Educational Setting
(This form can generate more than one printed page)
Name   IEP Date

 
District of
Service
  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
  Federal
Setting
 
Preschool Setting
(no longer prints)
  Federal
Preschool
Setting
 
Physical Education   (if other, specify type)
 

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

 
Promotion Criteria  
 

 
Parents will be informed of progress   
 
How?   
 

 
Other Agency Services
California Children's Services (CCS) Regional Center
Probation Department of Rehabilitation
Department of Social Services (DSS)
Other agency services (specify):
 
County Mental Health (CMH)  
  Student Eligible for Mental Health Services under Chapter 26.5?  
  Mental Health Services Language included on the IEP?  
 

 
Transportation
 
(Rationale:)
 

 
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