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PD 1C/4C FORM CONTENTS:

transmittal letter

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Instructions and Definitions

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Section A

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Section B

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Section C

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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:

Data Managers of Approved Charter Schools
Chief School Administrators of Approved Charter Schools

Date: November 2005
From: Inni Barone
Subject: PD-1C/4C- Charter School Report: Number of Students with Disabilities Provided Special Education on December 1, 2005 and the Settings in which Students with Disabilities are Provided Special Education Services. Due between December 1, 2005 and December 17, 2005.

Attached is the PD-1C/4C form to be used to report your December 1, 2005 count of students with disabilities. This report is due to the State Education Department between December 1, 2005 and December 16, 2005 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

A copy of Section B, Table 1 of this report must be provided to each public school district in which your students reside on December 1, 2005, also by December 16, 2005.

There are three main purposes for collecting these data:

  1. To establish the number of school age students with disabilities upon which to base your school's 2005-2006 federal fund allocations for IDEA Section 611 and Section 619. Upon submitting the required notifications by the required timelines to students’ resident school districts regarding significant program expansion, Charter schools also qualify to receive additional IDEA federal funds in the same school year in which the significant expansion occurs.

  1. To collect statistical data regarding the total enrollment in this Charter school of students with disabilities and nondisabled students who are provided education services on December 1, 2005, and the settings in which school age students with disabilities are provided educational services.

  1. Section B, Table 1, Report of Students with Disabilities By School District of Residence, will:

To be counted in this report, each student with a disability, on December 1, 2005, must meet all of the following criteria.

Federal law and regulation require that State education agencies ensure an unduplicated count of students with disabilities. Before submitting the PD-1C/4C 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 Charter Schools having several school buildings and for students receiving multiple special education programs or services.

The 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, 2013. Upon completing local verification procedures, if it is determined that one or more counts are incorrect a revised child count (i.e., PD-1C/4C form) must be submitted to SED and a revised Section B, Table 1 must be provided to the appropriate school district(s).

Compared to last year’s PD-1C/4C form, the 2005-2006 PD1C/4C report is modified in the following ways:

During 2005-2006, Strategic Evaluation Data Collection Analysis and Reporting 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, 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:

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


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-1C/4C-Charter School Report:

Number of Students with Disabilities Provided Special Education on December 1, 2005 and the Settings in which School-Age Students with Disabilities are Provided Special Education Services

Instructions:

  1. Return one copy of this report between December 1 and December 16, 2005 to the above address. (This report may not be signed or submitted prior to December 1, 2005.)

  1. Retain one copy (and supporting documentation) in your Charter School for reference and audit purposes. The required retention period ends June 30, 2013.

  1. 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
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 SEDCAR will be directed to the contact person identified in the PD web based data entry system at http://pd.nysed.gov. Please keep the contact person information current, including the e-mail address as most communication will occur via e-mail.

Certification and Assurances

I have reviewed the information reported on this form and certify that this is a complete and accurate count of students with disabilities served on December 1, 2005. I further certify that the students reported were enrolled in this Charter School, had a current Individualized Education Program and received special education programs or services in accordance with State standards.

I understand that the sub-allocation of federal funds to this Charter School will be based upon this count. If the reported count is lower than the actual count, additional funds will not later be claimed. If the reported count is higher than the actual count, a downward revised PD-1C/4C report will be submitted to the School District(s) of students’ residence and to the State Education Department, and funds received for those erroneously counted will be returned to the appropriate school district(s).

I assure that federal, State and local procedures will be completed to receive a sub-allocation of IDEA funds from each school district of students’ residence.

__________________________
Original Ink Signature

___________________
Date Signed

left arrow Chief School Administrator Must Sign and Date on or after December 1, 2005


__________________________________
Name of Chief School Administrator
(Please Type or Print)

     

 


Directions for Completing the PD-1C/4C Report

  1. Report information for all preschool and school-age students with disabilities enrolled in your approved charter school on December 1, 2005.

  2. Wherever information is requested regarding students' race/ethnicity, please use the definitions below to assist in determining the most appropriate category for reporting students. Also, the race/ethnicity of students must be reported consistently on all Department data collection instruments.
    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.

  3. Wherever students are to be reported by age, please report age as of December 1, 2005.

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

Directions for Selected Sections and Tables

Section B, Table 1: Provide the number of students with disabilities by public school district of residence by age ranges 4-5 and 6-21. Report all students with disabilities who are enrolled in the Charter School and who are provided special education services by the Charter School or by the public school district. The total number of students reported in this table must be equal to the number of students reported in Section A, Table 1, Line 4. This report must be submitted to the State Education Department and also to each school district of residence to assist them with sub-allocating a proportionate share of federal IDEA funds under Sections 611 and 619 for each Charter School.

Section C, Report 1, 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 nondisabled 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 nondisabled 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):

In order to determine the percent 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 that 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:

Section C, Report 1, Table 2: Report the number of students with disabilities who are educated in separate educational settings. These are settings that 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 Charter School or BOCES buildings that are attended by students with disabilities only.


Charter School Name:_______________________________________________ SED Code:____________________________

Section A, Table 1: School-Age Special Education Programs and Services

  • Provide an unduplicated count of all school age students with disabilities enrolled in this Charter School on December 1, 2005, and provided special education services in accordance with Individualized Education Programs (IEPs).

  • Include students provided special education services or programs as defined in Section 200.6 of the Regulations of the Commissioner of Education. This includes Transitional Support Services, Consultant Teacher Services, Related Services, Resource Room Programs, and Special Class Programs.

  • Do not include students who are determined to have a disability pursuant to Section 504 of the Rehabilitation Act of 1973, unless the student is also determined to have a disability pursuant to the Individuals with Disabilities Education Act and Part 200 of the Regulations of the Commissioner of Education.

  • If a student receives special education services in accordance with an IEP, from the Charter School as well as from the school district of residence, report the student in Line 1 and not in Line 2 below.

Line No.

Report Each Student Only Once

Ages 4-5

Ages 6-21

1

Count of school-age students with disabilities enrolled in this Charter School and provided special education programs or services by personnel employed or contracted by the Charter School.

   

2

Count of school-age students with disabilities enrolled in this Charter School and provided special education programs or services by personnel employed or contracted by the public school district.

   

3

Count of all school-age students with disabilities enrolled in this Charter School (Sum of Lines 1 and 2).

4

Total count of school-age students with disabilities (ages 4-21) (Sum of the two columns of Line 3) enrolled in this Charter School.

See Note Below

 

5

Of the count of all school-age students with disabilities reported in line 4 above, report the number of such students who are 14 years of age or older, on December 1, 2005.

6

Count of all school-age students (ages 4-21) enrolled in this Charter School on December 1, 2005. (This count includes students with disabilities, general education students, gifted students, etc.).

Please note: The Subtotal of Section A, Table 1, Line 4 must be identical to the Total of Section A, Table 2, Line 14 below.

Charter School Name: ________________________________________ SED Code: __________________________________

Section A, Table 2: School-Age Special Education Programs and Services

For students reported in Section A, Table 1, Line 4 (i.e. all school-age students with disabilities enrolled in this Charter School), provide the same count by age and disability. Please group students counted by their actual age on December 1, 2005 (e.g., a student who is 12 years and 10 months on December 1, 2005 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

Number of Students by Age on December 1, 2005

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           See Note Below
 

Please note: The Total of Section A, Table 2, Line 14 must be identical to the Subtotal in Section A, Table 1, Line 4 above.


The University of the State of New York
THE STATE EDUCATION DEPARTMENT
Office of Vocational and Educational Services for Individuals with Disabilities
CHARTER SCHOOL PD-1C/4C REPORT OF NUMBER OF
STUDENTS PROVIDED SPECIAL EDUCATION ON
DECEMBER 1, 2005

Section B, Table 1: Report of Students with Disabilities by School District of Residence

Charter School Name:______________________________________________ SED Code: __________________________

Charter School Address: ______________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Charter School Contact Person__________________________________________________________________________

Charter School Contact Person’s Telephone: _______________________________________________________________

Charter School Contact Person's Telefacsimile Number: _______________________________________________________

Charter School Contact Person’s E-Mail Address: ___________________________________________________________

Enter special education child count information for all school age students with disabilities enrolled in this Charter School, according to each public school district in which such students reside on December 1, 2005. Information contained in this Table should be submitted to each school district in which students with disabilities reside. Information contained in this table will assist school districts to sub-allocate federal funds under IDEA, Sections 611 and 619 to the Charter Schools. Please duplicate this page if your Charter School serves students with disabilities from more than one school district. Also, please note, the total number of students reported below, by school district in Line 5, must equal the total number reported in Section A, Table 1, Line 4.

1.

Public School District Name:                                                                               BEDS Code:

 

   

Ages 4-5

Ages 6-21

2. School-age students with disabilities, provided special education by Charter School    
3. School-age students with disabilities, enrolled in the Charter School but provided special education by the public school district.    
4. Count of all school-age students with disabilities, (Sum of Lines 2 and 3)    
5. Total count of all school-age students with disabilities, ages 4-21. (Sum of both columns of Line 4).    

Please duplicate this page and complete it for each school district of residence of students with disabilities. The total number of students reported on all such pages should be equal to the number of students with disabilities reported in Section A, Table 1, Line 4.


 

Section C: Settings in Which School-Age Students with Disabilities are Provided Educational Programs or Services and Race/Ethnicity Information

Report 1: Report of All School-Age Students with Disabilities Placed as of December 1, 2005

Directions: Please review directions and definitions for completing Section C, Report 1 beginning on page 2.

In the two tables below, report placement data for all students with disabilities who attend the school age program operated by this Charter School and receive special education programs/services based on an IEP. The students reported in Tables 1 and 2 below, must also be reported in Reports 2, 3 and 4 of this Section C. Please note that the total number of students with disabilities reported in Tables 1 and 2 below must be equal to the number of school age students reported in Section A, Table 1, Line 4 of this report.

Table1: In Regular School-Based Programs - In buildings attended by both general education students and students with disabilities. (Consultant Teacher, Resource Room, Special Class, et. al.)
 

  A B C D E F
Line Number Time OUTSIDE Regular Classroom

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 - In buildings attended by students with disabilities only (outside of regular school facilities).

  A B C D E F
Line Number

Type of Setting

Age Group

4-5

6-11

12-13

14-17

18-21

Total

01

Special Public Day School

           

02

Total

   

Note:

 

Report 2: Report of All Students with Disabilities as of December 1, 2005, by Race/Ethnicity Category and Type of Setting in which Educational Services are Provided

For all students reported in Section C, Report 1, Tables 1 and 2, enter the number of students who appear to belong, identify with, or are regarded in the community as belonging to each race/ethnic group. Please see page 2 for definition of each race/ethnic category. Each student should be counted only once. The Total (Column F) of each line in this report must match the Total (Column F) of each line in Report 1 on the previous page.

Table1: In Regular School-Based Programs - In buildings attended by both general education students and students with disabilities. (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 - In buildings attended by students with disabilities only (outside of regular school facilities).         

            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

Total

 

 

 

 

 

 

Report 3:  Report of All Students with Disabilities as of December 1, 2004, by Race/Ethnicity Category and Type of Disability

In the table below, report race/ethnicity data by disability for all students reported in Section C, Report 1, Tables 1 and 2.  Also, the total number of students with disabilities reported in this report must equal the total number of students with disabilities reported in Section A, Table 1, Line 4.  Furthermore, the total number of students reported in Columns A-F below must match the total number of students reported on the corresponding column totals of Table 1 plus Table 2 from Report 2.

Line
Number

Disability

Race/Ethnicity Category

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 4: Report of Students with Disabilities who are 14-21 years of age as of December 1, 2004, by Race/Ethnicity Category. (These students are a sub-set of the students reported in Section C, Reports 1, 2 and 3.)

In the table below, report race/ethnicity data for students with disabilities (ages 14-21) enrolled in the Charter school. The total number of students reported in this table must equal the total number reported in Section A, Table 1, Line 5 and also equal to the total number of students reported in Section C, Report 1, Table 1 and Table 2, Columns D and E.
 

Line
Number

Category of Students

Race/Ethnicity Category

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

 

 

 

 

 

 

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