FORM 5B – 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        Head Start 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.      Federal 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- more than ten hours per week- majority of            special education services provided in the regular early childhood program or kindergarten.

405      Regular early childhood program or kindergarten-more than ten hours per week- majority of            special education services provided in some other location than the

regular early childhood program or kindergarten.

410      Regular early childhood program or kindergarten-less than ten hours per week- majority of special education services provided in the regular early childhood program or kindergarten.

415     Regular early childhood program or kindergarten-less than ten hours per week- majority of special education services provided in some other location than the regular early childhood program or kindergarten.

440      Separate class

450      Separate school

460      Residential facility

470      Home

475      Service provider location

 

7.      All Special Education Services Provided at StudentÕs School of Residence: Check yes or no to the question Òall special education services provided at the studentÕs school of residence.Ó If the team determines Òno,Ó 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. NOTE: This box should only be checked if the student is eligible under 26.5 and receiving

mental health services.

 

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 ÔotherÕ should be noted if the childÕs 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. NOTE: Progress reporting should match frequency of report card schedule.

 

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 7and 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 has the ability to do so. This must be considered on an annual basis. Check appropriate box.

 

 

Educational Benefit Reminder

-   Is there a clear description of the location of services, including why some services may not be provided at the childÕs school of residence, if appropriate?

-   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?

-   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.?

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

 

 

[Excerpted from the State SELPA IEP Manual, July, 2013]