Educational Setting (5B)
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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:  
(select)  
 

 
  School Type School Type School Type   Federal Setting Federal Setting Federal 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?
 
 
 Español  (...)
 
 
  % 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 regular class and/or extracurricular and/or non-academic activities Student will not participate in the regular class and/or extracurricular and/or non-academic activities Student will not participate in the regular class and/or extracurricular and/or non-academic activities  
 
 
 Español  (...)
 
 
  because because because  
 
 
 
 Español  (...)
 
 

 
  Other Agency Services
 
 
 
 
 
  Other agency services (specify):
 
   
 

 
  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, 7th-9th grade)  
 
 
 
 
 
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Graduation Plan
(Grade 7 and Higher)
 
  Projected graduation date and/or secondary completion date Projected graduation date and/or secondary completion date
 
  Plan type Plan type Plan type   
 
  To participate in a functional/life skills curriculum leading to a Certificate of Completion To participate in a functional/life skills curriculum leading to a Certificate of Completion
 

 
NOTE: The state forms committee removed the following items (7.2011), and they no longer print:
 
    Student Eligible for Mental Health Services under Chapter 26.5?  
 
    Mental Health Services Language included on the IEP?