Educational Setting (5B)
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  Incomplete Incomplete
 
Name   IEP Date
 

 
Physical Education Physical Education Physical Education   (if other, specify type)
 
District of Service District of Service District of Service   School of Attendance School of Attendance School of Attendance
 
If you cannot find the school of attendance listed in the drop-down list, you can try entering the school code and/or name here:
 

 
School Type School Type School Type   Federal Setting Federal Setting Federal Setting
 
Preschool Setting Preschool Setting Preschool Setting   Federal Presch. Setting Federal Presch. Setting Federal Presch. Setting
 

 
All special education services provided at the student's school of residence? All special education services provided at the student's school of residence?
 
% of time student is OUTSIDE the regular class & extracurricular & non academic activities % of time student is OUTSIDE the regular class & extracurricular & non academic activities   Estimate
 
% of time student is IN the regular class & extracurricular & non academic activities % of time student is IN the regular class & extracurricular & non academic activities
 
 
  Student will not participate in the general education environment for  
  because  
 
 

 
Other Agency Services
 
 
 
Other agency services (specify):
 

 
 
 
  Student Eligible for Mental Health Services under Chapter 26.5?  
 
  Mental Health Services Language included on the IEP?  
 

 
Promotion Criteria? Promotion Criteria? Promotion Criteria?
 

 
Parents will be informed of progress Parents will be informed of progress Parents will be informed of progress   
 
   How? How? How?   
 
  Activities to Support Transition  
  (e.g. preschool to kindergarten, special education and/or NPS to general education class, 8th-9th grade)  
 
 
 

 
Graduation Plan
(Grade 8 and Higher)
 
Projected graduation date and/or secondary completion date Projected graduation date and/or secondary completion date
 
Plan type Plan type Plan type