Arizbeth Zavala

Mock IEP
Special Education 203
Professor Vicki Rieger
STUDENT INFORMATION

&

SCHOOL INFORMATION
 STUDENT & PARENT/GUARDIAN INFORMATION

Student name: Karl Myrvold Jr. 2016-2017 School Picture

Gender: Male

Date of Birth: April 13, 2006

Race: Multiracial

Address: 9400 S. Bermuda Rd.

City/State/Zip: Las Vegas, NV 89123

Mother’s name: Arizbeth Myrvold

Cell number: 702-704-2869

Father’s Name: Karl Myrvold

Cell number: 702-619-1621

Medical Alerts
Emergency contact: Jorge Zavala
Allergies: sulfa drugs
Phone number: 702-335-1356

Relationship: Uncle

Emergency contact: Deborah Selof

Phone number: 702-453-7706

Relationship: Grandmother

SCHOOL INFORMATION
School Name: Weenie Hut Jr. Middle School
District: Little Village County
School Address: 1234 Weenie Hut Rd. Las Vegas, Nevadas 89115
School phone number: 702-799-1234
School code: 812
INDIVIDUALIZED

EDUCATION

PROGRAM (IEP)
Student name: Karl Myrvold Jr. Disability

Date of birth: April 13, 2007 Autism Spectrum Disorder [X]

Student number: 254778 Deaf-blindness [ ]

Disability classification: AU Development delay [ ]

Anticipated year of graduation: 2024 Emotional disturbance [ ]

Classroom setting: self-contained Hearing Impairments [ ]

Intellectual disability [ ]
Multiple disabilities [ ]
Orthopedic impairment [ ]
Speech/language impairment [ ]
Traumatic brain injury [ ]
Visual Impairments [ ]

IEP Meetings

IEP team meeting: October 2, 2017

Projected date IEP is to be implemented: January 2018
Projected date of annual review: October 2018
Is student 14 years old at time of IEP? YES [ ] NO [X]

IEP Team

IEP Case Manager: Angel Ernesto

General Ed Teacher: Sofia Marybeth
Special Education Teacher: Brooke Smith
Speech/Language Pathologist: Anders Christian
Occupational Therapist: Jorge Gonzalez
Psychologist: Maria Miranda
Music Teacher: Concordia Claire
Parent/Guardian (1): Arizbeth Myrvold
Parent/Guardian (2): Karl Myrvold
 Present Levels of Performance & Teacher Observation

Language
Karl is functioning below his chronological age in the area of language development. He is
quiet most of the time and will only answer in short sentences using the pronoun “we” when
referring to himself. Sometimes he will not respond to questions and just look away. Karl does
not speak unless spoken to. Karl does not engage with his fellow classmates. Karl is currently
functioning below his chronological age in the area of receptive development. Karl is currently
functioning below his chronological age in the area of pragmatic/social speech development.
Reading & Writting
Karl is reading at or above grade level. He has good comprehension skills and is able to read
and follow written instructions. He enjoys reading science fiction the most. While he is
reading, Karl will make noises to imitate what he is reading. For example, while he reads
Galactic Battles, he will imitate the sounds of a spaceship and while he reads Generation X T-
Rex, he will imitate the voices of a tyrannosaurs followed by laughing and intense rocking in
his chair. In these instances, Karl is asked to read quietly or to relocate to the back room where
he will not distract classmates. Karl’s handwriting is sometimes illegible because he is unable
to hold a pencil properly. Student types well on the computer and tablet.
Math
Karl is performing at or above grade level. He is able to compute long division in his head
without using a calculator. He enjoys working with numbers and likes to compute
multiplication and fraction problems the best. Karl prefers to work on his math assignments
independently. He does not like to be called on for answers, even though they are almost
always correct. Karl requires individualized or and/or small groups for instruction in math.
Social Skills & Interaction
Karl is functioning below his chronological age in the area of social development. He has not
developed any friendships or seems interested in doing so. Karl prefers to sit by himself. He
does not like it when other students touch his belongings or are near his desk for long periods
of time. He does not participate in our morning meetings or stands up for the Pledge of
Allegiance. Karl will initiate conversations with adults only when he needs something
urgently. Karl responds to high fives but will not return greetings like hi or bye. Karl does not
display appropriate social adjustment to school and/or community events.
Specials
Music: Karl understands pitches and beats. He will participate when prompted by the teacher.
He enjoys this specials the best.
Art: Karl is performing below his chronological age in the area of arts. He does not seem
interested to color, paint, or build crafts. He becomes frustrated when instructed to color
between the lines and will rip up the project. Karl will sometimes refuse to complete an
assignment in art and run towards the back room to sit on the floor.
P.E.: Karl is performing below his chronological age in the area of physical education. He is
unable to kick a straight ball, throw a ball with both hands, or run for more than 30 seconds.
He does not show interest in sports or team playing with other students.
General
Given Karl’s functional level, Karl’s disability affects his involvement and progress in the
general education program.
GOALS
Goal #1 Social Skills
By the end of the 2017-2018 school year, Karl will be able to describe and exhibit the meaning
of 8 non-verbal communication behaviors such as: turning away, frowning, smiling, crossing
the arms, raising the voice, shrugging shoulders, rolling eyes, eye contact, and quiet finger
with 8% accuracy according to participation, and teacher/staff observations.
Benchmark 1.
By the end of 1st quarter, Karl will be able to understand and exhibit 3 out of 8 non-verbal
communication behaviors such as: quiet finger, frowning, and smiling without prompt from
teachers or peers with 80% accuracy.
Benchmark 2.
By the end of 2nd quarter, Karl will be able to understand and exhibit 5 out of 8 non-verbal
communication behaviors such as quiet fingers, frowning, smiling, crossing the arms, and
shrugging shoulders without prompt from teachers or peers with 80% accuracy.
Benchmark 3.
By the end of 3rd quarter, Karl will be able to understand and exhibit 7 out of 8 non-verbal
communication behaviors such as: quiet finger, frowning, smiling, crossing the arms,
shrugging shoulders, and rolling of the eyes without prompt from teachers or peers with 80%
accuracy.
Benchmark 4.
By the end of 4th quarter, Karl will be able to understand and exhibit all 8 non-verbal
communication behaviors such as: quiet finger, frowning, smiling, crossing the arms,
shrugging shoulders, rolling of the eyes, and maintaining eye contact without any prompt from
teachers or peers with 80% accuracy.

Goal #2 P.E.
By the end of the 2017-2018 school year, while in P.E. class, Karl will be able to throw a ball
with two hands simultaneously with force and accuracy to a basket/partner 3ft. away three
times achieving a criteria of 4 out of 5 trials as implemented by adapted P.E. Techer and
Teaching staff.
Benchmark 1.
By the end of 1st quarter, while in P.E. class, Karl will be able to choose a ball of his choice
and bring it to his chest in an attempt to throw, using both hands 3 consecutive times achieving
a criteria of 1 out of 5 times.
Benchmark 2.
By the end of 2nd quarter, while in P.E. class, Karl will be able to choose a ball of his choice
and bring it to his chest in an attempt to throw, using both hands 3 consecutive times achieving
a criteria of 3 out of 5 times.
Benchmark 3.
By the end of 3rd quarter, while in P.E. class, Karl will be able to choose a ball of his choice
and bring it to his chest in an attempt to throw, using both hands 3 consecutive times achieving
a criteria 4 out of 5 times.
Benchmark 4.
By the end of 4th quarter, while in P.E. class, Karl will be able to choose a ball of his choice
and bring it to his chest in an attempt to throw, using both hands 3 consecutive times achieving
a criteria 5 out of 5 times.
Goal #3 Social/Turn Taking
By the annual review 2017-2018, on school campus, Karl will take independent two turns with
a peer during a familiar game/activity and remain engage in cooperative play for 3 minutes
with 4 out of 5 trials as measured by observation and documentation as implemented by
Special Education Teacher/Staff.
Benchmark 1.
By the end of the 4th quarter 2017-2018 school year, on campus, Karl will take one turn with a
peer during a familiar game/activity with 4 out of 5 trials as measured by observation and
documentation as implemented by Special Education Teacher/Staff.
Benchmark 2.
By the annual review date 2017-2018 school year, on the school campus Karl will take two
turns with a peer during a familiar game/activity with 4 out of 5 trials as measured by
observation and documentation as implemented by Special Education Teacher/Staff.
Benchmark 3.
By the 4th quarter 2017-2018 school year, on the school campus, Karl will remain engaged in
cooperative play for 1 minute with 4 out of 5 trials as measured by observation and
documentation as implemented by Special Education Teacher/Staff.
Benchmark 4.
By the annual review date 2018-2019 school year, on the school campus, Karl will remain
engaged in cooperative play for 4 minutes with 4 out of 5 trials as measured by observation
and documentation as implemented by Special Education Teacher/Staff.

Related Services

Service: Instructor Frequency/Duration

Speech/language Mr. Anders Christian 2x week 30 mins in class
Occupational Mr. Jorge Zavala 1x week 30 mins in class
Psychological Maria Miranda 1x month 45 mins in class

Participation in State and Districtwide Assessments

Karl is able to participate in State and Districtwide assessments with the rest of his
classmates. Adaptations and modifications for assessments will be listed below.

Adaptations & Modifications

Karl is allowed additional time to complete assignments in class
Karl is allowed additional time during district wide testing
Karl is allowed to listen to music while he completes tasks and classwork
Karl is allowed 5 breaks that last 5 min each per day
 Participation with Typical Students/Community

Karl is currently enrolled in a self-contained classroom with other special needs students. He
is able to interact with general education students during specials, lunch, recess, and in-
between class periods.
Karl is a well behaved student who is able to participate in CBIs and field trips with other
special and general education students.

Cite Based Instruction (CBI) Information

Place Frequency Description

Tropical warehouse 1x week Sorting and packaging fosskits
Goodwill 1x week Sorting shoes
Animal sanctuary 1x monthly Help feed & groom animals

Resource Rooms:
Karl does not require a resource room because he is enrolled in a self-contained classroom.
He receives any and all related services in a private area of the self-contained classroom.
 Works Cited

At a Glance: Anatomy of an IEP. (n.d.). Retrieved November 11, 2017, from

https://www.understood.org/en/school-learning/special-services/ieps/at-a-glance-

anatomy-of-an-iep

Completed Sample IEP. (n.d.). Retrieved November 11, 2017, from

http://depts.washington.edu/lend/building_skills_files/5%20IEP%20C%20%20Sample_D

istan%20Learners%20for%20webposting_2-2017.pdf

Gargiulo, R. M. (2015). Special Education in Contemporary Society: An Introduction to

Exceptionality. Los Angeles. Sage.