EDUC 614
MF IEP 2015-2016
Plan Information
Meeting Date: 12/14/2015
Special Ed Status:
Special Ed Setting:
Adopted Date:
Adopted Date:
Student Information
Max Fuentes
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Student Name: Ethan
Nicholas Nealb
DOB: 11/23/1999
Student Number: 10290
#############XXXXXMaXXXXXX
Address: #######################
21401
Krypton Rd Kendall,
District of Residence:
$$$$$$$$$$$$$$$$$$$$$$$
b WI 54638
School of Attendance: New Lisbon JH/High
School
Grade: 09
Gender: M
Race (Ethnicity Code): White
b
b
Guardian Information
b
Parent's/Guardian's Name
Work Phone
Cell Phone
wtrdtrdtplkjkjjjjkjuyuuuiuhhhh
Chad
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Davey, Neil
(608)462-3883
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hkbhkjb
b Chad Fuentes
Email
Relationship to Student
b
Father
bfuentes.chad@gmail.com
Street Address, City, State, Zip
Home Phone
b
1234
House
St.
New
Lisbon,
WI
53950
21401
Krypton
Rd
Kendall,
WI
54638
(608)427-2212
&&&&&&&&&&&&&&&&&&&&
iuguyfiuyfytffufuyfuyfuyfffufkuyfufiugiuhiuhiuhiuhiuhiuhihiuhiuhih
#########
&&&&&&&&
@@@@@@@@@@@@@888888888888888888888888
608-555-4747
b
Parent's/Guardian's Name
Work Phone
Cell Phone
b
&&&&&&&&&&&
Neal,
Nicole
(608)847-6161x4494
Sibly
Miller
#############
#S#######
%$%$%$%$%$******************
b
Email
Relationship to Student
b
Mother
#############
ndavey@gmail.com
XXXXXXXXXX
$$$$$$$$$$$$$
Home Phone
7766
Radcliffe Dr. #B Madison, WI 53719-2065 5775 Mentor St. Madison, WI 53701
$$##$#$#$#$#$#$#$#$#$#$#$#$#$#
&&&&&&&&&&&&&&&&&&&&&&&&&
(608)495-0163
#########$$$$$$$$$
*@@@@@
#########
Neal, Nicole
&&&&&&&&
Mrs. Fuentes
Neal, Ethan
&&&&&&&&
########
Max Fuentes
Davey, Neil
&&&&&&&
########
Mr. Fuentes
Invited
Yes
Attended
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Teacher (SPEDSTAFF)
Svardahl, Tia
Yes
Yes
Teacher (SPEDSTAFF)
Mecikalski, Julie
Yes
Yes
Teacher
Pedersen, Jennifer
Yes
Yes
Teacher
Lenz, Scott
No
No
Teacher
*************
Mecikalski, Julie
&&&&&&&&&
###########
No
No
Teacher
Morey, Ben
No
No
Teacher
Svardahl, Tia
No
No
MF IEP 2015-2016
IEP Review/Revision
Placement
Manifestation determination
Alternate Assessment
Other:
If a purpose of this meeting is IEP development, review, and/or revision related to the academic, developmental and functional needs of the child,
the IEP team considered the results of:
Initial or most recent evaluation
Statewide assessments
Districtwide assessments
Yes
Yes
Yes
Not Applicable
x
Not Applicable
Not Applicable
If the parent did not attend or participate in the meeting by other means and did not agree to the time and place of the IEP team meeting, document
3 efforts to involve the parents:
MF IEP 2015-2016
@@@@$$$$$
Student Name: Ethan
Neal
$$$#$#$#$%%
%%%
Note: Present level of academic achievement and functional performance must include information that corresponds with each annual goal
Describe the student's strengths and the concerns of the parents about the student's education.
Max is a student that does well academically. His favorite subject in and out of school is history and he enjoys
researching anything Civil War related. Max has appropriate academic language skills and is an avid reader. Max
has good school and class attendance.
Parent concerns:Parents are concerned that Max does not establish relationships with peers. Max does work with
adults but only when there is a need. Max struggles to stay organized and then comes home from school and
doesn't know what he needs to do for school work. He loses assignments daily.
Describe the student's present level of academic achievement and functional performance including how the student's disability affects his
or her involvement and progress in the general education curriculum. For preschool children, describe how the disability affects
involvement in age-appropriate activities.
Max's disability affects his daily routine and impacts his ability to interact with peer and adults. This prevents him
from being able to move from classroom to classroom without repeating the same sequence. Max struggles with
transition between classes, change in routine, and sensory overload when there is a lot of classroom noise. Max
does not participate in whole group work or discussions.
Reading:
Max's reading skills are at grade level. Max Is able to read, and comprehend through verbal sharing and writing
about text that he reads. 8th grade reading test of the Abbreviated Stanford Test
Vocabulary = 9.2GE, Comprehension = 10.1GE, Total = 9.7GE
His current state test scores are as follows:
BADGER EXAM
2014/2015 grade 8
English Language Arts
Score range:
below basic 2288-2486
basic 2487-2566
proficient 2567-2667
advanced 2668-2769
Max's Score:
Proficient-2601
District Wide
Math:
Max's math skills are at grade level. His 8th grade STAR test results in the normal range of 457 for math fluency,
492 for math operations and 487 for math comprehension.
His current state math test scores are as follows:
BADGER EXAM
2014/2015 grade 8
Mathematics
Score range:
below basic 2265-2503
basic 2504-2585
proficient 2585-2652
advanced 2653-2802
Max's Score:
Proficient-2594
Functional Performance:
Max struggles with completing assignments, remember due dates, what he should study and keeping track of his
work and materials. Max will complete half of an assignment and put it in his folder at the end of class. He will then
get a new assignment for the following day and place that half finished assignment on top of the other one and
never hand them in to the teacher.
MF IEP 2015-2016
Will the student be involved full-time in the general education curriculum or, for preschoolers, in age-appropriate
activities?
x
Yes
No
(If no, describe the extent to which the student will not be involved full-time in the general curriculum or, for preschoolers, in
age-appropriate activities.)
The student will participate in an alternate or replacement curriculum that is aligned with alternate achievement standards in: (check all that apply)
Reading
Math
Language Arts
Science
Social Studies
Other (specify):
Special Factors
After consideration for special factors (behavior, limited English proficiency, Braille needs, communication needs including deaf/hard of hearing,
and assistive technology), is there a need in any of the areas?
x
Yes
No
(If yes or the student has a visual impairment, attach I-5 Special Factors page)
#######%%%
Student Name: Ethan
Neal
MF IEP 2015-2016
#$$$$$
%%
Note: For any need(s) identified below, there must be a statement of the service(s) to meet that need (including amount/frequency, location, and
duration) on the Program Summary page (I-9).
Yes
No
Please include the positive behavioral interventions, strategies, and supports to address that behavior:
Max has responded well to the following intervention tools:
Visual Schedule
Graphic Organizers
Scheduled Sensory Breaks
Yes
No
No
Not Applicable
If yes, include Braille needs; no or cannot be determined, attach ER-3 from the latest evaluation/reevaluation.
Yes
D. Does the student have communication needs that could impede his/her learning?
No
If yes, include communication needs. If yes and the student is deaf or hard of hearing, identify the communication needs
including (a) the student's language; (b) opportunities for direct communication with peers and professional personnel in the
student's language and communication mode; and, (c) academic level and full range of needs including opportunities for direct
instruction in the student's language and communicative mode:
E. Does the student need assistive technology services or devices?
Please specify particular device(s) and service(s):
Yes
No
MF IEP 2015-2016
No
Note: When reviewing goals, use the Progress Report Form to make periodic comments and assessments.
Will the student participate in an alternate assessment aligned with alternate achievement standards for students with disabilities in any subject
area?
Yes
No
No
Note: When reviewing goals, use the Progress Report Form to make periodic comments and assessments.
Will the student participate in an alternate assessment aligned with alternate achievement standards for students with disabilities in any subject
area?
Yes
No
No
Note: When reviewing goals, use the Progress Report Form to make periodic comments and assessments.
Will the student participate in an alternate assessment aligned with alternate achievement standards for students with disabilities in any subject
area?
Yes
No
MF IEP 2015-2016
#######
Student Name: Ethan
Neal
$$$$$$$
MF IEP 2015-2016
4th
5th
6th
7th
8th
10th
Complete the sections below. Check each of the WCKE content areas and need for accommodation, if any, or the alternate assessment. If the IEP
team is unsure about the student's participation in the WKCE with accommodations, complete the Wisconsin Alternate Assessment (WAA)
checklist and include it with the IEP.
Reading
WKCE without accommodations
WKCE with accommodations (list accommodations for each content area)
MF IEP 2015-2016
MF IEP 2015-2016
$########
Regular
Specially Designed
Vocational Education:
Regular
Specially Designed
Environment
The student will participate full-time with non-disabled peers in a regular education classes.
x
The student will not participate full-time with non-disabled peers in regular education classes, or for preschoolers, in
age-appropriate settings. (If you have indicated a location other than regular education classes or age-appropriate settings in the
case of a preschooler in I, II, or III above, you must check this box and explain why full-time participation with non-disabled peers
is not appropriate.)
Max requires specially designed instruction in behavior and social skills in a small group setting. This will occur in
the special education classroom for 20 minutes once per day to work on his social skills and sensory issues.
Max requires specially designed instruction in organization and homework completion. This will occur in the special
education classroom for 43 minutes once per day.
Yes
No
(If no, describe the extent to which the student will not be involved in extracurricular and non-academic activities with non-disabled students)
Service
Provider
Frequency/Amount
(direct/indirect min)
(5.0/0.0) minutes
2.0 times per
day
Location
Special
Education
Classroom
Duration
ESY
12/21/2015 12/20/2016
Comments:
Student will begin and end day in special education classroom for a check in and out to work on organization and
homework tracking.
(43.0/0.0)
minutes 1.0
times per day
Study Skills
Special
Education
Classroom
12/21/2015 12/20/2016
Comments:
Provide support for organizational skills and tools for remember due dates, completing assignments, keeping track
of material, and due dates
(20.0/0.0)
minutes 2.0
times per week
Life Skills
Special
Education
Classroom
12/21/2015 12/20/2016
Service
Provider
Frequency/Amount
(direct/indirect min)
(20.0/0.0)
minutes 3.0
times per week
Comments:
Provide services to Max to increase social skills interaction.
Location
Duration
12/21/2015 12/20/2016
ESY
MF IEP 2015-2016
$#######
Supplementary Aids and Services (I-9)
Supplementary Aids and Services - aids,
services, and other supports provided to or
on behalf of the student in regular education
or other educational settings.
Service
Provider
Frequency/Amount
(direct/indirect min)
Location
(0.0/0.0) minutes
0.0 times per
week
Visual Schedules
Duration
ESY
12/21/2015 12/20/2016
(0.0/0.0) minutes
12/21/2015 0.0 times per
12/20/2016
week
Duration, Frequency, and Location: (if service is not tracked in direct/indirect minutes or standard frequency options)
Assignment Notebook
Special
Education/General
Education
12/21/2015 12/20/2016
Duration, Frequency, and Location: (if service is not tracked in direct/indirect minutes or standard frequency options)
Allow one scheduled break per day to manage sensory overload during school hours. Student can go to office,
instructional support room or school counselor office.
(180.0/0.0)
minutes 1.0
times per day
Special
Education/General
Education
12/21/2015 12/20/2016
Duration, Frequency, and Location: (if service is not tracked in direct/indirect minutes or standard frequency options)
Daily during classroom instructions, transitions, school specials, and school activities.
(0.0/0.0) minutes
Special
12/21/2015 0.0 times per
Education
12/20/2016
week
Duration, Frequency, and Location: (if service is not tracked in direct/indirect minutes or standard frequency options)
Other
Headphones or earbuds as needed for situations including school assemblies, loud classrooms, passing time.
(0.0/0.0) minutes
General
12/21/2015 0.0 times per
Education
12/20/2016
week
Duration, Frequency, and Location: (if service is not tracked in direct/indirect minutes or standard frequency options)
Other
Student is allowed to wear non-marking sandals during gym class without penalty.
Service
Provider
Frequency/Amount
(direct/indirect min)
(10.0/0.0)
minutes 1.0
times per week
Location
Regular
Education
Classroom
Duration
12/21/2015 12/20/2016
ESY
MF IEP 2015-2016
$#######
[If you need this notice in a different language or communicated in a different way, or have questions about this notice, please contact
Marie Vitcenda
Date of the placement determination:
12/14/2015
12/14/2015
Ethan Neal
#######
$$$$$$$
Name of Student:
Nicole
Neal, Neil Davey,
##############
$$$$$$$$$$$$$$$
Dear
at
12/21/2015
.]
Max Fuentes
will be implemented at
in the
(608)562-3700x1505
Will the child attend the school he/she would attend if non-disabled?
x Yes
No
(If no, explain)
List other options considered, if any, related to the placement site (school building or school district), frequency, location, and duration of the
special education and related services, supplementary aids and services, program modifications and supports, and the place of those services that
were considered. List the reason(s) rejected, and a description of any other factors relevant to the proposed action:
PowerPoint lecture presentations were suggested by Mr. Fuentes. However, most teachers include
overhead notes in google classroom or on paper.
Mr. Fuentes requested an independent study project to expend Max's history knowledge. The history
teacher already does several projects that allows students to decide on their topic choice and research
accordingly.
x
You previously received a copy of your child's evaluation report and a copy of his/her IEP is enclosed.
A copy of your child's evaluation report and the IEP are enclosed.
You and your child have protection under the procedural safeguards (rights) of special education law. The school district must provide you with a
copy of your procedural safeguards once a year. Previously you received a copy of your procedural safeguard rights in a brochure about parent and
child rights. If you would like another copy of this brochure, please contact the district at the telephone number above. In addition to district staff,
you may also contact
Marie Trifecta
Sincerely,
Marie Vitcenda
Name and Title of District Contact Person
at
608-555-3700
x1500