FORM 5B – EDUCATIONAL SETTING OFFER OF FAPE
1. Physical
Education: Check the type of physical education, if applicable.
2. District of Service: Specify district providing the majority of services to the student.
3. School of Attendance: This is the school where the student is enrolled.
4. School Type: Select one of the following:
00 No school
(0-5)
10 Public day school
11 Public residential
school
15 Special
education center
or facility
19 Other public school
or facility (i.e.,
store front
transition program)
20 Continuation school
22 Alternative work education center/work study program
24 Independent study
30 Juvenile court school
31 Community school
32 Correctional
institution or facility
40 Home instruction based on IEP team determination
45 Hospital facility
50 Community college
51 Adult education program
55 Charter
school operated by an LEA/district
56 Charter
school operated as an LEA/district
61 Head Start program
62 Child development or childcare facility
63 State preschool
64 Private preschool
65 Extended day care
70 Nonpublic day school
71 Nonpublic residential
school-in California
72 Non-public residential school- outside California
75 Private day school (not certified by CDE Special Education Division)
76 Private residential school (not certified by CDE Special Education Division)
79 Nonpublic agency
80 Parochial school
5. Federal Setting (ages 6-22): Indicate the type of school
setting the student attends. If
the student turns 6 years old on or before December 2 of the current
school year, this category is completed.
400 Regular classroom/public day school
Select if the student attends classes
on a general education school campus regardless
of
the type of program
450 Separate school
460 Residential facility
470 Homebound/hospital
480 Correctional facility
490 Parentally placed in private school
6. Federal Preschool
Setting (ages 3-5):
Indicate the type of school setting the student attends. If the student
turns 6 years after December 2 of the current
year,
this category
is
completed. If the student is dually or concurrently enrolled in general education and a
special
education program
for an equal amount of
time,
consider the student as being in a regular early childhood
or kindergarten program.
400 Regular early childhood
or kindergarten program-
more than ten hours per week- majority of special education services provided in the regular
early childhood
program or
kindergarten.
405 Regular early childhood
program or
kindergarten-more than ten hours per week- majority of special education services provided in some other location than the
regular early childhood program or
kindergarten.
410 Regular early childhood
program or
kindergarten-less than ten hours per week- majority of special education services provided in the regular early childhood program
or kindergarten.
415 Regular early childhood
program or
kindergarten-less than ten hours per week- majority of special education services provided in some other
location than the regular early childhood
program or kindergarten.
440 Separate class
450 Separate school
460 Residential facility
470 Home
475 Service provider location
7. All Special
Education Services Provided at StudentÕs School of Residence: Check yes or
no to the question Òall special education services provided at the studentÕs school
of residence.Ó
If
the team determines Òno,Ó
rationale must
be documented.
8. Percentage of
Time Outside and In Class & Extracurricular & Non Academic Activities: Document the percentage of time the student
is outside the regular
environment
and document percentage of
time the student is
in the regular
education environment. Consider the full
day including lunch, recess, passing periods,
etc.
9. Student Will
Not Participate in the Regular Class & Extracurricular & Non Academic
Activities: Document
the
regular education environments where the student will not participate with typically developing peers: Provide rationale for
non-participation.
10. Other Agency Services: Note other agency services the child is receiving.
11. Student Eligible for Mental Health Services under
Chapter 26.5: Check yes or
no. NOTE: This box should only be checked if the student is eligible under 26.5 and receiving
mental health services.
12. Mental Health Services Included on the IEP: Check yes or
no. (Be sure to list the service received from County Mental Health on the Services page (Form
5A).
(i.e. counseling,
day treatment,
etc.)
13. Promotion Criteria: Check appropriate box.
District criteria are the same for students
without disabilities. Progress on goals or
ÔotherÕ
should be noted if the childÕs curriculum
has been modified to meet his/her unique needs.
14. Parents will
Be
Informed of Progress and How: Check the frequency and how the progress will
be reported. NOTE: Progress reporting should match frequency of report
card
schedule.
15. Activities to Support Transition:
If
the student is going through a transition (preschool to
kindergarten, special
education to general education, etc.), document the activities to
support the transition.
16. Graduation Plan:
This needs to be done for students in grade 7and higher.
NOTE: The IEP Team must use caution when determining if the student
will be working
towards a diploma or a certificate of completion. Students must
have
the opportunity to
work toward a diploma if
he/she has the ability to do so. This must be considered on an annual basis. Check appropriate box.
Educational
Benefit Reminder
- Is there a clear description of the location of
services, including why some services may not be provided at
the
childÕs school of
residence, if
appropriate?
- Is there a clear description of the amount of time the student is outside the general
education environment, including an explanation of
why
the student will not
participate in general
education for all
or
part of the day?
- If appropriate, are the activities clearly identified to support
transition from preschool
to
kindergarten,
from
special education and/or NPS
to
general education,
8th-9th grade, etc.?
- If appropriate, is the graduation plan identified for students Grade 8 or higher?
[Excerpted
from the State SELPA IEP Manual, July, 2013]