-IEP Form – Educational Setting

Offer of FAPE

 

1.            Physical Education: Check the type of physical education, if applicable.

 

2.            District of Service: Specify district providing the majority of services to the student.

 

3.            School of Attendance: This is the school where the student is enrolled.

 

4.            School Type: Select one of the following:

 

00        No school (0-5)

10                Public day school

11                Public residential school

15                Special education center or facility

19                Other public school or facility (i.e., store front transition program)

20                Continuation school

22        Alternative work education center/work study program

24                Independent study

30                Juvenile court school

31                Community school

32                Correctional institution or facility

40        Home instruction based on IEP team determination

45                Hospital facility

50                Community college

51                Adult education program

55                Charter school operated by an LEA/district

56                Charter school operated as an LEA/district

61                HeadStart program

62                Child development or childcare facility

63                State preschool

64                Private preschool

65                Extended day care

70                Nonpublic day school

71                Nonpublic residential school-in California

72                Non-public residential school- outside California

75        Private day school (not certified by CDE Special Education Division)

76        Private residential school (not certified by CDE Special Education Division)

79                Nonpublic agency

80                Parochial school

 

5.            Federal Setting (ages 6-22): Indicate the type of school setting the student attends. If the student turns 6 years old on or before December 2 of the current school year, this category is completed.

 

400            Regular classroom/public day school

 

Select if the student attends classes on a general education school campus regardless of the type of program

 

450            Separate school

460            Residential facility

470            Homebound/hospital

480            Correctional facility

490            Parentally placed in private school

 

6.            Preschool Setting (ages 3-5): Indicate the type of school setting the student attends. If the student turns 6 years after December 2 of the current year, this category is completed. If the student is dually or concurrently enrolled in general education and a special education program for an equal amount of time, consider the student as being in a regular early childhood or kindergarten program. 

 

400            Regular early childhood or kindergarten program

440            Separate class

450            Separate school

460            Residential facility

470            Home

475            Service provider location

 

7.            All Special Education Services Provided at Student’s School of Residence: Check yes or no to the question “all special education services provided at the student’s school of residence.” If the team determines “no,” rationale must be documented.

 

8.            Percentage of Time Outside and In Class & Extracurricular & Non Academic Activities: Document the percentage of time the student is outside the regular environment and document percentage of time the student is in the regular education environment. Consider the full day including lunch, recess, passing periods, etc.

 

9.            Student Will Not Participate in the Regular Class & Extracurricular & Non Academic Activities: Document the regular education environments where the student will not participate with typically developing peers:  Provide rationale for non-participation.

 

10.        Other Agency Services: Note other agency services the child is receiving.

 

11.        Student Eligible for Mental Health Services under Chapter 26.5: Check yes or no.

 

12.        Mental Health Services Included on the IEP: Check yes or no. (Be sure to list the service received from County Mental Health on the Services page (Form 5A). (i.e. counseling, day treatment, etc.)

 

13.        Promotion Criteria: Check appropriate box. District criteria are the same for students without disabilities. Progress on goals or ‘other’ should be noted if the child’s curriculum has been modified to meet his/her unique needs.

 

14.        Parents will Be Informed of Progress and How: Check the frequency and how the progress will be reported.

 

15.        Activities to Support Transition: If the student is going through a transition (preschool to kindergarten, special education to general education, etc.), document the activities to support the transition.

 

16.        Graduation Plan: This needs to be done for students in grade 8 and higher. 

         NOTE: The IEP Team must use caution when determining if the student will be working towards a diploma or a certificate of completion. Students must have the opportunity to work toward a diploma if he/she have the ability to do so. This must be considered on an annual basis. Check appropriate box.

 

   Educational Benefit Reminder  

o        Is there a clear description of the location of services, including why some services may not be provided at the child’s school of residence, if appropriate?

o        Is there a clear description of the amount of time the student is outside the general education environment, including an explanation of why the student will not participate in general education for all or part of the day?

o        If appropriate, are the activities clearly identified to support transition from preschool to kindergarten, from special education and/or NPS to general education, 8th-9th grade, etc?

o        If appropriate, is the graduation plan identified for students Grade 8 or higher?

 

 

[Excerpted from the State SELPA IEP Manual, July 2009. For the 2008-2009 form set.]