-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.
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
72
Non-public residential school- outside
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
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.
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?