Services
(This form can generate more than one printed page)
Name
,
IEP Date
Service options considered (in selecting LRE, consideration is given to any harmful effect on the child or quality of services that the child needs)
SPECIAL EDUCATION and RELATED SERVICES
ESY
Services
Ind/Grp
Provider
Start/End Date
Frequency
Duration
Location
Yes No
[DNR]
Grp Ind
- /wk
NOTE: Pressing CANCEL does not undo changes to the list (above).
Special Education Support Exceeds 50% of school day.
EXTENDED SCHOOL YEAR (ESY)
Yes
No
Yes
No
Programs and services will be provided according to when student is in attendance and consistent with the public school calendar and scheduled services, excluding holidays, vacations, and non-instructional days unless otherwise specified.