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PD 2A/4 FORM CONTENTS:

Transmittal Letter

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Instructions and Definitions

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Section A: Preschool-Age Special Education Programs and Services

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Section B: School-Age Special Education Programs and Services

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Section C: Settings in Which Students are Provided Educational Services Pursuant to Article 81 of the Education Law by Disability, and Race/Ethnicity Information

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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:

 

 

Special Education Data Managers and Chief School Officers of Special Act School Districts and Approved Private Schools Located in New York State that Provide Education Services to Students with Disabilities Pursuant to Article 81 of the Education Law.

Date:  November 2005

From: Inni Barone
Subject: PD-2A/4 – Special Act School Districts and In-State Approved Private Schools that Provide Education Services to Students with Disabilities Pursuant to Article 81 of the Education Law Report: Number of Students with Disabilities Provided Special Education on December 1, 2005 and the Settings in Which Special Education Services are Provided. Due between December 1, 2005 and December 16, 2005.

Attached is the PD-2A/4 form to be used to report the count of school age students with disabilities placed in your school by a public school district and students with disabilities provided special education services pursuant to Article 81 of the Education Law, on December 1, 2005. This report also requests the settings in which students with disabilities who are provided special education services pursuant to Article 81 are provided special education services. If this school also operates an approved preschool program for children with disabilities, this report requests the count of preschool students provided preschool special education programs and services pursuant to Section 4410 of the Education Law, on December 1, 2005. If this school does not provide education services pursuant to Article 81 to students who are placed in a child care institution, connected to this school, by the courts or other agencies please do not complete this PD-2A/4 report, instead, complete a PD-2 report. Please call our office to request a PD-2 form. This report is due in 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

To be counted in this report, each student with a disability, on December 1, 2005, 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-2A/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 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 report (i.e., PD-2A/4 form) must be submitted to SED.

Compared to the PD-2A/4 report for 2004-2005, the PD-2A/4 report for 2005-2006 has been modified in the following ways:

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
 


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-2A/4- Special Act School Districts and In-State Approved Private Schools that Provide Special Education Services to Students with Disabilities Pursuant to Article 81 of the Education Law Report: Number of Students with Disabilities Provided Special Education on December 1, 2005 and the Settings in Which Special Education Services are Provided.

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.)

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

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 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 New York State students with disabilities served on December 1, 2005. I further certify that the students reported were placed in this school by New York State school districts, or by the courts or other agencies in a child care institution connected with this school and are provided special education services pursuant to Article 81 of the Education Law. Also, all special education services are provided in accordance with 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, 2005


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

     

 


Instructions and Definitions for Completing the PD-2A/4 Report

  1. 1. Approved private schools that do not provide educational services pursuant to Article 81, on December 1, 2005, should not complete this PD-2A/4 report. Instead, a PD-2 report should be completed and may be requested by calling our office.

  2. Wherever information is requested regarding students' race/ethnicity, 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.

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

  2. If specific instructions for some tables are not provided below, they are included with each table of the PD-2A/4 form.

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, 2005. Only include in these tables students with disabilities who are placed by the courts or other agencies in a child care institution connected to this school and are provided special education services pursuant to Article 81 of the Education Law.  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):

  • All Special Act School buildings that are attended by both disabled and non-disabled school-age students.

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

  • 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 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 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:

    Table 2: Report the number of students with disabilities who are educated in separate education settings. These are settings that are attended by students with disabilities only. The definition of each separate education setting follows:

    Special Public Day Schools- Public day schools that are attended by students with disabilities only. These schools include public school district or BOCES buildings that 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.
    Special Private Day Schools- Approved private schools for students with disabilities that are attended by students with disabilities only, on a day basis.
    Public Residential Facility- A public facility in which the student resides, placed by the courts or other agencies, and attends an education program affiliated with the facility, in buildings that serve only students with disabilities. Public residential facilities include the Special Act School Districts for students who reside in facilities affiliated with these schools. Students with disabilities who reside in Child Care Institutions but are provided special education services in buildings which include disabled and non-disabled students, should be reported in Table 1.
    Private Residential Facility- A private facility in which the student resides, placed by the courts or other agencies and attends an education program affiliated with the facility, in buildings that serve only students with disabilities. Private residential facilities include approved private schools with a residential component. Not all students residing in such facilities will be reported in this category; if students with disabilities receive special education services in buildings that include disabled and non-disabled students, such students are to be reported in Table 1.
    Home- Use this setting if the approved private school’s Committee on Special Education has determined that the most appropriate educational placement for the student is in the student’s residence (or "home"), and not in a school setting.
    Hospital or Other Non-School- These are settings in which students with disabilities are provided special education services based on their unique needs.


     

    School District Name:__________________________________  SED Code:____________
       
    Check here if no preschool students with disabilities are provided special education services in your school on December 1, 2005 pursuant to Section 4410 of the Education Law. If so, skip Section A.
     
    Check here if no school-age students with disabilities are provided special education services in your school on December 1, 2005. If so, skip Sections B and C.

    If both boxes are checked, your PD-2A/4 report is complete. Please complete page 1 and 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: If this school operates an approved preschool special education program pursuant to Section 4410 of the Education Law, in Line 1 report the number of preschool children provided full-time or part-time special class or special class in an integrated setting and/or special education itinerant teacher (SEIT) services on December 1, 2005. In Line 2, report the number of preschool children provided related services only on December 1, 2005. If children are provided related services as well as special class or special class in an integrated setting and/or SEIT services, they should be included in Line 1 only. Report children by age as of December 1, 2005.

    Do not include preschool children receiving evaluation services only in this table.

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

    Line No. Type of Preschool Special Education Service

    Ages 3-4*

    Age 2**

    1

    Count on December 1, 2005 of preschool children provided full-time or part-time special class or special class in an integrated setting and/or special education itinerant teacher (SEIT) services pursuant to Section 4410 of the Education Law. If children receive related services as well as special class or special class in an integrated setting and/or SEIT services, count them in this line, not in Line 2.

       
    2

    Count on December 1, 2005 of preschool children provided related services only pursuant to Section 4410 of the Education Law.

       
    3 Total    

    *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, 2005 (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 with disabilities (from New York State) provided special education, on December 1, 2005, by this school.

    Line No.

    Report Each Student Only Once

    Age 4 to 21*

    1

    Count of school-age students with disabilities placed in this school by public school districts through a contract.

    See Note Below

     

    2

    Count of school age students with disabilities placed in a child care institution connected to this school and provided special education services pursuant to Article 81 of the Education Law. The number entered for this line must match the number of students reported in Section C, Report 14.

     

    3

    Total of Lines 1 and 2: This count is the total count of New York State school age students with disabilities served in this program.

    *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, 2000, and the school/agency policy for admission to school is “five years of age by December 31”, the student could be enrolled in the kindergarten program and be 4 years old on December 1, 2005.

    Section B: School District Placements of school-age Students with Disabilities

    Table 2: For students reported in Section B, Table 1, Line 1 above; provide the same count by age and disability. Please report students according to their actual age on December 1, 2005 (i.e., a student who is 12 years and 10 months on December 1, 2005 is counted as age 12). Any student having both Deafness and Blindness 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
     

    *Only include 4-year-old students if they are in your school age program. See asterisk under Section B, Table 1.


    Section C: Settings in Which Students are Provided Educational Services Pursuant to Article 81 of the Education Law by Disability, and Race/Ethnicity Information

    Directions: Please review directions and definitions for completing reports 1-14 beginning on page 2. In the following 17 reports in this section, only include students with disabilities who are provided educational services pursuant to Article 81 of the Education Law. The total number of students reported in reports 1-13 and in reports 15 and 16 must be equal to the total number of students reported in Section B, Table 1, Line 2.

    Report 1: Report of Students with Autism as of December 1, 2005

    Table1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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 , outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%            

    07

    Total

       

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%            

    07

    Total

       

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%            

    07

    Total

       

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%            

    07

    Total

       

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%            

    07

    Total

       

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%            

    07

    Total

       

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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) as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%            

    07

    Total

       

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%            

    07

    Total

       

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%

    07

    Total

     

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%            

    07

    Total

     

     

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%            

    07

    Total

       

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    Table 1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students (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%            

    07

    Total

       

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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 as of December 1, 2005

    The two tables 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 non-disabled students (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%            

    07

    Total

       

    Table 2: In Separate Settings outside of regular school facilities, in buildings that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

      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

    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:

    • The Report 14 total in Table 1, Line 4, Column F, plus the total in Table 2, Line 7, Column F must equal the total in Section B, Table 1, Line 2 (students provided services pursuant to Article 81) of this PD-2A/4 form.

    • The total in each cell of Tables 1 and 2 of Report 14 should be the cumulative total of the corresponding cells from Reports 1-13.

    • The totals on each line of Column F in Tables 1 and 2 above should be identical to the totals in Column F of each line in Tables 1 and 2 of Report 15.

    • The total for Table 1 plus Table 2 above should equal the total reported in Line 14 of Column F of Report 16.

    • The total for Report 14, Table 1, Columns D and E plus Table 2, Columns D and E must be equal to the total number of students reported in Report 17.


    Report 15: Report of Students with Disabilities Provided Educational Services Pursuant to Article 81, as of December 1, 2005, by Race/Ethnicity Category and Type of Placement

    For all students reported in Table 1 and Table 2 of Report 14, enter the number that 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 non-disabled students (Consultant Teacher, Resource Room, Special Class, et. al.)

    Line
    Number

    Settings

    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 that are attended by students with disabilities only. In Line 5, include students who are placed on home instruction by the CSE.

    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 Students with Disabilities Provided Educational Services Pursuant to Article 81, as of December 1, 2005, 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 each column below by race/ethnicity must be equal to the total reported in each column, by race/ethnicity, in Table 1 plus Table 2 of Report 15.

    Racial/Ethnic Group

    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 Provided Educational Services Pursuant to Article 81 Who are 14 to 21 Years of Age as of December 1, 2005 by 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 Article 81 students with disabilities (ages 14-21) for whom the school 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