DATE 07/24/2021 PAGE 1 OF 10

STATE OF NEVADA

INDIVIDUALIZED EDUCATIONAL PROGRAM (IEP)

INFORMATION
STUDENT/PARENT INFORMATION ELIGIBILITY CATEGORY MEETING INFORMATION
Student Chloenette Baker Sex Female ✔ Autism Spectrum Disorder DATE OF MEETING 7/24/2021
DATE OF LAST IEP MEETING 7/24/2020
Birthdate 8/15/2008 Grade 3rd Student ID # 1076166 Deaf/Blind
Student Primary Language English PURPOSE OF MEETING
Developmental Delay
Student English Proficiency Code (optional) Interim IEP
Emotional Disturbance
Address 111 Ocean Park, Orange CA 92677 Initial IEP
Health Impairment
Student Phone 510 345 8765 Annual IEP
Hearing Impairment/Deaf
✔ IEP Following 3-Yr Reevaluation
Intellectual Disability
Parent/Guardian/Surrogate Andy Baker and Alice Baker Revision To IEP Dated
Multiple Impairment
Parent Phone (Home) 510 345 8765 (Work) Exit/Graduation
Orthopedic Impairment
Optional: Cell 510 276 4589 Email andybaker@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 Pending Other
Federal Placement Code SAC Traumatic Brain Injury
IEP SERVICES WILL BEGIN 7/25/2021
Federal Student Ethnicity Code Caucasian Visual Impairment/Blind
ANTICIPATED
Interpreter or Other Accommodations Needed No ELIGIBILITY DATE 7/24/2021 DURATION OF SERVICES 7/25/2029
Emergency Contact/Phone Number 562 098 1234 ANTICIPATED IEP REVIEW DATE 7/24/2022
3-YR REEVALUATION 7/24/2024
Current School Sunnydale Elementary Zoned School Sunnydale Elementary COMMENTS NA

IEP PARTICIPATION
Parent/Guardian/Surrogate* Alice Baker Speech/Language Therapist/Pathologist/Specialist Kacy Trevor M.A CCC-SLP
Student** Chloenette Baker School Nurse NA
LEA Representative* Sarah Roberts Interpreter NA
Special Education Teacher* Jackie Wolley Other (name and role) Andy Baker-Father
Regular Education Teacher*** Other (name and role) Dianna Encino OTR/L
School Psychologist Megan Rivas M.S Other (name and role) Sarah Wade M.A.E.D
*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.

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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
Brigance Comprehensive Vineland-II: Typical 3rd grade studenst should be able to score witin the
Inventory of Basic Skills, 2nd According to the Vineland Adaptive Behavior
Edition (Brigance-II) standard scale score, which has a mean of 100 and a
Scale Chloenette's overall adaptive behavior
composite of 74, which falls within the standard deviation of 15. Adaptive behaviors are nessesary for
Developmental Assessment of individuals to get along wit others and take care of themselves.
Young Children, 2nd Edition
moderately low range and places her in the 4th
(DAYC-2) percentile rank. As typical 3rd garders activities change as they get older and
The comminication domain such as talking, becomes less dependent of others. Due to Chloenette
Leiter International listening, reading and writing, Chloenette reflect standars scores and delays in domains such as
Performance, Scale 3 (Leiter-3) a standard score of 70, wihch falls within the
low range and places her in the 2nd percentile. communication, living skills, and socialization she is not yet
The Beery Buktenica Test of The daily living skills domain such as managing able to perform or participate in these age appropiate
Visual- Motor Integration, 6th personal needs, understanding time, money developmentally tasks, skills and activities.
Edition (VMI-6) and math, Cholenette reflects a standard score
Vineland Adaptive Behavior
of 82, which falls within the moderately low and
Scales, 2nd Edition places her in the 12th percentile rank.
(Vineland-II) In the socialization domain such as how
students interact with one another, and how she
Receptive One Word Picture plays and uses leisure time, Chloenette reflects
Vocabulary Test, 4th Edition a standard score of 76, which falls within the
(ROWPVT-4) moderately low and places her at the 5th
percentile rank.
Autisim Spectrum Raiting The motor skills domain such as manipulating
Scales (ASRS)
small object and cutting, Chloenette
Preschool Language Scale, demostrated the ability to engage in these
5th Edition (PLS-5) activities. She reflected a stantard scire of 94,
which falls within the adequare range and
Goldman-Fristoe Test of places her at the 34th percentile rank.
Articulation, 2nd Edition
(GFTA-2) Peabody Picture Vocabulary Test-4:
Chloenette was able to receptively identify 62
Peabody Developmental Motor common object presented in pictures including
Scales, 2nd Edition (PDMS-2)
51 nouns, 9 verbs, 2 adjectives. Cholenette
Sensory Processing Measure- receptive-single word vocabulary finctioning
Preschool was below average range.
(SPM-P)

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STRENGTHS, CONCERNS, INTERESTS AND PREFERENCES

STATEMENT OF STUDENT STRENGTHS

Per parents report, Chloenette stenghts include having good memory, very organized, is self learner, and has great balance. She is also bale to navigate
technology independently and is very neat. Per ABA input, Chloenette strenghts include receptive identification, expressive labels, matching, and ability to
complete close ended activities. Per teacher input, Chloenette is vert good at math skills, enjoys books and can sequence a simple story from first, next
and last. She is able to iniciate interaction and is able to play propertly. Chloenette has excellent gross motor skills.
STATEMENT OF PARENT EDUCATIONAL CONCERNS
Chloenette parrents concerns include behaviors such as eloping, dropping to the floor, climbing and tantruming. They also report
concerns with writing, eating by herself, sitting still and the ability to follow directions in her classroom.

STATEMENT OF STUDENT'S PREFERENCES AND INTERESTS (required if transition services will be discussed, beginning at age 14 or younger if appropriate)
Chloenette enjoys crafting, loves being around people and always wants to play. She likes to fall and be dizzy or off balance
when she plays outside, seeking both proprioceptive and vestibular movements. Per teacher report, Chloenette stuggles with
change in her schedule or when something is out of her routine. She also struggles when she makes a mistake on her work.
If student was not in attendance, describe the steps taken to ensure that the student's preferences and interests were considered:

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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. Does the student have communication needs that require IEP services? No. ✔ Yes.

If YES, IEP committee must determine nature and extent of services.

Addressed in IEP.

6. 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 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.

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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 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.

STUDENT'S VISION FOR THE FUTURE

A short statement that directly quotes what the student wants for the future.

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

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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

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):

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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 Date Date Date

1 1
BENCHMARK OR SHORT-TERM OBJECTIVE
#
By 7/24/2022 Chloenette will be able to communicate effectively in full sentences. Ex. "I want pencil" to "Can I please have a pencil?" Chloenette will be also increse her social skills by interacting and iniciating conversation with peers.

#1
By 7/24/2022 Chloenette will be able to formulate complete sentences to express needs and wants 3 out of 5 presented opportunities.
#2
By 7/24/2022 Chloenette will be able to formulate complete sentences to express needs and wants 4 out od 5 presented opportunities.
#3
By 7/24/2022 Chloenette will be able to formulate complete sentences to express needs and wants 5 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

1 1
BENCHMARK OR SHORT-TERM OBJECTIVE
#
By 7/24/2022 Chloenette will be able to print lowercase dictated by 80 percent of the presented opportunities.
#1
By 7/24/2022 Chloenette will be able to print 8 lowercase letters in 4 out of 5 presented opportunities.
#2
By 7/25/2022 Chloenette will be able to print 15 lowercase letters in 4 out of 5 presented opportunities.
#3
By 7/25/2022 Chloenette will be able to print 26 lowercase letters 4 out of 5 presented opportunities.

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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 AND FREQUENCY OF LOCATION OF
ENDING DATES SERVICES SERVICES
Chloenette will be involve in reading and writing activities throughout the day to provide support and structure to meet her goals 7/25/2022 30 min per day Resource Room
Chloenette will use picture systems to help her transitions during the day. 7/25/2022 when transitioning SAC room
Chloenette will be able to incease social interactions and social skills by attending general education specials. (PE, Library, Art) 7/25/2022 55 min per day General classroom

SUPPLEMENTARY AIDS AND SERVICES

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
Chloenette will have her individual visual schedule to follow troughout the day. 7/25/2022 Everyday SAC room and any other classroom

Chloenette will participate in small group instructuon during her reading and writing times. 7/25/2022 30 min per day Resource room
Chloenette will be provided with activities that supposr social/emotional skills. 7/25/2022 3 times a week SAC room
Chloenette will be provided one on one instruction and support and then fade support when appopiate. 7/25/2022 2 times a week Resoure room
Chloenette will be given extra time to complete tasks 7/25/2022 Everyday SAC room

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RELATED SERVICES
RELATED SERVICE SERVICE TYPE AND/OR DESCRIPTION BEGINNING AND FREQUENCY OF LOCATION OF
A – Assessment C - Consultative D - Direct ENDING DATES SERVICES SERVICES

✔ Speech/Language D 7/25/2022 30 min every other day Individually and group

Physical Therapy
✔ Occupational Therapy D 7/25/2022 30 min three times a week group
Transportation
Counseling
Psychological Services
✔ Orientation and Mobility D 7/25/2022 20 min twice a week idividual
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

PARTICIPATION IN STATEWIDE AND/OR DISTRICT-WIDE ASSESSMENTS

Indicate how the student will participate If the student will participate in an alternate assessment, explain why If the student will participate in a regular
in statewide or district-wide assessments. the student cannot participate in the regular assessment, and why assessment, does the student require
the particular alternate assessment selected is appropriate. accommodations?

State Criterion-Referenced Test (CRT) No Yes

Yes ✔ N/A Alternate If YES, list on "Accommodation(s) for the Nevada
Proficiency Examination Program" (attach form).
College and Career Readiness Assessment No Yes
Yes ✔ N/A Alternate If YES, list on "Accommodation(s) for the Nevada
Proficiency Examination Program" (attach form).
Other (List): No Yes List Accommodation(s):
Yes ✔ N/A Alternate

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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 30 % 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

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.

*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

✔ 7/24/2022
A copy of this IEP was provided to the studentʼs parent on: _________________________ by _________________________________________________________
(date) (name) (title)

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