Educational Setting
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Name
IEP Date
Physical Education
(if other, specify type)
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
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?
Yes
No (rationale)
Yes
No (rationale)
% of time student is OUTSIDE the general education environment
% of time student is OUTSIDE the general education environment
% 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
Other Agency Services
California Children's Services (CCS)
California Children's Services (CCS)
Regional Center
Regional Center
Probation
Probation
Department of Rehabilitation
Department of Rehabilitation
Department of Social Services (DSS)
Department of Social Services (DSS)
Other agency services (specify):
County Mental Health (CMH)
County Mental Health (CMH)
Student Eligible for Mental Health Services under Chapter 26.5?
Yes
No
Yes
No
Mental Health Services included on the IEP?
Yes
No
Yes
No
Promotion Criteria
Parents will be informed of progress
How?
Activities to Support Transition
(e.g. preschool to kindergarten, special education and/or NPS to general education class, 8th-9th grade)