IEP 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       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 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.

 

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.

 

15.   Transportation: Check appropriate box. If special education transportation is indicated, specify the type (door-to-door, curb-to-curb, wheelchair bus, etc.). Include parent provided transportation, if parent is being reimbursed. Special education transportation is appropriate if special provisions are required for the student to access special education services.

 

16.   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.

 

17.   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.

 

 

[Source: State SELPA IEP Manual, December, 2007]