School/Site: Richard Elementary School

Attending School/Site: Red Rock Elementary School Track: ___________________________

Emergency Contact(s): Maria Gomez___________________________________________________________________

Emergency Number(s): (702) 555-5859__________________________________________________________________

1. Identify the student/s disability-related need for bus transportation (check all that apply).

1A. Safety/Security/Behavioral 1B. Physical 1C. Medical 1D. Special Program at other than Zoned School

2. Special Considerations:

Special Equipment Safety/Security Factors Supervision Needed Medical Concerns

No special equipment is Not any safety factors Minimum supervision No medical concerns
needed needed

3. Student requires early release from class as a disability-related accommodation to safely pass through school corridor(s)
and access transportation. YES NO Minutes Needed: ______

4. Student requires modified schedule at school as a disability related accommodation. YES NO

Time in: _________ Time Out: _______________ Attendance days: M T W TH F

5. Does the student have a behavior/health plan? If so, fax to Transportation. YES NO

6. Any additional instructions for the bus drivers awareness?

The only awareness is that the student presents to be imperative and needs to be watched to stay seated and
calm.
 INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP)
ACCOMODATIONS AND MODIFICATIONS
Student Name: Marlyne Montez Grade: 1 DOB: 08/05/09 ID#: 555111
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 student with disabilities to be educated with non-disabled students to
the maximum extent appropriate.
MODIFICATION, ACCOMIDATION, OR BEGINNING&END DATES FREQUENCY OF LOCATION OF

SUPPORT FOR STUDENT OR PERSONNEL SERVICES SERVICES

An aid in the presence of Marlyne will help her 08/29/16-06/06/17 Every other day Students School

maintain calm and can help her behave better.

PARTICIPATION IN STATEWIDE AND/OR DISTRICT-WIDE ASSESSMENTS

Indicate how the student will participate in a If the student will participate in an alternate If the student will participate in a
State-wide or district-wide assessments. assessment, explain why the student cannot regular assessment, does the student

Participate in the regular assessment require accommodations?

State Norm-Referred Tests (NRT) NO YES

YES N/A Alternate

State Criterion-Referred Tests (CRT) NO YES

YES N/A Alternate

High School Proficiency Exam NO YES

YES N/A Alternate

Proficiency Examination in Writing NO YES

YES N/A Alternate

NASAA NO YES

YES N/A Alternate

 INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP) PLACEMENT
Student Name: Marlyne Montez Grade:1 DOB:08/05/09 ID#: 555111
PLACEMENT: _________ to __________________ Total Minutes Per Week in School: 1,200
PLACEMENT CONSIDERATIONS PERCENTAGE OF TIME IN REGULAR

EDUCATION ENVIRONMENT

Selected Rejected

Regular class with supplementary aids and services (no removal) 50 %

Regular class and special education class (e.g recourse) combination

Self-Contained program

Special School

Residential

Hospital

Other:

JUSTIFICATION FOR PLACEMENT INVOLVING REMOVAL FROM REGULAR EDUCATION ENVIRONMENTS

Student requires extra help in order to be caught up at the rate with the average student in first grade. With the
student being in a special education class this will help with the behavior issues as well as the educational concerns. With this
being done, the student will be able to reach an appropriate level in academics by the end of elementary school
years._______________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
_

*Regular education environments include academic classes (which might include field trips linked to 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 not in attendance Parent participated via telephone

A copy of this IEP was provided to the students parent on: 03/20/16
Parent Signature: __________________________________