Services Services (Alt. year: )
Name
,
IEP Date
Service options considered:
* Service delivery model (Individual (I) Group (G))
Services
Supplementary Aids and Services, Program Modifications, and/or Supports for School Personnel
*
Provider
Start/End Date
Duration
Frequency
Location
G I
ESY
Services
*
Provider
Start/End Date
Duration
Frequency
Location
Yes No
[DNR]
G I
- /wk
Physical Education
None
None
General
General
Specially Designed (describe)
Specially Designed (describe)
Attendance School
Attendance School
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
Early Inter/IFSP
Yes
No
Yes
No
Other Agency Services
California Children's Services (CCS)
California Children's Services (CCS)
Regional Center
Regional Center
Probation
Probation
Dept. of Rehabilitation
Dept. of Rehabilitation
Dept. of Social Services
Dept. of Social Services
Other:
County Mental Health
County Mental Health
- Student Eligible for Mental Health Services under Chapter 26.5?
Yes
No
Yes
No
Mental Health Services Language Included on the IEP?
Yes
No
Yes
No
Student will not participate in the general education environment for
because
Extent student will NOT participate in general education classes and extra curricular activities
All special education services be provided at student's school of residence?
Yes
No (rationale)
Yes
No (rationale)
Transportation
Transportation
Yes
No
Yes
No
General Ed
Special Ed (specify)
General Ed
Special Ed (specify)
Yes
No
Yes
No
Activities to support transition (e.g. preschool to kindergarten, special education and/or NPS to general education class, 8th-9th grade, etc.)
NOTE: Pressing CANCEL does not undo changes to the lists (above).