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?
Yes
No (rationale)
Yes
No (rationale)
% 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?
Yes
No
Yes
No
Mental Health Services Language included on the IEP?
Yes
No
Yes
No
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