Extended School Year (ESY) Eligibility Worksheet (p. 1) |
Page help |
|
|
|
|
|
Student Name |
|
|
Date of Birth |
|
|
IEP Date |
|
|
|
|
|
|
|
Definitions |
|
|
ESY |
Extended School Year services are programs and services that assist the student in working toward the same goals and objectives that the student works on during the school year. ESY services are only provided for those areas on the current IEP where the student has demonstrated a) regression of skills during an extended school break and b) limited ability to benefit from re-teaching of skills after an extended school break. |
|
|
|
|
Regression |
Loss of previously attained skills documented by a review of the IEP goals, due to an extended school break. |
|
|
|
|
Rate of Recoupment |
Length of time required to re-lean skills following an extended school break. |
|
|
|
|
Regression and Recoupment |
Some students have disabilities that are likely to continue indefinitely or for a prolonged period. In this situation, interruption of the student's educational programming may cause regression, when coupled with limited recoupment capacity, rendering it impossible or unlikely that the student will attain the level of self-sufficiency and independence that would otherwise be expected in view of his or her disabling condition. (5 C.C.R. Section 3043.) |
|
|
|
|
|
|
Directions: The IEP Team shall determine the following in order to designate a student as requiring ESY as part of FAPE |
|
|
Using input from staff and parents, answer the following questions |
|
|
1. |
At the start of the school year, with a review period equal to that of general education students, was the student unable to regain skills lost over the break that would otherwise be expected in view of the student's disabling condition? |
|
|
|
|
|
|
If yes, specify what area(s): |
|
|
|
 |
|
|
|
|
|
Si no, especificar en qué área(s): |
|
|
|
 |
|
|
|
|
|
|
|
2. |
Does this student display a loss of previously taught skills and an inability to regain those skills following interruptions in instruction during the regular school year, i.e., Thanksgiving Break, Winter Break, and Spring Break? |
|
|
|
|
|
|
If yes, specify what area(s): |
|
|
|
 |
|
|
|
|
|
Si no, especificar en qué área(s): |
|
|
|
 |
|
|
|
|
|
|
|
3. |
Is the student currently at a crucial stage in learning skill(s), such that an interruption in school program might cause loss of skill(s) that the student would not be able to re-learn in a reasonable period of time, in view of the student's disabling conditon? |
|
|
|
|
|
|
If yes, specify what essential skill(s): |
|
|
|
 |
|
|
|
|
|
En caso afirmativo, especifique qué habilidad esencial(s): |
|
|
|
 |
|
|
|
|
|
|
|
4. |
Is the student able to maintain the skills identified without Extended School Year? |
|
|
|
|
|
|
If no, specify what skill: |
|
|
|
 |
|
|
|
|
|
Si no, especifique qué habilidad: |
|
|
|
 |
|
|
|
|
|
|
|
5. |
Does the student require ESY to continue to achieve the level of independence that is expected in view of the student's disabling condition? |
|
|
|
|
|
|
|
Note: Refer to criteria specified on the ESY Worksheet 2 if answer is "yes" on any of the above. |
|
|