>
[_bars/f2pm.htm]

PD 2 FORM CONTENTS:

Transmittal Letter

bullet

School Information

bullet

Section A: Table 1

bullet

Section B: Table 1

bullet

Section B: Table 2

bullet
 

Section B: Table 3

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 and Chief School Officers of:
In-State Approved Private Schools for Students with Disabilities (That do not Provide Educational Services to Students with Disabilities Pursuant to Article 81 of the Education Law)
Approved Private Schools for Students with Disabilities
       Located Out-of-State
State-Operated Schools
State-Supported Schools

September 2004
From: Inni Barone
Subject: PD-2 – In-State and Out-of-State Approved Private Schools, and State-Operated and State-Supported Schools Report: Number of Preschool and School-Age Students with Disabilities Provided Special Education on December 1, 2004. Due between December 1 and December 17, 2004.

Attached is a PD-2 form to be used to report the count of preschool and school-age students with disabilities provided special education programs and services on December 1, 2004. Preschool students with disabilities may be counted if they are provided special education services by your school pursuant to Section 4410 or 4201 of the Education Law. School-age students with disabilities may be counted if they are placed in your school by public school districts or by Commissioner’s appointments. Out-of-State approved private schools are to report the number of New York State students placed in the school by New York State school districts and by New York State courts and other agencies. All schools submitting this report must be either schools that are approved for educating students with disabilities or are State-operated or State-supported schools. This report is due in the State Education Department between December 1 and December 17, 2004 and should be submitted to:

New York State Education Department
Office of Vocational and Educational Services for Individuals with Disabilities
Strategic Evaluation Data Collection, Analysis and Reporting
Room 1613, One Commerce Plaza
Albany, New York 12234

To be counted in this report, each student with a disability, on December 1, 2004, must meet both of the following criteria:

Federal law and regulation require that State and local education agencies ensure an unduplicated count of students with disabilities. Before submitting the PD-2 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 schools having several school buildings and for students receiving multiple special education programs or services.

The New York State Education Department (SED) 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, please maintain a list (hard copy or other readily retrievable format) of all students included in this child count until June 30, 2011. Upon completing local verification procedures, if it is determined that one or more counts are incorrect, a revised child count (i.e., PD-2 form) must be submitted to SED.

As compared to the PD-2 form for 2003-2004, the PD-2 for 2004-2005 is revised in the following ways:

Please note:

Please note that the data collected through the PD forms are used in the following reports and activities:

If you have any questions or are in need of assistance in completing this report, please contact the Strategic Evaluation Data Collection, Analysis and Reporting (SEDCAR) Unit by using the contact information provided in the letterhead. Thank you.

Attachment

cc: Rebecca H. Cort


The University of the State of New York
THE STATE EDUCATION DEPARTMENT
Office of Vocational and Educational Services for Individuals with Disabilities
Strategic Evaluation Data Collection, Analysis and Reporting
One Commerce Plaza – Room 1613
Albany, NY 12234-0001

PD-2- In-State and Out-of-State Approved Private Schools, and State-Operated and State-Supported Schools Report: Number of Preschool and School-Age Students with Disabilities Provided Special Education on December 1, 2004.

Instructions:

  1. Return one copy of this report between December 1 and December 17, 2004 to the above address. (This report may not be signed or submitted prior to December 1, 2004.)

  2. Retain one copy (and supporting documentation) in your school for reference and audit purposes. The required retention period ends June 30, 2011.

  3. If you have questions about this report, please call (518) 486-4678 or e-mail your questions to dataquest@mail.nysed.gov

School Information

(Enter 12-digit SED Code Below)
 

                       
SCHOOL NAME
ADDRESSS

Contact Person Information*

NAME
TITLE
TELEPHONE 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 information reported on this form and certify that this is a complete and accurate count of New York State students with disabilities served on December 1, 2004. I further certify that the students reported were placed in this in-State school by a New York State school district or in this out-of-State school by a New York State school district or by a New York State court or other agency or were Commissioner’s appointment in this State-operated or State-supported school. All students were served in accordance with their Individualized Education Programs and in accordance with State standards.

__________________________
Original Ink Signature

___________________
Date Signed

left arrow

Chief Administrative Officer Must Sign and Date on or after December 1, 2004


__________________________________
Name of
Chief Administrative Officer
(Please Type or Print)

     

 


 

School Name:__________________________________  SED Code:____________
   

 

Check here if no preschool students with disabilities are provided special education services on December 1, 2004 pursuant to Section 4410 or 4201of the Education Law. If so, skip Section A.
 
Check here if no school age students with disabilities are provided special education services on December 1, 2004. If so, skip Sections B.

If both boxes are checked, your PD-2 report is complete. Please return the entire form to the address printed on the top of page 1.

Section A: Preschool-Age Special Education Programs and Services

Table 1: Number of preschool students with disabilities receiving special education programs and services in an approved preschool special education program pursuant to Section 4410 or 4201 of the Education Law. Preschool students receiving evaluation services only are not to be counted.

Please note, for students receiving itinerant services and/or related services from more than one approved preschool special education program, only the program that provides itinerant services or is designated by the CPSE to coordinate all related services must count the students on this report.

 

Ages 3-4*

Age 2**

If this school operates an approved preschool special education program, report the count of students provided preschool special education programs and services on December 1, 2004 pursuant to Section 4410 or 4201 of the Education Law.

   

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

**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 or 4201 of the Education Law, should be included in the column for students age 2.

 

Section B: School-Age Special Education Programs and Services

Table 1: Provide an unduplicated count of all school-age students (from New York State) with disabilities provided special education, full-time, by approved private schools at a school, home, hospital or other non-school facility, on December 1, 2004. (If services are provided at several sites, submit a single combined count of all students served at all sites.)

Students with disabilities who are placed in this school by parents/guardians at parents expense are not to be included in this report.

If this approved private school, located within New York State, provides educational services to students with disabilities (pursuant to Article 81) who are placed by the courts or other agencies in a Child Care Institution connected to this school, do not complete this report, but rather contact our office to request a PD-2A/4 form.

Line No.

Report Each Student Only Once in the Appropriate Line

Age 4 to 21*

1

School-age students with disabilities in:
Approved private schools located within New York State. Include only students placed in this school by a contract with public school districts;
State-Operated Schools; or
State-Supported (Section 4201) Schools

 

2

School-age students with disabilities in Out-of-State schools placed by New York State school districts.

 

3

School-age students with disabilities in Out-of-State Schools placed by New York State courts or other agencies.

4

Total number of students with disabilities in your school on December 1, 2004.

*Only include 4 year old students if they are in your school-age program. Students are eligible to enroll in school-age (kindergarten) programs if they become five years old by December 1 or by a later date established by the school/agency. For example, if a student’s birthday is on December 5, 1999, and the school/agency policy for admission to school is "five years of age by December 31", the student could be enrolled in a kindergarten program and be 4 years old on December 1, 2004.


 

School Name:__________________________________  SED Code:____________
   

 

Section B: School-Age Special Education Programs and Services by Disability

Table 2: For students reported in Section B, Line 4 above; provide the same count by age and disability. Please group students counted by their actual age on December 1, 2004 (i.e., a student who is 12 years and 10 months on December 1, 2004 is counted as age 12). Any student classified as both Deaf and Blind must be reported as "Deaf-Blindness" on Line 12.

Line No.

Disability Category

Age as of December 1, 2004

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

1

Autism

2

Emotional Disturbance

3

Learning Disability            

4

Mental Retardation            

5

Deafness            

6

Hearing Impairment            

7

Speech or Language Impairment            

8

Visual Impairment (includes Blindness)            

9

Orthopedic Impairment            

10

Other Health Impairment            

11

Multiple Disabilities            

12

Deaf-Blindness            

13

Traumatic Brain Injury            

14

Total – Lines 1 through 13            

*Only include 4 year old students if they are in your school-age program.

Section B: Populations and Poverty Counts in the State-Operated Schools

Table 3: This table is to be completed by only the New York State School for the Blind in Batavia and the New York State School for the Deaf in Rome. The numbers provided in this table will be used to determine a portion of these schools federal allocations under IDEA, Sections 611 and 619.

Line No.

Description

Student Count

1

Provide the total enrollment of all school-age students (disabled and nondisabled) who were provided educational services on December 1, 2004.

2

Of the students reported in Line 1 provide the number of students who were eligible to receive a free or reduced price lunch.

Top of Page