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PD 1/4 FORM CONTENTS:

Transmittal Letter bullet
Instructions and Definitions bullet
Section A: Students Receiving Preschool Special Education Programs or Services bullet
Section B: Students Receiving School-Age Programs or Services bullet
Section C: Educational Placement of School-Age Students with Disabilities and Race/Ethnicity Information bullet

Official Seal of the New York State Education Department THE STATE EDUCATION DEPARTMENT / THE UNIVERSITY OF THE STATE OF NEW YORK / ALBANY, NY 12234
_____________________________________________________________________________________________________
MANAGER, STRATEGIC EVALUATION DATA COLLECTION, ANALYSIS AND REPORTING
1613 ONE COMMERCE PLAZA
ALBANY, NEW YORK  12234
Tel. (518) 486-4678
Fax (518) 408-3363
 E-mail:  dataquest@mail.nysed.gov

 

To:

Special Education Data Managers of Public Schools Districts
Superintendents of Public School Districts

September 2004
From: Inni Barone
Subject:

PD-1/4 – Public School District Report of Number of Students with Disabilities Provided Special Education on December 1, 2004 and Number of Students with Disabilities Provided Special Education in Regular School-Based Programs and in Separate Settings.

Important:  Due Date is Between December 1, 2004 and January 2, 2005.  All school districts must submit this report electronically through the PD web-based system at http://pd.nysed.gov or through the File Transfer Protocol (FTP) process. Paper copies of this report will not be accepted.  Only the Certification and Assurance Form (page 1 of the PD-1/4 form), with an original ink signature must be submitted through regular mail. 

Attached is the PD-1/4 form for your use in recording child count and placement information for all students with disabilities (ages 3-21) who are the responsibility of your Committee on Preschool Special Education (CPSE) or Committee on Special Education (CSE) and receive special education programs or services on December 1, 2004. This form also requests data for students with disabilities who are also limited English proficient; data for students with disabilities receiving testing accommodations; and data for students not classified as students with disabilities by the CSE, but receiving accommodations pursuant to Section 504 of the Rehabilitation Act. Pursuant to Section 618 of Public Law 101-476 and Section 300.754 of Federal Regulations, the New York State Education Department (SED) is required to report these data to the U.S. Department of Education.
  
The PD-1/4 data are to be submitted by all school districts by entering the data through the website or by using the File Transfer Protocol (FTP) process. Paper copies of this report are not accepted. The web-based PD data system provides immediate feedback on any data reporting errors and allows school districts to make any necessary corrections. A User ID and password to access the web-based system has been mailed to the latest contact person identified on the PD website. If your school district has a new contact person, or did not get this information, please contact my office. Please note, if your school district has the capability of submitting PD-1/4 data through the FTP process, the User Name and password for that process are different from the User ID and password that has been assigned to the contact person to submit PD data through the web-based system. If your school district needs a User Name and password to submit data through the FTP process, please contact this office. The due date for this report is between December 1, 2004 and January 2, 2005. Only the Certification and Assurance Form (page 1 of the PD-1/4 form), with an original ink signature must be submitted through regular mail. Paper copies of this report will not be accepted. Your timely and accurate completion of this report is required in order to ensure full compliance with federal reporting requirements.
  
The data entered on the PD-1/4 form will provide the December 1, 2004 count of students with disabilities and will indicate the extent to which students with disabilities are removed from regular education and are placed in separate educational settings outside of regular school facilities. This report requests data regarding the settings in which students receive regular and special education services and will not affect your State aid allocations in any way. (In contrast, the SA-100 form collects data for State aid purposes, regarding the cumulative extent to which students receive special education programs and services.) 
  
Data from the PD-1/4 form, child count data from Charter Schools on the PD-1C/4C form and program expansion information from Charter Schools, and information provided on the SEDCAR-1 forms, which will be sent to your school district by approved special education programs (ASEPs), will establish the number of school-age and preschool-age students with disabilities to be included in local level calculations to determine your school district’s 2005-2006 federal fund allocations, under IDEA, Sections 611 and 619. These data will also be useful in determining the amount of Charter Schools’ federal fund-allocations, and suballocations for ASEPs. ASEPs are all SED approved preschool and non-public (or private) school-age programs for students with disabilities, including State-supported (Section 4201 Schools). 
 
To be counted in this report, each student with a disability, must meet all of the following criteria as of December 1, 2004:

  • The student must be the responsibility of your school district’s CSE or CPSE. A student with a disability who relocates from your school district and becomes the responsibility of another school district’s CSE or CPSE before December 1, 2004, may not be included in the count for your school district. A student who relocates from another school district and becomes the responsibility of your school district’s CSE or CPSE after December 1, 2004 may not be included in the count for your school district.  

  • The student must have an Individualized Education Program (IEP) and be receiving special education programs and/or related services that meet State standards.

Federal law and regulation require that State and local education agencies ensure an unduplicated count of students with disabilities. Before submitting the PD-1/4 report, please complete local verification procedures to ensure that each student is counted only once. Such verification procedures may include visual scans, computer scans or other methods; and are especially important for school districts having several school buildings and for students receiving multiple special education programs or services.

The State Education Department will confirm the accuracy of information included in this report as part of the program review process, or as is otherwise indicated. To facilitate such review for your school district, please maintain a list (hard copy or other readily retrievable format) of all students included in this report until June 30, 2011. Upon completing local verification procedures, if it is determined that one or more counts are incorrect, a revised report (i.e., PD-1/4 form) must be submitted to SED.

Compared to the PD-1/4 form for December 1, 2003, the December 1, 2004, PD-1/4 form is revised in the following ways:

  • Section A, Tables 1, 3, 4, 5 and 6 have been modified to collect information on preschool children with disabilities ages 3-4, not 3-5. All children who are 5 years of age on December 1, 2004 and receive special education services are “school-age” students with disabilities and as such, must be reported in Sections B and C of this report, and not in Section A.

  • Column D has been added to Section A, Table 1 to collect a subset of preschool children, ages 3 to 4, provided related services only.

  • Some instructions or explanatory notes are added to provide clarifications.

During 2004-2005, Strategic Evaluation Data Collection Analysis and Reporting (SEDCAR) Unit personnel may be available to conduct a limited number of regional training programs regarding the various special education data forms (i.e., the PD forms). If you feel that such training would be useful to the data managers in your area, please contact your local Special Education Training and Resource Center (SETRC). The data collected through the PD forms are used in the following reports and activities: 

  • Annual Performance Report for Special Education

  • Pocketbook of Goals and Results for Individuals with Disabilities 

  • Chapter 655 Report to the Governor and the Legislature on the Status of the State’s Schools

  • Special Education Quality Assurance Reviews

  • School Report Cards 

  • BOCES Report Cards 

  • Charter School Report Cards 

  • Calculations to identify instances of possible race/ethnicity disproportionality 

  • Other reports required by State or federal statutes

  • Summary reports for public information, placed on the Department’s website

  • Evaluation of programs and policies 

If you have any questions or are in need of assistance in completing this report, please contact the SEDCAR Unit by using the contact information provided in the letterhead. Thank you.

Attachment

cc: Rebecca Cort

 

The University of the State of New York
THE STATE EDUCATION DEPARTMENT
Office of Vocational and Educational Services for Individuals with Disabilities (VESID)
Strategic Evaluation Data Collection, Analysis and Reporting (SEDCAR)
One Commerce Plaza – Room 1613
Albany, NY 12234

PD-1/4 – Public School District Report of:
Number of Students with Disabilities Provided Special Education on December 1, 2004 and
Number of Students with Disabilities Provided Special Education in Regular School-Based
Programs and in Separate Settings

Instructions:
  1. Please submit these data electronically at http://pd.nysed.gov  between December 1, 2004 and January 2, 2005. 
  2. Sign, in original ink, the Certification and Assurances at the bottom of this page and return just this page to the above address.
  3. Retain one copy (and supporting documentation) in your school district for reference and audit purposes. The required retention period ends June 30, 2011.
  4. Carefully read the Instructions and Definitions on the following pages.
  5. If you have any questions about this report, please call (518) 486-4678, or e-mail your questions to dataquest@mail.nysed.gov 

 

School District Information

(Enter 12-digit SED Code Below)

                       
SCHOOL DISTRICT NAME
ADDRESS (include building name, room number , or mail stop information)
 
CITY STATE ZIP

Contact Person Information

NAME
TITLE
TELEPHONE (include Area Code) FAX
E-MAIL ADDRESS

*All correspondence from the address at the top of this page will be directed to the contact person reported in the PD web-based system at http://pd.nysed.gov.  You may update the contact person at any time through the PD web-based system located at http://pd.nysed.gov.

Certification and Assurances

I have reviewed the PD-1/4 data that has been submitted electronically to the State Education Department.  I will also review any modifications that may be made to these data and the final verification report that will be issued to the school district by the State Education Department.  These data provide the number of students with disabilities provided special education programs and services on December 1, 2004 and number of students with disabilities provided special education in regular school-based programs and in separate settings.  I certify that this is a complete and accurate count of students with disabilities served on December 1, 2004.  I further certify that the students reported were the responsibility of this school district’s CSE or CPSE, had a current Individualized Education Program and received special education programs or services that met State standards.

I assure that IDEA funds will be sub-allocated, in a manner consistent with State and federal laws and regulations, to Charter Schools in which resident students with disabilities are enrolled and provided special education services directly or indirectly by Charter Schools and to approved special education programs.

 

__________________________
Original Ink Signature

___________________
Date Signed

left arrow

Superintendent Must Sign and Date on or after December 1, 2004


__________________________________
Name of Superintendent
(Please Type or Print)

     

 


 

Instructions and Definitions for Completing the PD-1/4 Report

  1. Report information only for those students with disabilities for whom this school district has CPSE or CSE responsibility on December 1, 2004.

  2. Report information for all students with disabilities (ages 3 to 21) who are the responsibility of this district’s CPSE or CSE and receive special education programs or services on December 1, 2004. (School districts of residence must report information for students with disabilities placed in the State-operated schools in Rome and Batavia, for students with disabilities enrolled in Charter Schools and for students with disabilities who were residents of the school district at the time they were placed by the courts or State agencies in out-of-State approved residential schools. School districts of residence must also report students with disabilities who are placed by the school district in BOCES, Special Act School districts, approved private schools and in out-of-State schools as Emergency Interim Placements.)

  3. Students with disabilities’ race/ethnicity must be reported consistently on all PD forms and other Department data collection instruments. Each student must be reported in a single category. We recommend the parents be provided an opportunity to designate their children as belonging to one of the five race/ethnicity categories as described below. If they are unable to choose among the categories, school district personnel must use their best judgement and report the student in the category based on the group to which the student appears to belong, identifies with, or is regarded in the community as belonging. Please use the following definitions to assist you in determining the most appropriate category for reporting students:
    American Indian/Alaskan Native: A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
    Asian or Pacific Islander: A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. The Pacific Islands include Hawaii, Guam, and Samoa.
    Black or African American (not Hispanic): A person having origins in any of the Black racial groups of Africa.
    Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
    White (not Hispanic): A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

  4. Wherever students are to be reported by age, please report age as of December 1, 2004.

  5. If specific instructions for some tables are not provided below, they are included above each table of the PD-1/4 form.

Directions for Section A

This section contains six Tables. Tables 1 and 3 request placement information by age and by race/ethnicity category for all preschool students with disabilities, ages 3 to 4, who are the responsibility of your CPSE. These students must be receiving preschool special education programs or services, pursuant to Sections 4201 or 4410 of the Education Law, on December 1, 2004. The total number of preschool students, ages 3-4, reported in each of these two tables must be identical. Table 2 is to report the count of preschool students with disabilities, age 2, who are receiving preschool special education services, pursuant to Sections 4201 or 4410 of the Education Law, on December 1, 2004. Table 4 is to be completed by public school districts which operate an approved preschool special education program. The count of children to be reported in Table 4 is the total enrollment of preschool students with disabilities in the district’s approved preschool special education program, who are receiving special education services pursuant to Section 4410, disaggregated by students who are residents of the school district and those who are not. Table 5 is to report, by race/ethnicity, the total number of preschool students with disabilities who are residents of the school district, who are enrolled in regular parochial or other private schools at parents or guardians expense, but who are provided special education programs or services at public expense. Students reported in Table 5 are also reported in Tables 1 and 3. Table 6 is to report the number of preschool students with disabilities who are reported in Tables 1 and 3, and who are also limited English proficient (or English language learners).

Definitions for Section A, Tables 1 and 3

Line 1 - Early Childhood Setting
Unduplicated total who received all of their special education and related services in programs designed primarily for children without disabilities. This may include, but is not limited to:
  • private preschools,
  • Head Start Centers,
  • child care facilities,
  • regular preschool classrooms open to an eligible pre-kindergarten population by the public school system,
  • home/early childhood combinations,
  • home/Head Start combinations,
  • special class in an integrated setting, and
  • other combinations of early childhood settings.
Line 2 - Early Childhood Special Education Setting
Unduplicated total who received all of their special education and related services in State Education Department approved programs designed primarily for children with disabilities housed in regular school buildings or other community based settings. This may include, but is not limited to:
  • special education classrooms in regular public school buildings,
  • special education programs/services in child care facilities or other community based settings,
  • special education classrooms in trailers or portables outside regular school buildings,
  • special education programs/services in neutral sites (e.g., libraries), and
  • special education programs/services provided in the therapist's office.
Line 3 - Home
Unduplicated total who received special education itinerant teacher services and/or related services in the principle residence of the child’s family or caregiver.
Line 4 - Itinerant Services Outside the Home, in a Hospital
Unduplicated total who received all of their special education and related services at a hospital for a short period of time, up to 3 hours per week on an outpatient basis. (This category does not include children receiving services at home.) These services may be provided individually or to a small group of children.

Please note that preschool students who received special education or related services at a hospital for more than 3 hours per week on an outpatient basis, should be reported in Line 5, Part-Time Early Childhood/Part-Time Early Childhood Special Education Setting, if a portion of services are provided at home or in a regular education program; or in Line 2, Early Childhood Special Education Setting, if all the special education is provided in the hospital setting.

Preschool students receiving special education or related services at a hospital on an inpatient basis, should be reported in Line 6, Residential Facility.
Line 5 - Part-Time Early Childhood Setting/Part-Time Early Childhood Special Education Setting
Unduplicated total who received general and/or special education services in multiple settings, such that: 1) a portion of their general education, special education and related services are provided at home or in programs designed primarily for children without disabilities, and 2) the remainder of their special education and related services are provided in programs designed primarily for children with disabilities. This may include, but is not limited to:
  • home/early childhood special education combinations,
  • Head Start, child care, nursery school facilities, or other community based settings, with special education provided outside of the regular class,
  • regular pre-kindergarten classes with special education provided outside of the regular class,
  • separate school/early childhood combinations, and
  • residential facility/early childhood combinations.
Line 6 - Residential Facility
Unduplicated total who received all of their special education and related services in publicly or privately operated residential schools, or residential medical facilities on an in-patient basis.
Line 7 - Separate School
Unduplicated total who received all of their special education and related services in educational programs in separate public or private day school buildings specifically for children with disabilities.

Directions and Definitions for Section B, Table 1

Section B, Table 1, requests the count of all school-age students for whom the district has Committee on Special Education (CSE) responsibility to provide special education services, and is providing such services on December 1, 2004. Additional directions to assist school districts to accurately complete this table are provided above the table. The school districts of residence maintain CSE responsibility for students except in the following circumstances:

  • If students are placed by another agency (e.g., courts, social services, Office of Children and Family Services, etc.), in Child Care Institutions (CCI) located within New York State, the residential schools connected with the CCIs assume the CSE responsibility for such students and provide services pursuant to Article 81 of the Education Law. Therefore, such students are not to be reported by school districts in this report;

  • Students who reside in State agency facilities of the Office of Children and Family Services, Office of Mental Health, Office of Mental Retardation and Developmental Disabilities or the Department of Correctional Services and attend their educational programs are the responsibility of the State agencies and are not to be reported in this report;

  • School districts that receive students through contract with less than K-12 school districts pursuant to Sections 2040-2045 of the Education Law assume CSE responsibility. For example, once students leave a K-8 school district and attend a school district with grades 9-12, the district with grades 9-12 assumes CSE responsibility for such students (CR 200.2(f)). The K-8 district is not to report students in grades 9-12;

  • Students who reside in group homes or in State agencies, but attend public schools, are the CSE responsibility of school district in which the group home or State agency is located; and

  • Students who are incarcerated in county correctional facilities are the CSE responsibility of the school district in which the correctional facility is located.

Directions and Definitions for Section C, Reports 1-14

Section C, Reports 1-14: There are two tables for each disability category- Table 1 and Table 2. These tables request placement information for all school-aged students with disabilities, ages 4-21, who are the responsibility of your CSE and are provided school-age special education programs and services on December 1, 2004.

Table 1: Report the number of students with disabilities who are educated in regular school buildings and removed from regular classes for "Less than 20%", "21% to 60%", or "More than 60%" of the school day or school week. "Regular school buildings" are buildings for both disabled and non-disabled school-age students. "Regular classes" are classes for both disabled and nondisabled school-age students. Time outside of regular classroom is a measure of the extent of removal from the regular classroom setting, NOT of the total amount of special education services provided. It is the percent of each school day or week that a student receives special education including related services, apart from non-disabled students while within a regular school building. For purposes of these data collection, students in the following settings should be reported in Table 1 (regular school buildings):

  • Students who are home-schooled at their parent's or guardian's choice. 

  • Students who are receiving transition support services.

  • Students who attend regular school buildings for at least 50 percent of the school day or school week, even though they may attend programs in separate settings which include only students with disabilities for the rest of the day or week.

  • All public school buildings which are attended by both disabled and non-disabled school-age students.

  • All BOCES buildings which are attended by both disabled and non-disabled school-age students.

  • All non-public schools which are attended by both disabled and non-disabled school-age students. These are schools in which parents/guardians pay tuition for the basic program, and special education programs or services are provided by public school districts at public expense.

  • All Special Act Schools which are attended by both disabled and non-disabled school-age students.

  • All approved private schools that are attended by both disabled and non-disabled school-age students.

  • All State agency programs which are attended by both disabled and non-disabled school-age students.

  • All Alternative High School programs which are attended by both disabled and non-disabled students.

  • All age appropriate community-based settings that include individuals with and without disabilities, such as vocational sites, in which students with disabilities interact with non-disabled individuals other than non-disabled individuals who are providing services to the students.

In order to determine the percentage of time students receive services outside regular classrooms (i.e., in rooms/groupings attended by students with disabilities only), it is important to consider where the service is provided rather than the type of service which is provided. To calculate the percentage of time outside the regular classroom, divide the number of hours the student receives special education and related services outside the regular classroom each day or week by the total number of hours in the school day or school week. Use the length of the entire school day, including all periods and lunch. The following examples are provided for purpose of clarification:

  • A student who attends a resource room for one period each day in which special education services are provided to a group of students with disabilities would be counted in Table 1, Line 1 since one period outside of regular classroom would constitute 20 percent or less of the school day.

  • A student who is assigned a full-time, one-to-one teacher aide, but who attends regular classrooms for 80 percent or more of the school day should be included in Line 1 of Table 1.

  • A student who receives special education services for two hours per day outside of regular classrooms would be reported on Table 1, Line 2. If the services are provided in the regular classroom, the student should be reported in Table 1, Line 1.

  • A student whose first period begins at 8:30 a.m. and last period ends at 2:30 p.m. would have a six-hour day or 30-hour week. If the student attends a special class for four 45-minute periods daily and participates in the general education environment for the remainder of the day, that student’s “time outside regular classroom” would be 15.0 hours per week or 50 percent of the week. Such a student would be reported in Table 1, Line 2.

  • The special education services provided by a public school district to a student who attends a nonpublic school should be deemed outside regular classrooms if special education services are provided at a neutral site or in a public school outside of regular classrooms. These students should be reported in the appropriate line of Table 1.

  • Special education services provided outside the normal school day (e.g., before school or after school) should not be considered time outside the regular classroom, regardless of the type of services or where they are provided. Such students should be counted in Table 1, Line 1.

  • Students with disabilities who receive special education programs or services in regular classes that include non-disabled students should be reported in Table 1. This includes regular classrooms in which consultant teachers provide special education programs and services or regular classes in which special class programs are located.

  • A student with a disability who is home-schooled at his/her parent’s choice, and who receives one hour of special education service per day at the student’s home, should be counted in Table 1, Line 1.
     

Table 2: Report the number of students with disabilities for whom the school district has CSE responsibility and who are educated in separate educational settings. These are settings which are attended by students with disabilities only. The definition of each separate educational setting follows:

Special Public Day Schools- Include public day schools that are attended by students with disabilities only. These schools include public school district or BOCES buildings which are attended by students with disabilities only. These schools also include Special Act School Districts if they are attended on a day school basis, and if they include students with disabilities only. Students with disabilities attending the two State-operated schools, on a day basis, would also be reported in this category.
Special Private Day Schools- Include approved private schools for students with disabilities, and State-supported schools (Section 4201 schools) which are attended by students with disabilities only, on a day basis.
Public Residential Facility- Include public residential facilities in which students with disabilities are placed by the school district and attend an education program affiliated with the facility in buildings which serve only students with disabilities. Public residential facilities include the two State-operated schools, and the Special Act School Districts. Students with disabilities, who are in residential facilities but are provided special education services in buildings that include non-disabled students, should be reported in Table 1.
Private Residential Facility- Include private residential facilities in which students with disabilities are placed by the school district and attend an education program affiliated with the facility in buildings which serve only students with disabilities. Also, include students with disabilities who are placed in private residential facilities by the courts or State agencies, but for whom the district has CSE responsibility (e.g., students with disabilities who were residents of the district at the time they were placed by the courts or State agencies in private out-of-State residential facilities). Private residential facilities include State-supported schools (Section 4201 Schools) with a residential component and approved private schools (in-State and out-of-State). Students with disabilities, who are in residential facilities but are provided special education services in buildings that include non-disabled students, should be reported in Table 1.
Home- Use this setting if the school district Committee on Special Education has determined the home as the student’s placement on December 1. Students who are home-schooled by parent’s choice should not be reported in this category, but rather in Table 1.
Hospital or Other Non-School- These are settings in which students with disabilities are provided special education services based on their unique needs.

 

Table 1:  Educational Placements of Preschool Students with Disabilities (Ages 3-4*)

Enter the total number of preschool students with disabilities for whom this school district has CPSE responsibility to ensure the provision of special education programs or services. Report preschool students who were 3 to 4 years of age and who received preschool special education programs or services on December 1, 2004. In Column D, report the number of students who were provided related services only. Students reported in Column D are a subset of Column C. Column D cannot be greater than Column C. Only count students who were served pursuant to Sections 4410 or 4201 of the Education Law. Please determine age as of December 1, 2004. Counts reported in Tables 1 and 4 of this section and information contained on the SEDCAR-1 forms which school districts will receive from approved preschool special education programs, will assist you in determining the amount of federal IDEA funds, under Sections 611 and 619, which must be suballocated to other programs, and the amount to be retained by your school district, for preschool students with disabilities, ages 3-4. Important information for completing this section is included in the Directions and Definitions for Section A, beginning on page 2.

*Children who are 5 years of age on December 1 are "school-age" children, and must be reported in Sections B and C of this report not in Section A.

Table 2:  Count of Preschool Students with Disabilities, Age 2.

Line Number

Description

 Age 2*

1

Provide the count of preschool students with disabilities, who were 2 years old on December 1, 2004, and were receiving preschool special education programs or services on December 1, 2004.  Report students who were the responsibility of your school district’s CPSE, and who were provided services pursuant to Sections 4410 or 4201 of the Education Law.  
*Students who are 2 years old on December 1, 2004 (who will turn 3 years of age by December 31, 2004) and are receiving preschool special education services, pursuant to Section 4410 of the Education Law, should be included in this column.

______________________
1The order of these settings does not reflect a continuum from least to most restrictive. These settings are alphabetized.

Table 3:  Educational Placements of Preschool Students with Disabilities
(Ages 3-4), According to Race/Ethnicity Category

In the Table below, report race/ethnicity data for all preschool students reported in Column C of Table 1. The Total (Column C) for each line in Table 1 must match the Total (Column F) for each Line in Table 3.

For all preschool students reported in Table 1, enter the number which appear to belong, identify with, or are regarded in the community as belonging to each race/ethnic group. (Each student should be counted once.) See definition of each race/ethnic group on page 2, under Instructions and Definitions for Completing the PD-1/4 report.
 

Table 4:  Count of Preschool Students with Disabilities, Ages 2 to 4, Served in
School District-Operated Approved Preschool Program.

If this district operates an approved preschool special education program, report the number of preschool students with disabilities provided special education programs or services, pursuant to Section 4410 of the Education Law, on December 1, 2004.  Report students in Line 1 if they are residents of your school district, or in Line 2, if they are residents of other school districts.
Line
No.
Preschool Students in District-Operated Approved Programs Ages
3-4
Age
2*

1

Report the number of preschool students with disabilities who are residents of your school district, and are enrolled in your district-operated preschool program on December 1, 2004.    

2

Report the number of preschool students with disabilities who are residents of other school districts, and are enrolled in your district-operated preschool program on December 1, 2004.  Please note that your district must submit a SEDCAR-1 form to each school district of residence, in order to receive a sub-allocation of IDEA funds under Sections 611 and 619 for students reported in this line.    

*Students who are 2 years old on December 1, 2004 (who will turn 3 years of age by December 31, 2004) and are receiving preschool special education services, pursuant to Section 4410 of the Education Law, should be included in the column for students age 2.  Such students will not be used to calculate a suballocation of federal funds under IDEA, Sections 611 and 619, but may be served with Section 611 funds.

Table 5:  Race/Ethnicity of Preschool Students with Disabilities Enrolled by Their Parents or Guardians in Regular Parochial or Other Private Schools.

In the Table below, report  the number of preschool students with disabilities (who are also reported in Tables 1 and 3 above) whose basic education is paid through private resources and who receive special education programs or services at public expense.

Table 6:  Preschool-age Students with Disabilities who are also Students with Limited English Proficiency

Of the preschool-age students with disabilities reported in Section A-Tables 1 and 2 (i.e., all preschool-age students with disabilities for whom the school district has CPSE responsibility), report the subset of such students having limited English proficiency (LEP) in Line 1. Such students should be reported based on LEP designation, regardless of the extent or type(s) of LEP services provided. Preschool students with disabilities are considered to be limited in English proficiency if the primary language spoken at home is other than English (excluding manual methods of communication). December 1, 2004 should be used in determining student age.

Students determined to have a disability pursuant to Section 504 only, and do not have an IEP developed by a Committee on Preschool Special Education, should not be reported in this section, regardless of LEP status.
 

Line No. Description 2 4 Years

1

Preschool LEP Students with Disabilities  

 

Section B: Students Receiving School-Age Programs or Services

Table 1: 
Type of Programs in Which Special Education Services are Provided to
School-age Students with Disabilities

Provide an unduplicated count of all school-age students with disabilities for whom this school district has Committee on Special Education (CSE) responsibility to provide special education services, and is providing such services on December 1, 2004, in accordance with Individualized Education Programs (IEPs) at a school, home, hospital or other non-school facility, directly or through a contract with another service provider. Please determine age as of December 1, 2004. The counts reported in this section, child count data from Charter Schools on the PD-1C/4C forms, any enrollment expansion information received from Charter Schools, and information reported in the SEDCAR-1 forms received from the approved special education programs are to be used by school districts to determine the amount of federal IDEA funds under Sections 611 and 619 to be sub-allocated to approved special education programs, charter schools and the amount to be retained by school districts, for school-age students with disabilities.
In addition to the description provided for each line below, the following are additional clarifications:

  • Do not include in this report students who are receiving declassification support services on December 1, 2004.

  • Include in Line 1, all students with disabilities for whom the school district has CSE responsibility and provides special education services directly or through contracting with other service providers. Examples include: students with disabilities in drug or alcohol rehabilitation facilities regardless of where such facilities are located; students with disabilities who are in county correctional facilities, located in the school district; students with disabilities who are hospitalized, regardless of where the hospital is located; and students with disabilities who are "home-schooled" if some special education service is provided by the school district.)

  • Include in Line 1, students with disabilities who are enrolled by their parents or guardians at private expense in non-public schools but who are provided special education programs or services (i.e., consultant teacher services, related services, transportation*, etc.) by this school district, at public expense. (*Special education services include suitable transportation services provided pursuant to Section 4402.2.(d)(4)(d); whereby a student with a current IEP is transported up to 50 miles to and from a nonpublic school which the student with a disability attends for the purpose of receiving services or programs similar to special education programs recommended by the school district CSE.)

  • Include in Line 1, students with disabilities for whom transitional support services are provided on December 1, 2004.·

  • Include in Line 5, students with disabilities who resided in this school district at the time they were placed in out-of-State residential schools by the courts or State agencies.

Please see additional directions and definitions for Section B, Table 1 on page 4 of 24 for information regarding CSE responsibility. If you have specific questions about which students are the responsibility of your CSE, please contact your regional associate.

 

Line
No.

Report Each Student Only Once

Ages 4-5

Ages 6-21

1 Count of school-age students provided special education services in district-operated programs.  (See above directions for additional guidance on who to include.)    
2 Count of school-age students provided special education services in programs operated by another school district (not a Special Act School District).    
3 Count of school-age students provided special education services full-time in programs operated by a Board of Cooperative Educational Services (BOCES).    
4 Count of school-age students provided special education services while enrolled in a Charter School.    
5 Count of school-age students provided special education services in approved private schools for students with disabilities, and  State-supported schools listed in Section 4201 of the Education Law.  Include students with disabilities who were resident to your district at the time they were placed in out-of-State residential schools by courts or other State agencies. Also include in this line all other out-of-State placements.    
6 Subtotal (Sum of Lines 1, 2, 3, 4 and 5):  This number and information received by districts on the SEDCAR-1 forms will assist school districts to determine a per pupil amount of IDEA funds to be sub-allocated to approved special education programs and Charter Schools during the 2005-2006 year.    
7 Count of school-age students, provided special education services by contracting with  Special Act School Districts, or in the New York State School for the Blind in Batavia or the New York State School for the Deaf in Rome.    
8 Total (Sum of Lines 6 and 7):  This number represents the total number of school-age students who are the responsibility of this school district’s CSE and are provided special education programs or services on December 1, 2004.  (The number entered for this line must match the number entered in Section C, Report 14 of this form.)    

 

Table 2: 
School-age Students with Disabilities Whose Basic Education Costs are Paid by Private Resources
or Who are Home Schooled.

  1. Enter by race/ethnicity the total number of school-age students with disabilities, also reported in Section B- Table 1, enrolled by their parents or guardians in a non-public school and whose basic education is paid through private resources and who receive special education programs or services at public expense through the public school district.

2.

Enter the total number of school-age students with disabilities, also reported in Section B- Table 1, who are home-schooled by their parent’s or guardian’s choice, and who receive special education programs or services at public expense, through the public school district.



 

Table 3: 
Students Placed in Home School Buildings.

1.

For all students with disabilities who are the responsibility of your school district’s Committee on Special Education on December 1, 2004, who attend school-age special education programs (reported in Section B-Table 1), report the number served in their home school.  The term home school is defined below.

Home School – A school building in which the student would otherwise attend if he/she did not have a disability. This determination is based on local school district characteristics such as feeder patterns, magnet school configurations, and desegregation orders; as well as student characteristics, such as age/grade level, race/ethnicity, and place of residence. (Students attending Charter Schools, non-public schools and students who are home-schooled (pursuant to Article 65 of Education Law) are considered to be attending their home school building.) It is possible to have more than one school building be regarded as a student’s “Home School”. Students receiving services in more than one site should be reported according to the site they attend for the majority of their school day. (Students should be reported as attending their “Home School” if they are placed in their home school for 50 percent or more of their school day and are placed in another facility, not considered to be their “Home School”, for less than 50 percent of their school day.)



 

Table 4: 
Test Accommodations for Students with Disabilities

  1. Of the school-age students reported in Section B-Table 1, enter the number of students whose individualized education programs (IEPs) include one or more testing accommodations, by the appropriate age interval in Line 1.  Students should be reported once, regardless of the number of testing accommodations listed in their IEPs.  Also, all students should be reported regardless of whether they will be administered a State assessment during the 2004-2005 school year.

Line
No.
Description Students Ages
4 - 12
Students Ages
13 - 15
Students Ages
16 - 21

1

Total number of students provided any type(s) of testing accommodations.      

 

Table 5: 
School-age Students with Disabilities who are also Students with Limited English Proficiency (also referred to as English language learners.)

Of the school-age students with disabilities reported in Section B-Table 1, report the subset of such students having limited English proficiency (LEP) in Line 1.  Such students should be reported based on LEP designation, regardless of the extent or type(s) of LEP services provided.

Students determined to have a disability pursuant to Section 504 only, and do not have an IEP developed by a Committee on Special Education, should not be reported in this section, regardless of LEP status

Line
No.

Description

4 - 5
Years
6 - 11
Years
12 - 13
Years
14 - 17
Years
18 - 21
Years
Total

1

School-Age LEP Students with Disabilities            

 

Table 6: 
Students Provided Section 504 Accommodations

Number of school-age students provided “reasonable accommodations” pursuant to Section 504 of the Rehabilitation Act of 1973. Students should be reported if they were the responsibility of this school district’s Section 504 Multidisciplinary Team and provided services/accommodations specified in a Section 504 Accommodation Plan on December 1, 2004. Please note that students reported in the table below, should not be included in Section B-Table 1 of this report, and students included in Section B-Table 1 of this report are not to be counted in this Section, even if they qualify to be counted for both.
Line
No.

Disability Category

4 - 5
Years
6 - 11
Years
12 - 13
Years
14 - 17
Years
18 - 21
Years
Total

1

Section 504 Disability            

 

Table 7: 
School-Age Students with Disabilities by Grade or Age

For all students with disabilities reported in Section B, Table 1, Line 8 (Ages 4-21) report the number of students by grade level in Part 1 below. For students with disabilities who are not enrolled in a grade, report them by age in Part 2 below. Each student with a disability is to be reported in only one line of either Part 1 or Part 2. Assignment of students with disabilities should be reported by grade if students attend classes with a particular grade. If students with disabilities attend classes with more than one grade, report them in the grade that they attend for majority of their classes, or the grade with which they identify. Please note the total number of students with disabilities in Line 14 of Part 1 plus the total number of students with disabilities in Line 16 of Part 2 must equal the total number of students with disabilities reported in Section B, Table 1, Line 8 (Ages 4-21).
Part 1 - Number of Students with Disabilities in Each Grade Regardless of Age
Line # Grade Number of Students with Disabilities
1 Kindergarten  
2 Grade 1  
3 Grade 2  
4 Grade 3  
5 Grade 4  
6 Grade 5  
7 Grade 6  
8 Grade 7  
9 Grade 8  
10 Grade 9  
11 Grade 10  
12 Grade 11  
13 Grade 12  
14 Total  

 

Part 1 - Number of Students with Disabilities who are not Assigned to a Grade , by Age as of 12/01/04
Line # Grade Number of Students with Disabilities
1 Age 4  
2 Age 5  
3 Age 6  
4 Age 7  
5 Age 8  
6 Age 9  
7 Age 10  
8 Age 11  
9 Age 12  
10 Age 13  
11 Age 14  
12 Age 15  
13 Age 16  
14 Age 17  
15 Ages 18 - 21  
16 Total  

 

Section C: Educational Placement of School-age Students with Disabilities
and Race/Ethnicity Information

Directions: Please review directions and definitions for completing reports 1-18 beginning on page 4.

Report 1:  Report of Students with Autism Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 2:  Report of Students with Emotional Disturbance Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 3:  Report of Students with Learning Disabilities Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 4:  Report of Students with Mental Retardation Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 5:  Report of Students with Deafness Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 6:  Report of Students with Hearing Impairments Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 7:  Report of Students with Speech or Language Impairments Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 8:  Report of Students with Visual Impairments (including Blindness) Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 9:  Report of Students with Orthopedic Impairments Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 10:  Report of Students with Other Health Impairments Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE. Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 11:  Report of Students with Multiple Disabilities Placed as of December 1, 2004

pd-1-4_13Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 12:  Report of Students with Deaf-Blindness Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 13:  Report of Students with Traumatic Brain Injury Placed as of December 1, 2004

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 14:  Summary Report of All Students with Disabilities Placed as of December 1, 2004

The two sections below aggregate the data reported in Reports 1 to 13 to facilitate State and local data verification procedures.  Completing these two tables will facilitate the reporting of race/ethnicity data in Reports 15 and 16.

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

Age Group

4 - 5

6 -11

12 - 13

14 - 17

18 - 21

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

Notes for Reviewing Data Reported in Report 14 Above:

 

Report 15:  Report of All Students with Disabilities as of December 1, 2004,
According to Race/Ethnicity Category and Type of Placement

For all students reported in Table 1 and Table 2 of Report 14, enter the number which appear to belong, identify with, or are regarded in the community as belonging to each race/ethnic group.  (Each student should be counted once.)  The Total (Column F) for each Line in this Report must match the Total (Column F) for each Line in Report 14.

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

Line
Number

Time OUTSIDE Regular Classroom

A B C D E F

American Indian or Alaskan Native

Asian or Pacific Islander

Black (not of Hispanic origin)

Hispanic

White (not of Hispanic origin)

Total

01 20% or less            
02 21% to 60%            
03 More than 60%            

04

Total            

Table 2: In Separate Settings Outside of regular school facilities, in buildings which are attended by students with disabilities only.  In Line 5, include students who are placed on home instruction by the CSE.  Students who are home-schooled by parent choice should be reported in Table 1.

Line
Number

Type of Setting

A B C D E F

American Indian or Alaskan Native

Asian or Pacific Islander

Black (not of Hispanic origin)

Hispanic

White (not of Hispanic origin)

Total

01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home            
06 Hospital or Other Non-school            

07

Total            

 

Report 16: Report of All Students with Disabilities as of December 1, 2004, According to Race/Ethnicity Category and Type of Disability

In the table below, report race/ethnicity data by disability for all students reported in Tables 1 and 2 of Reports 1 to 13.

The total reported below in Column F for each disability must match the sum of totals reported in Tables 1 and 2 under the corresponding disability in Reports 1 to 13. Also, the total reported in Line 14 for each column must match the sum of corresponding columns of Tables 1 and 2 of Report 15.

Racial/Ethnic Group

Line Number

Disability

A B C D E F
American Indian or Alaskan Native Asian or Pacific Islander Black 
(not of Hispanic origin)
Hispanic White 
(not of Hispanic origin)
Total
01 Autism
02 Emotional Disturbance
03 Learning Disability
04 Mental Retardation
05 Deafness
06 Hearing Impairment
07 Speech or Language Impairment
08 Visual Impairment (includes Blindness)
09 Orthopedic Impairment
10 Other Health Impairment
11 Multiple Disabilities
12 Deaf-Blindness
13 Traumatic Brain Injury
14 Total (Lines 1-13)

 

Report 17: Report of Students with Disabilities Who are 14 to 21 Years of Age as of December 1, 2004 According to Race/Ethnicity Category.  (These students are also reported in Reports 15 and 16 of this report.)

In the table below, report race/ethnicity data for students with disabilities (ages 14-21) for whom the school district has CSE Responsibility.  The total number of students reported in Column F of this report must be the same as the total number of students reported in Report 14, Tables 1 and 2, Columns D plus E.
Line
Number

Category of Students

A B C D E F

American Indian or Alaskan Native


Asian or Pacific Islander

Black (not of Hispanic origin)


Hispanic

White (not of Hispanic origin)

Total

01 Students with Disabilities, Ages 14-21            

 

Report 18: Report of School-Age Students with Disabilities In Specific Types of Schools, as of December 1, 2004, by Race/Ethnicity.  (These students are also reported in Reports 15 and 16 and, if applicable, in Report 17.)

In the table below, report race/ethnicity data for school-age students with disabilities, enrolled in Charter Schools, BOCES, approved private schools, Special Act School Districts, State-Operated, and State-Supported Schools, and in out-of-State court placements and emergency interim placements as of December 1, 2004. The total reported in Line 7, Column F below must be the same as the sum of numbers reported in Section B, Table 1, Lines 3, 4, 5 and 7 of this PD-1/4 form. Furthermore, Line 1 below should equal Section B, Table 1, Line 4; Line 2 below should equal Section B, Table 1, Line 3; Line 3 plus Line 6 below should equal the number of students reported in Section B, Table 1, Line 5; Line 4 plus Line 5 below should equal the number of students reported in Section B, Table 1, Line 7.

Line
Number

Type of Setting

A B C D E F

American Indian or Alaskan Native

Asian or Pacific Islander

Black (not of Hispanic origin)


Hispanic

White (not of Hispanic origin)

Total

01 Charter Schools            
02 BOCES            
03 Approved Private Schools            
04 Special Act School Districts            
05 State-Operated Schools (in Rome and Batavia)            
06 State-Supported Schools (Section 4201)            
07 Total            

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