Tia Svardahl

EDUC 614

WI MF IEP 2015-2016 IEP 06, Page 1 of 12

Student Name: $$$$$$$

Ethan
Neal
#######

MF IEP 2015-2016

Individualized Education Program

New Lisbon School District
500 South Forest Street
New Lisbon, WI 53950
(608)562-3700x1505

Plan Information
Meeting Date: 12/14/2015
Special Ed Status:

Start Date: 12/21/2015

End Date: 12/20/2016

Evaluation Date: 12/01/2014

Special Ed Setting:

Primary Disability: Autism

Secondary Disability:
Eval Adopted From:

Adopted Date:

Plan Adopted From:

Adopted Date:

Student Information
Max Fuentes
pojpjpjpjpojpjpojbbbbbbbbbbbbb
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
ugiugguygi
Davey, Neil
(608)462-3883
oihguggiugkjhbuh
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
$$$$$$$$$$$$$

Street Address, City, State, Zip

Home Phone

7766
Radcliffe Dr. #B Madison, WI 53719-2065 5775 Mentor St. Madison, WI 53701
$$##$#$#$#$#$#$#$#$#$#$#$#$#$#
&&&&&&&&&&&&&&&&&&&&&&&&&

(608)495-0163
#########$$$$$$$$$
*@@@@@

IEP Meeting Participants

This Team Meeting was held at 07:45 AM on 12/14/2015 in/at School Psyh. Office.
Title
Names of All Team Members
School Psychologist/LEA
Vitcenda, Marie
Mother (GUARDIAN)
(STUDENT)
Father (GUARDIAN)

#########
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

WI IEP 06, Page 2 of 12

Student Name: %$%$%$

Ethan
Neal
#######

MF IEP 2015-2016

District Cover Sheet (I-3)

Purpose of Meeting:

(check all that apply):

Evaluation including determination of eligibility

Initial or Annual IEP Development

IEP Review/Revision

Develop a statement of transition goals and

services (required for students age 14 and older, or
younger if appropriate)

Placement

Manifestation determination

Determine setting for services during disciplinary

change in placement

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:

WI IEP 06, Page 3 of 12

MF IEP 2015-2016

@@@@$$$$$
Student Name: Ethan
Neal

Present Level Of Academic Achievement and Functional Performance (I-4)

$$$#$#$#$%%
%%%

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.

WI IEP 06, Page 4 of 12

Student Name: %%%%%

Ethan
Neal
#######

MF IEP 2015-2016

Present Level Of Academic Achievement and Functional Performance (I-4)

Baseline: Max has a paper planner and successfully fills it out 2 out of 5 days each week. He completes his planner
approximately 40% of the time.
Max needs a daily schedule to help him stay focused and on task. When there is a change to the daily schedule
Max needs prior notice. If there is a sub in one of his classrooms he may need to take a break during that class time
to gather himself and adjust appropriately. Max struggles with loud noises, hallway passing time, school wide
assemblies that include clapping during the presentation. Max wears the same clothes and shoes everyday.
Max can move from class to class independently, eat lunch, and perform all self-care functions.
Behavior:
Max does not make or keep friends. Though Max uses appropriate academic language he struggles to know the
proper social language required for interactions with peers and/or teachers. Max says he has no interest in making
friends. When in conversation with peers Max only discusses items of high interest to himself. He does not
participate in a typical conversation exchange with peers.
Baseline: Max struggles to have conversations with peers and only talks about high topics of interest to himself in
90 % of his interactions.
Max does not keep anything in his locker. If he forgets a book in another class, Max has to go back through each
class before he can pick up the book and move on with his day. Max's parents bought him a rolling backpack for
him to keep his books in during the day.

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)

WI IEP 06, Page 5 of 12

#######%%%
Student Name: Ethan
Neal

MF IEP 2015-2016

#$$$$$
%%

Special Factors (I-5)

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

A. Does the student's behavior impede his/her learning or that of others?

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

B. Is the student a student with limited English proficiency?

No

Please include the language needs that relate to this IEP:

C. If visually impaired, does the student need instruction in Braille or the use of Braille?
Yes

No

Cannot be determined at this time

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

WI IEP 06, Page 6 of 12

MF IEP 2015-2016

Student Name: #######

Ethan Neal
$$$$$$$

Annual Goals and Objectives (I-6)

Measurable annual academic or functional goals to enable the child to be involved in and progress in the general education curriculum, and to meet
other educational needs that result from the disability.
(Note: present levels of academic achievement and functional performance must include information that corresponds with each annual goal)
Goal # 1
Max will increase his functional social skills to include reciprocating conversations with other students when given
the opportunity in 60% of his observed conversations using 2 or more exchanges.
Procedures for measuring the student's progress toward the annual goal:
Observations, video recordings
Will annual goal (including benchmarks or short-term objectives) be addressed during ESY?
Yes

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

(If yes, include benchmarks or short-term objectives for the student)

When will reports about the student's progress toward meeting the annual goal be provided to parents?
quarterly
Goal # 2
Max will increase his organizational skills by tracking his daily assignments using a written or electronic organizer
daily in 3/5 opportunities (60%).
Procedures for measuring the student's progress toward the annual goal:
Point sheet, observations
Will annual goal (including benchmarks or short-term objectives) be addressed during ESY?
Yes

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

(If yes, include benchmarks or short-term objectives for the student)

When will reports about the student's progress toward meeting the annual goal be provided to parents?
quarterly
Goal # 3
Max will investigate his employment options by completing the following objectives below.
Procedures for measuring the student's progress toward the annual goal:
assessment, documentation
Will annual goal (including benchmarks or short-term objectives) be addressed during ESY?
Yes

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

(If yes, include benchmarks or short-term objectives for the student)

When will reports about the student's progress toward meeting the annual goal be provided to parents?
quarterly

WI IEP 06, Page 7 of 12

MF IEP 2015-2016

Student Name: Ethan

Neal
$$$$$$$
#######

Annual Goals and Objectives (I-6)

Benchmarks or short-term objectives necessary (1) to allow the student to be involved in and progress in general education curriculum and (2) to
meet other educational needs that result from the student's disability:
Objective # 1: Max will complete a career assessment survey and choose two jobs of interest.
Objective # 2: Max will complete a slide presentation including details of his two career interests.

WI IEP 06, Page 8 of 12

#######
Student Name: Ethan
Neal
$$$$$$$

MF IEP 2015-2016

Participation in Statewide and Districtwide Assessments (I-7)

To be completed for students participating in statewide or district-wide assessments
Participation in Statewide Assessments
The student will be in the following grade when the Wisconsin Knowledge and Concepts Examination (WKCE) and Wisconsin Knowledge and
Concepts Examination-Criteria Reference Test (WKCE-CRT) are given.
3rd

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)

WAA SwD (Include the WAA checklist*)

Math
WKCE without accommodations
WKCE with accommodations (list accommodations for each content area)

WAA SwD (Include the WAA checklist*)

Language Arts
WKCE without accommodations
WKCE with accommodations (list accommodations for each content area)

WAA SwD (Include the WAA checklist*)

Science
WKCE without accommodations
WKCE with accommodations (list accommodations for each content area)

WAA SwD (Include the WAA checklist*)

Social Studies
WKCE without accommodations
WKCE with accommodations (list accommodations for each content area)

WAA SwD (Include the WAA checklist*)

* The attached WAA participation checklist describes why the student cannot participate in the regular assessment and why the alternate
assessment is appropriate.
Participation in District-Wide Assessments
x

District-wide assessments given

District-wide assessments not given
Student will not be in the grade when assessment is given

List district-wide assessment(s) student will take:

Universal Screener-reading/math/english language arts
Describe appropriate testing accommodations, if any:

WI IEP 06, Page 9 of 12

MF IEP 2015-2016

Student Name: #######

Ethan
Neal
$$$$$$$

Participation in Statewide and Districtwide Assessments (I-7)

Alternate Assessment
If student does not take regular district-wide assessment, describe why the student cannot participate in the regular assessment, and why the
alternate assessment is appropriate.

WI IEP 06, Page 10 of 12

Student Name: $$$$$$$$

Ethan Neal

MF IEP 2015-2016

$########

Program Summary (I-9)

Projected beginning and ending date(s) of IEP services and modifications: 12/21/2015 to 12/20/2016
Physical Education:

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.

Extracurricular and Non-academic Activities

Will the student be able to participate in extracurricular and non-academic activities with non-disabled students?
x

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)

Special Education Services (I-9)

Special Education Services

Service
Provider

Frequency/Amount
(direct/indirect min)
(5.0/0.0) minutes
2.0 times per
day

Check In/Check Out

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

Related Services (I-9)

Related Services - needed to benefit from
special education including frequency,
location, and duration (if different from IEP
beginning and ending dates)
Speech and Language

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

WI IEP 06, Page 11 of 12

Student Name: $$$$$$$$

Ethan Neal

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

an manual or electronic assignment device for tracking assignments

(15.0/0.0)
minutes 1.0
times per day

Leave Classroom for Resource Room

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

para professional support

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.

Modifications and Support Services (I-9)

Program Modifications and Supports - for
school personnel that will be provided
Consultation with General Education
Teachers

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

WI IEP 06, Page 12 of 12

Student Name: $$$$$$$

Ethan Neal

MF IEP 2015-2016

$#######

Determination and Notice of Placement (P-2)

SCHOOL DISTRICT

New Lisbon School District

[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

Date parent provided with notice of placement:

12/14/2015

Ethan Neal
#######
$$$$$$$

Name of Student:

Nicole
Neal, Neil Davey,
##############
$$$$$$$$$$$$$$$

Dear

The IEP developed on

at

12/21/2015

.]

Max Fuentes

Mr. and Mrs. Fuentes

12/14/2015

will be implemented at

New Lisbon School District/New Lisbon

in the

(608)562-3700x1505

New Lisbon JH/High School

School District/City, with a projected date of implementation on

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

if you have questions about your rights.