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I
4 WEST END SELPA
INDIVIDUALIZED EDUCATION PROGRAM
PA: Wesf End SELPA
a;r,emanager:
-
rnitial EAnnualflTriennialtr lndividual Transition Plan nOther
DISTRICT: CHINO VALLEY SD
First Name
Age:12
EnltaleEremate
Current Annual IEP: 1 0/09/201 2
Next Annual tEcP: tOtOg/2013-
CSIS lD No
Current Evaluation: 1 A/09/201 2
Next Evaluation (Tri): 10/13/2014
Middle:
Grade: 06 Sirth
qrade
Race 2. Race 3.
Native Language: English
IRedesignated lnterpreter: EruoIyes
EP Date: 10/09/2012
PED Entry Date: 1 1/1 3/2008
1. STUDENTINFORMATION
Last Name
DOB:
District lD No
Student Address: --._.=..-=_:. City:
State: CA Zip:91710
Ethnicity: 50A Hispanic Race 1. 90A hbntionallv Blank
Migrant: MtrtoLlYes
Et: EnoIYes English Proficiency: EFtuentELimited
Responsible Adult:
ElParentfI Guardian I Conservaiorl Surrogate Parentf] other
Work Ph:
Email:
Address: City: State: CA Zip:
(lf different than studeni address)
Other Responsible Adult (state name, address, phone and relationship - include person holding educational rights if necessary):
2. RESIDENTIAL STATUS
EParent or legal guardian
[1 Hospiial(except state hospital)
flstate hospital
E Licensed children's institution
E Residential Facility
E Developmental Center
EFoster farnily home
f] I ncarcerated lnsiitution
flotner
lf the child has been placed into an LCI or FFH provide name of Agency and Contact Person:
District of Residence: CHINO VALLEY SD District Providing Education: CHINO VALLEY SD
District Assigned Home Residence School: ALICIA CORTEZ
School of Attendance: ALICIA CORTEZ School Type: 10 Public dav school
lf student is served outside of resident disirict, explain:
SELPA Placing Student: 3603 West End SELPA
I
:.^
,
.Last
Name
'3. DXSA,BILITY
DOB
-,
_q;*
IEP Date: 10/9/2012 First Name
l-l tntellectuat Disability f]Haro of Hearing*
peech or Language lmpairment flvisual lmpairment*
-
Orthopedic lmpairment*
MSpecific Learning Disabiliiy IDeaf-Blindness*
flRutism
*
Low lncidence Disability
nTraumaiic Brain lnjury
flSecondary Disability (if applicable): 200 None
EOtner Health lmpairment LlEmotionalDisturbance
flDeafness*
E Established Medical Disability
tr uuttipte Disability
be how student's disabiliiy affects involvement and progress in the general cuniculum (or for preschoolers, participation in
activities): Delays in nonverbal abstract categorical reasoning,word knowledge and retrieval, short-term auditory
skills, visual
perception,
attention,and fine- motor coordination skills impede classroom success.
Plan Type:
Etfp or tFSp
fl lndividual Service Plan (lSP)
Dltnitiat Only) Eligible
-
no lEP, IFSP, or ISP
-
Parentally ptaced in a privaie school
EltnitiatOnly) Eligible
-
No lEP, IFSP, or ISP
-
Other reasons
nltnitiat Only) Not eligible for specialeducation or related services
E exiting from Special Education (returned to general education/no longer eligible)
Date of Exit Reason:
4, O:T}iER AGENCY SERVICES
r-legionalCenter
[CCs Eoept of Rehabilitation flother
-_
;ounty Mental Health EOept of Social Services nProbation
r, your child has Medi-Cal; health insurance benefits may be accessed by the District for applicable services such as OT, Speech
and Language, etc.
Additional Cover Page Gomments (if needed):
. WEST END SELPA
INDIVIDUALIZED EDUCA.TION PROGRAM
|
-st Name First Narne DOB IEP Date: 1A/9/2012
..-:IBEI9I]iflLUIEBE9I9lsBNI[gELqEISS9AIIPENJEIEI-=,H-LES[.TS:."9.I.SIJ.4=l'tP-S*LU.-P"FJ.IE
iLearns
best by visual and kinesthetic.
QgIp-ej.lg_glpry_e_rylfg!-er_il"l,to_educ?ti_o-nalp.rg-_s_1ess:
iParents are concemed with reading.
j
i
PRE-ACADEMIC/ACADEMIC/COGNITIVE/FUNCTIONAL SKILLS (including recent STAR Assessment Results)
.Eryg!
rn gg,g[gljgue ne_ecl
ICMA scores BB ELA, PRO Math and Science. Math is an area of strength for
ffi -::#*a :jJ*;;:#r:1i15:#:--i
16:' PRESENT,:LEVELS
TOF,PERF.ORMAN
GE.,
-i::-
-_ r
j:*:!:--:::,...::*-
t able to add and subtract multi-
,-
"" -
---'
tdigit
probtems, telltime, add fractions with the sim{denominanr amd soiie 1 digit multiplication and division problems. twtyta ytvutvttta, 19il Luttv,
quu
ttqgatvttn YvrLt, Llt9 oatttv usttv,rilttaavt attw ovtYg I utgla ttlulalyilgqLtvtt Qrtw vrvttrw, I ytwutottt0. I :
neplt
tpEgghlSnuftiplicqtlon facts and hg_w to solve long division problems with multiple digits. ln math his SS is 68 and he
" ris ailh-e middle 3rd
qrade
levet. reading has improved and he was able to read 76 words per minute at the Sth grade ',
level.
Additionatty, is now decoding regular and irregular multkyllabic ln word recognition his
ISS is 66 and he is at the beginning 3rd grade level. Reading
1..,,.
for he strug$les i
iwith identifying details to supportthe main idea.
;When given a witing prompt
nain idea. struggles
SS was 71, which puts hin puts him at the 3rd percentile.
,MM UNICATI ON DEVELOPM ENT
*,:r!g!-?
n.ergq
-ol-
urqgg $9
q
MOTOR DEVELOPMENT
Etttot an area of unique need
Fine
,age appropnae
i
Qre-sg.,* .- ,_
;age appropriate
SOCIAL/EMOTIONAL DEVELOPMENT
Fluot a1_alxq
-oJ
Uryque-1g9j .
relationship with his teachers and peers has improved. When
ADAPTIVE/DAILY LIVING SKILLS
Enot an area ofunique need
wori is ciitiquea ie is dbite io iiiiixe ca,rreciions
-. -"- - -:::i==--..
. .. ::H
--*' r-:-
-- -
-.---;---: - -
)age appropnate
i
i
CATIONAL
g1-l!.91
en
afg-?
_91
yl'iqy.g negq
I
I
7. HEALTH
Hearing Screening: (R)passed (L) passed 09/01/2011
Date
Health Alert ENonYes
:if
vei,ipiCiat
ru;tth conoiiionisl
:
I
Vision Screening: (R)pass (L)pass 09/01/2011
Date
spegie!Z9gtl_ee!![,9e.re_f rogeQur3Ql-rloEv_99
ilf yes, identify:
i
1. Behavior: Does student's behavior impede his/her learning or that of others?
[ruoEyes
DespnatP EBehavior Goat trother:
2.Communication: ls the student Deaf or Hard of Hearrng?
Eruo[yes
^
Vision: ls the student Blind or Visually lmpaired?
Eruonyes
:.. \ssistive Technology: Does the student require assistive iechnology devices or services?
Enof]yes
-.
Low lncidence: Does the student require low incidence services, equipment and/or rnaterials to
Etrtolyes
meet educational goals?
6. English Learner: ls the student an English leamer?
Elruo[yes
lf yes, English Proficiency Level:
--
lf yes to any speiiat iactors, clar'rfy and describe:
WEST END SELPA
INDMIDTIALIZED EDUCATION PROGRAM
.-!r-_J-,_-,L+_
IEP Date: 10/9/2012
Student is expected to
mqet the same standards of curriculum content mastery as non-special education studenis within
. classroom -WTHOUT ACCOMMODATTO-NS.
r''
E Student is expected to meet the same standards of curriculum content mastery as non-special education students within
classroom -WITH ACCOMMODATIONS: claifv directions, flexible time and setting
,
have student mark booklet. Look for
Iitv of work not
quantitv.
Ernestudentwillbeexposedtothegeneraleducationcurriculuminordertodevetoppoffiorgain
cademic competence in the curriculum. Student will require accommodations and will receive MODIFIED curriculum for the
rllowing classes: spellinq list, classwork and homework shortened,
qrade
based on
proeressfrd|GTeP qoats.
I The student will be exposed to the general education cuniculum in order to develop positive peer interaction, improve
skills, andior gain academic competence in the curriculum. Student will require accommodations and modificaiions and
NOT receive a
qrade
for the followinq classes:
am modifications or suooorts for school oersonnel on behalf of the student:
Student will participate in the following assessments during the school year(check all that apply):
tl Preschool
Eonop-n
Donop-R
trl California Standard Tests (CST) and/or CMA, or CAPA:
-
M engtish Language Arts (ELA) (Grades 2 through 1 1; CMA only applies to grades 3 through 8)
21
CMA lMh testing accommodations
et
V answer options and test questions read aloud, supervised breaks within a section, test over more than one dav for
sinole sitting test
E nnatfr (Grades 2 through 11; CMA only applies to grades 3 through 7)
21 CMA With testing accommodations
Student marks responses in test booklet
B answer options and test
questions read aloud, use of math maniputatives, supervised breaks within a subtest. test over
more than one day for single sitting test
n Science (Grades 5 and 8 only; Grades 9 through 1 1, end-of-course)
90 Not to participate (outside testing
qraup
or
plan
tvpe ISP)
nUistorytSOClAL SCIENCE (Grade 8; Grade 11 for U.S. History; Grades 9 through 11 World History)
90 Not to
participate (outside
testinq
group
or
plan tvpe lSPl
Ewriting (Grades 4 and 7 only)
90 Not to
participate (outside testing
eroup or
plan
tvpe ISP)
lf participating in the CAPA, select Level:
-.student
will not participate in the CST or GMA and CAPA is appropriate because:
I California English Language Development Test (CELDT)(For English Learners only)
'.n
rr
,\ _-,.
n
E
Standards based Tests in Spanish STS(For English Learners only)
California High School Exit Examination (CAHSEE) 90 Not to
participate (outside
testinq
group
or
plan
tvpe !SP)
\
EceHseercln f]Passed Date: score:
f]cRxseEruatt' flPassed Date:
Physical Fitness (sth,7th,9th Grades Only)
District Wde Assessments
With the same
Agcommodat!9tns/$odificatlons
aqreed to for State Achievement tests
Additional Notes (if needed):
|___-
l-/
:vi
WEST END SELPA
INDIVIDUALIZED EDUCATION PROGRAM
Last Name First Name IEP Date: 10/9/2012
.l
No: d GoalAdopted By IEP Team f NoMyes Date Adopled: 10/09/2012
NN UnE GO_Al:;,l E6'rm n)
-
ra of Need: Edrfing
-
snrY structure
s wellwritten, however he had difficulty with spelling, punctuation, and capitalization.
vleasurable Annual Goal: (Annual Goal) By 10/09/2013, when given a witing prompt, willrevise witing to improve
rganization and consistency in 2 of 3 trials with 85 %o accuracy as measured by student work samples.
).to
E Enables student to be involvediprogress in general curriculum
DAddresses other educational needs resulting from the disability
flLinguistically appropriate (addresses EL Students)
Dsupports the following Post-Secondary Goals
E Education/Training D Employment fl lndependent Living
Person(s) Resoonsible:
Annual Goal Met?
Druonves
Date Annual Goal Met:
\ssistive Technoloqy and/or Supplementary Aids to support the
goal:
ort Term Objective: By 3/2013, when given a writing prompt,
'uill revise witing to improve organization in 1 of 3 trials
h 75% accuracy as measured by student work samples.
Sh
wit
Date Met:
)rogress
Report:
\4aking appropiriate progress to meet
annual goal?
E ttoEyes
Recommend modifying goal?
Eruollves
Date Met: ort Term Objective: By 6/2013, when given a writing prompt,
will revise writing to improve consistency in 1 of 3 trials
\
80%o accuracy as measured by studentwork samples.
)rogress
Report:
Making appropriate progress to meet
rnnual goal?
Et'toflves
Recommend modifying goal?
D t to Ey"s
Date Met: ihort Term Objective: Progress Report:
Making appropriate progress to meet
annual goal?
D r'iotryes
Recommend rnodifying goal?
trruoDves
\dditional Comments:
WEST END SELPA
INDIVIDUALIZED EDUCATION PROGRAM
.
-9- --ii- -' l-rf
IEP Date: 10/9/2012 Last Name First Name
@
irAN N U A!j:
i9_o,Al:i{E0tmffi
ra of Need: Comprehension
sed GoalAdopted By IEP Team flNoElYes Date Adopted: 7010912072
3oal Baseline: Reading comprehension remains an area of need for
,
he struggles with identifying details to support the
nain idea and open ended guestrbns.
\4easurable Annual Goal: (Annual Goal) By 10/109/2013 when given a sixth grade brt, will analyze by
:onnecting/clartfying main idea in 2 of 3 trials with 801/o accuracy as measared by student work samples.
5.2.3
M Enables student to be involvediprogress in general curriculum
EAddresses other educational needs resulting frorn the disability
I Linguistically appropriate (addresses EL Students)
Dsupports the following Post-Secondary Goals
E Education/Training I Employmentfl lndependent Living
Person(s) Resoonsible:
Annual Goal Met?
f ruotrves
Date Annual Goal Met:
\ssistive Technoloov and/or Suoolementarv Aids to suooort ihe ooal:
3hort Term Objective: By 3/2013, when given a sirth grade
iext, , will analyze by connecting main idea in 1of 3 trials
uith 70% accuracy as measured by student work samples.
Date Met: ?rogress Report
Making appropriate progress to meet
annual goal?
It'ioIyes
Recommend modifying goal?
nNonves
ihort Term Objective: By 6/2013, when given a sixth grade Date Met:
ext, will analyze by clarifying main idea in I of 3 trials
",th 75% accuracy as measured by student work samples.
rrogress
Report:
Making appropriate progress to meet
annual goal?
nNoEves
Recommend modifying goal?
f,NoIYes
Date Met: Shod Term Objeotive:
rrogress
Report:
[4aking appropriate progress to meet
annual goal?
ENoEves
Recommend modifying goal?
DruoXYes
\ddiiional Comments:
WEST END SELPA
INDIVIDUALIZED EDUCATION PROGRAM
-.r-# - _++
IEP Date: 10/9/2012 Last Name First Name DOB
sed Goal IEP Team trNoEYes Date : 10/09/2012
reading has improved and he was able to read 76 words per minute at the Sth grade level. Additionally,
now decoding regular and irregular multisyllabic words with 80%o accuracy. ln word recognition h/s SS is 66 and he is at
e beginning 3rd grade level.
hort Term Objeciive: Annual Goal. By 6/2013, when given a Date Met:
af one syllable and multi-syllable words at his independent
,^ading
level, will read words that contain digraphs,
sonant blends, r-controlled words, dipthongs (oi, oy, ou,
'
ow), and long/short vowel patterns w/ 75% accuracy on 1
3 trials as measured by teacher-records.
easurable Annual Goal'. Annual Goal. By 10/09/2013, when given a list of one syllable and multi-syllable words at his
dent reading level, will read words that contain digraphs, consonant blends, r-controlled words, dipthongs (oi, oy,
,
oo, ow), and long/short vowq patterns w/ 80% accuracy on 2 of 3 trials as measured by teacher-records.
E Enables student to be involved/progress in general curriculum
flAddresses other educational needs resulting from the disability
ILinguistically appropriate (addresses EL Students)
Esupports the following Post-Secondary Goals
tr Education/Training I Employmentl lndependent Living
f ruo[ves
te Annual Goal Met:
siive T andior Aids to support the al:
king appropriate progress to meet
commend modifying goal?
flNoEves
rrt Term Objective: Annual Goal. By 3/2013, when given a
of one syllable and niulti-syllable words at his independenl
ading level,
-
will read words that contain digraphs,
blenos, r-controlled words, dipthongs (oi, oy, ou,
,
ow), and long/short vowel patterns w/ 7a% accuracy on 1
3 trials as measured by teacher-records.
aking appropriate progress to meet
NoDYes
d modifying goal?
Nof Yes
appropriate progress to meet
f trtoEyes
I NoIves
itional Comments:
WEST END SELPA
INDIVIDUALIZED EDUCATION PROGRAM
Last Name First Name DOB IEP Date: 10/9/2012
I
rl No: Mafh Proposed GoalAdopted Bv IEP Team flNoEyes Date Adopted: 10/09/2012
,ANN GOAL
:,dimlA),,
ea of Need:
3oal Baselinel. Math is an area of strength for is able to add and subtract multi-digit problems, tell time, add
'ractions with the same denominator and solve 1 dryit muftiplication and division problems needs to learn his
nultiplication facts and how to solve long division problems with multiple digits. ln math his SS ls 68 and he is at the middle 3rd
trade level.
Measurable Annual Goal: (Annual Goal) By 10/09/2013 when given a mixture of 5 math problems requiring both single and muft,
'sfep so/uftbns,
-
will determine how and when to break a problem into simpler parts with 80% accuracy in 2 of 3 trials as
neasured by student work samples.
i.1.3
E Enables student to be involved/progress in general curriculum
f]Addresses other educational needs resulting from the disability
l-l Linguistically appropriate (addresses EL Students)
Dsupports the following Post-Secondary Goals
D Education/Training I Employment I lndependent Living
Person(s) Resoonsible:
\nnualGoal Met?
Iruonyes
Jate Annual Goal Met:
\ssistive Technoloqv and/or Supplemeniarv Aids to support the
qoal:
rort Term Objective: By 3/2013, when given a mixture of 5
*h problems requiring both single and multi-step so/ufions,
will sort the problems based on this criteria with 70%
curacy in 1 of 3 trials as measured by student work
mples.
Date Met: Progress Report:
Nlaking appropriate progress to meet
annualgoal?
nruo[ves
Recommend modifying goal?
It'toEyes
tort"Term Objeciive: By 6/2013, when given a mixture of 5
-th problems requiing multi-step solutions, will
>rmine how ta break a problem into simpler parts with 75%
uracy in 1 of 3 triais as measured by student work
Date Met: Progress Report
Making appropriate progress to meet
annualgoal?
EttoEyes
Recommend modifying goal?
DttoEyes
3hort Term Objective: Date Met: Progress Report:
Mlaking appropriate progress to meet
annualgoal?
l-lNoEyes
Recommend rnodifying goal?
fluoEves
\ddiiional Comments:
WEST END SELPA
INDIVIDUALIZED EDUCATION PROGRAM
Last Name First Name DOB
,I
2"]NSTRUCTJONAL SETTINGS/SERVICES
IEP Date: 10/9/2012
)grams and seruices will be provided according to when student is in attendance and consistent with the public
-
tool calendar and scheduled services, excluding holidays, vacations and non-instructional days unless otherwise
specified.
12a. Services considered by the IEP Team based on the student's educational needs and adopted goals:
EGeneral Education
Mspecialized Academic lnstruction in General Education
Especialized Academic lnstruction ouiside General Education
ERelated Services:
f otner:
: Specialized Academic lnstruction Delivery: Group Class Type: RSP
From: 10/09/2012 To:06/30/2013 Duration/Frequency:
UOx
90 min session(s)Yearlv Totaling: 9000min
ider: District of Service Location: Separate classroom in public
inteqrated facilitv
: exceptions due to absences, field trips, assembiles, SIAR tesflng.
'12b.
Free Public Education FAP based on the student's un ue educational needs and
rom:07/01/2013 10/09/2013 Duration/Frequency: 5 x 100 min session(s) WeeklV Totaling: 500 min
rovider: District of Service Location: Separate classroom in public
intearated facilitv
.otes: RSP Math and RSP ELA
Parent will be informed of Progress: n Quarterly E Trimester E Semestertr Otner
How? M Progress Summary Reportl otner
Data Collection for Transportation:
Requires Special Education TransportaiionE ruoIYes
n Consideration for wheelchair and/or other medrcal equipment
nRequires Child Safety Restraint System (CSRS)
Eotner:
E etiginte for transportation, however parent declined offer and will transport student
12c. Due to the student's unique needs identified in the present levels and goals, the student will not participate in the general
ed ucation environment:
Efor general education academic curriculum:
E in non-academic and/or extracurricular activities:
nfor related services:
fIat school of residence; educational placement will be provided at:
i12d.
Activiiies to support transition (e,9., preschool to kindergarien, special education and/or NPS to general education class, 8th
i-9th orade
1 3. EXTENTIED SCTIOOL'YEAR (ESY)
The student demonstrates a handicapping condition which is llkely io continue indeflnitely or for a prolonged period; interrupiion of
to recoup skills; and specific area of :rvice fcr a prolonged period may cause regression based on the student's limited caoacity
-
red has been identified through the student's goaland objectives. nyesEruo