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PD-3A/4 FORM CONTENTS:
 

Transmittal Letter

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Instructions

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Section A

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Section B

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Section C 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
Email: dataquest@mail.nysed.gov

To: Special Education Data Managers and
Chief Administrative Officers of:
Department of Correctional Services
Office of Children and Family Services
Office of Mental Health
Office of Mental Retardation and Developmental Disabilities

Date:     October 2006

From: Inni Barone
 
 
Subject:

PD-3A/4 – State Agency Report: Number of Students with Disabilities Provided Special Education on December 1, 2006 and the Settings in Which Students with Disabilities are Provided Educational Services.

Important: Due Date between December 1 and December 15, 2006.

Attached is a new PD-3A/4 form to be used to report your count of pre-school and school-age students with disabilities provided special education programs and/or services on December 1, 2006. This report also requests the settings in which students with disabilities are provided educational services. This report is due in the State Education Department between December 1, 2006 and December 15, 2006 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, 2006, must meet the following criteria:

Federal law and regulation require that state agencies ensure an unduplicated count of students with disabilities. Before submitting the PD-3A/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 agencies with multiple sites where students receive special education programs and/or services.

The New York State Education Department (NYSED) 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 agency, please maintain a list (hard copy or other readily retrievable format) of all students included in this child count until June 30, 2014. Upon completing local verification procedures, if it is determined that one or more counts are incorrect, a revised report (i.e., PD-3A/4 form) must be submitted to SED.

Compared to the PD-3A/4 report for 2005-2006, the PD-3A/4 report for 2006-2007 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 call the Strategic Evaluation Data Collection, Analysis and Reporting (SEDCAR) Unit by using the contact information provided in the letterhead. Thank you.


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
One Commerce Plaza - Room 1613
Albany, NY 12234-0001

PD-3A/4-State Agency Report: Number of Students with Disabilities Provided Special Education on December 1, 2006 and the Settings in Which Students with Disabilities are Provided Educational Services

Instructions:
  1. Return one copy of this report between December 1 and December 15, 2006 to the above address. (This report may not be signed or submitted prior to December 1, 2006.)
  2. Retain one copy (and supporting documentation) in your school for reference and audit purposes. The required retention period ends June 30, 2014.
  3. If you have questions about this report, please call (518) 486-4678 or e-mail your questions to dataquest@mail.nysed.gov
  4.  
School Information

(Enter 12-digit SED Code Below)
 

                       
STATE AGENCY NAME
ADDRESS

 
CITY STATE ZIP
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, 2006. I further certify that the students reported were served in accordance with their Individualized Education Programs and in accordance with State standards.

__________________________
Original Ink Signature

___________________
Date Signed

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Chief Administrative Officer Must Sign and Date on or after December 1, 2006


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

     



Instructions and Definitions for Completing the PD-3A/4 Report

  1. 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 of Hispanic origin): 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 of Hispanic origin): A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
    Multi-Racial (not of Hispanic origin): This is not a required reporting category, however, if schools report students in this category on the fall 2006 Basic Education Data System (BEDS) enrollment report, they must report students in the same category in this report. The definition of this category is, a person having origins in two or more of the categories of people classified as American Indian or Alaska Native, Black or African American (not of Hispanic Origin), Asian or Pacific Islander, or White (not of Hispanic Origin). Note: Any person of Hispanic of Latino origin, in whole or in part, should be reported as Hispanic or Latino.
  2. Wherever students are to be reported by age, please report age as of December 1, 2006.
  3. If specific instructions for some tables are not provided below, they are included with each table of the PD-3A/4 form.
  4. Directions and Definitions for Section C, Reports 1-14

Section C, Reports 1-14: There are three tables for each disability category- Table 1, Table 2, and Table 3. 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/or services on December 1, 2006.

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 programs and/or 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:

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 - 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 students reside and attend an education program affiliated with the agency, in buildings that serve only students with disabilities. If students with disabilities receive educational services in State agency buildings that are attended by both students with and without disabilities, they must be reported in Table 1.

Private Residential Facility - A private facility in which students reside, and attend an education program operated by the agency, in buildings that serve only students with disabilities. If students with disabilities receive special education programs and/or services in buildings that include disabled and nondisabled students, such students are to be reported in Table 1.

Home - Use this setting if the State agency’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 programs and/or services based on their unique needs.

Table 3: Report the number of students with disabilities for whom the agency has CSE responsibility and who are educated in the specific settings described below.

Incarcerated in Correctional Facilities - Use this setting to report students with disabilities who are incarcerated in county correctional facilities, secure detention facilities or in State correctional facilities. The Department of Correctional Services must report all students with disabilities who are provided special education services as of December 1, 2006 in this category and the Office of Children and Family Services must report all students with disabilities who are provided special education services in secure detention facilities as of December 1, 2006 in this category.

Home Schooled - Use this setting to report students with disabilities who are home-schooled at parent choice, but who are provided special education programs or services at public expense.

Parentally Placed in Non Public Schools - Use this setting to report students with disabilities who are parentally placed in non-public schools at private expense, but who are provided special education services at public expense.


School/Agency Name: ____________________________________ SED Code: _________________

 
Check here if no preschool students with disabilities are provided special education programs and/or services in your agency on December 1, 2006. If so, skip Section A.
 
 
Check here if no school-age students with disabilities are provided special education programs and/or services in your agency on December 1, 2006. If so, skip Sections B and C.

If both boxes are checked, your PD-3A/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/or Services
Table 1: If this agency operates an approved preschool special education program, in Line 1 report the number of preschool children provided full-time or part-time special class programs and/or special education itinerant teacher (SEIT) services on December 1, 2006. In Line 2, report the number of preschool children provided related services only on December 1, 2006. If children are provided related services as well as special class services and/or SEIT services, they should be included in Line 1 only. Report children by age as of December 1, 2006.

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

Please note that 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 in this report.
 
Line No. Type of Preschool Special Education Service Ages 3-4* Age 2**
1 Count on December 1, 2006 of preschool children provided full-time or part-time special class services or special education itinerant teacher (SEIT) services. If children receive special class or SEIT services as well as related services, count them in this line, not in Line 2.    
2 Count on December 1, 2006 of preschool children provided only related services.    
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, 2006 (who will turn 3 years of age by December 31, 2006) and are receiving preschool special education programs and/or services should be included in the column for students age 2.

Section B: School-age Special Education Programs and/or Services
Table 1: Provide an unduplicated count of all school-age students with disabilities provided special education, on December 1, 2006, by this agency.
Line No.

Report Each Student Only Once

Ages 4-21*
1 Count of school-age students with disabilities provided special education programs and/or services in State agency’s education programs. **

**Only include 4-5 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 31 or by a later date established by the school/agency. For example, if a student’s birthday is on December 5, 2001, 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, 2006.

Section B: Population and Poverty Counts
Table 2: The numbers provided in this table will be used to determine a portion of this agency’s federal aid allocation under IDEA, under Sections 611 and 619.
Line 1: Provide the total enrollment of all school-age students (disabled and nondisabled) who were provided educational services in Kindergarten through grade 12 programs, on December 1, 2006. Do not include individuals who are of school-age but are not enrolled in a special and/or general education program.  
Line 2: Of the students reported in Line 1, provide the number of students who were eligible to receive a free or reduced price lunch.  
Section C: Educational Placement of School-age Students by Disability, Race/Ethnicity, Gender and Limited English Proficiency

Directions: Please review directions and definitions for completing reports 1-14 beginning on page 2. The total number of students reported in reports 1-13, reports 15A and 15B, reports 16A and 16B, reports 17A and 17B must be equal to the total number of students reported in Section B, Table 1, Line 1.

Report 1: Report of Students with Autism Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 2: Report of Students with Emotional Disturbance Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 3: Report of Students with Learning Disabilities Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 4: Report of Students with Mental Retardation Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 5: Report of Students with Deafness Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 6: Report of Students with Hearing Impairments Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 7: Report of Students with Speech or Language Impairments Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 8: Report of Students with Visual Impairments (Including Blindness) Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 9: Report of Students with Orthopedic Impairments Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 10: Report of Students with Other Health Impairments Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 11: Report of Students with Multiple Disabilities Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 12: Report of Students with Deaf-Blindness Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 13: Report of Students with Traumatic Brain Injury Placed as of December 1, 2006

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 14: Summary Report of All Students with Disabilities Placed as of December 1, 2006

The three sections below aggregate the data reported in Reports 1 to 13 to facilitate State and local data verification procedures. Completing these tables will facilitate the reporting of race/ethnicity, gender, and limited English proficiency data in Reports 15A, 16A and 16B, 17A and 17B.

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
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 that 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 3.
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 Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
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 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Non-Public School            
04 Total            

Report 15A: Report of All School-Age Students with Disabilities Placed as of December 1, 2006, According to Race/Ethnicity Category and Type of Placement – Ages 4-5

For all students reported in Tables 1, 2 and 3 of Report 14 in Column A (age group 4-5), 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 G) for each Line in this Report must match the number reported in Column A of each corresponding Line in Report 14.

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
Line Number Time OUTSIDE Regular Classroom A B C D E F G
Race/Ethnicity of School-Age Students Ages 4-5
American
Indian or
Alaska
Native
Asian or
Pacific
Islander
Black (Not
of Hispanic
Origin)
Hispanic
or Latino
White (Not
of Hispanic
Origin)
Multi-
Racial (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. Students who are home-schooled by parent choice should be reported in Table 3.
Line Number Type of Setting A B C D E F G
Race/Ethnicity of School-Age Students Ages 4-5
American
Indian or
Alaska
Native
Asian or
Pacific
Islander
Black (Not
of Hispanic
Origin)
Hispanic
or Latino
White (Not
of Hispanic
Origin)
Multi-
Racial (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 Placement              
06 Hospital or Other Non-school              
07 Total              

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
Line Number Type of Setting A B C D E F  
Race/Ethnicity of School-Age Students Ages 4-5
American
Indian or
Alaska
Native
Asian or
Pacific
Islander
Black (Not
of Hispanic
Origin)
Hispanic
or Latino
White (Not
of Hispanic
Origin)
Multi-
Racial (Not
of Hispanic
Origin)
Total
01 Incarcerated in Correctional Facilities              
02 Home Schooled at Parental Choice              
03 Parentally Placed in Non-Public School              
04 Total              

Report 15B: Report of All School-Age Students with Disabilities as of December 1, 2006, According to Race/Ethnicity Category and Type of Placement – Ages 6-21

For all students reported in Tables 1, 2 and 3 of Report 14 in Columns B-E (age group 6-21), 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 G) for each Line in this Report must match the number reported in Column B-E of each corresponding Line in Report 14.

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
Line Number Time OUTSIDE Regular Classroom A B C D E F G
Race/Ethnicity of School-Age Students Ages 6-21
American
Indian or
Alaska
Native
Asian or
Pacific
Islander
Black (Not
of Hispanic
Origin)
Hispanic
or Latino
White (Not
of Hispanic
Origin)
Multi-
Racial (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. Students who are home-schooled by parent choice should be reported in Table 3.
Line Number Type of Setting A B C D E F  
Race/Ethnicity of School-Age Students Ages 6-21
American
Indian or
Alaska
Native
Asian or
Pacific
Islander
Black (Not
of Hispanic
Origin)
Hispanic
or Latino
White (Not
of Hispanic
Origin)
Multi-
Racial (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 Placement              
06 Hospital or Other Non-school              
07 Total              

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
Line Number Type of Setting A B C D E F  
Race/Ethnicity of School-Age Students Ages 6-21
American
Indian or
Alaska
Native
Asian or
Pacific
Islander
Black (Not
of Hispanic
Origin)
Hispanic
or Latino
White (Not
of Hispanic
Origin)
Multi-
Racial (Not
of Hispanic
Origin)
Total
01 Incarcerated in Correctional Facilities              
02 Home Schooled at Parental Choice              
03 Parentally Placed in Non-Public School              
04 Total              

Report 16A: Report of All School-Age Students with Disabilities as of December 1, 2006, According to Gender and Limited English Proficiency (LEP) Status – Ages 4-5

For all students reported in Tables 1, 2 and 3 in the 4-5 year old age group of Report 14, enter the number, by gender and limited English proficient status. The Totals (Columns C and F) for each Line in this Report must match the Total (Column A) on each Line of Report 14.

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
Line Number Time OUTSIDE Regular Classroom A B C D E F
Gender for Ages 4-5 Limited English Proficiency (LEP)
Status for Ages 4-5
Male Female Total Yes No 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. Students who are home-schooled by parent choice should be reported in Table 1.
Line Number Time OUTSIDE Regular Classroom A B C D E F
Gender for Ages 4-5 Limited English Proficiency (LEP)
Status for Ages 4-5
Male Female Total Yes No Total
01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
Line Number Time OUTSIDE Regular Classroom A B C D E F
Gender for Ages 4-5 Limited English Proficiency (LEP)
Status for Ages 4-5
Male Female Total Yes No Total
01 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Nonpublic School            
04 Total            

Report 16B: Report of All School-Age Students with Disabilities as of December 1, 2006, According to Gender and Limited English Proficiency (LEP) Status – Ages 6-21

For all students reported in Tables 1, 2 and 3 in the 6-21 year old age group of Report 14, enter the number, by gender and limited English proficient status. The Totals (Columns C and F) for each Line in this Report must match the Total of Columns B-E combined on each Line of Report 14.

Table 1: In Regular School-Based Programs in buildings attended by disabled and nondisabled students
Line Number Time OUTSIDE Regular Classroom A B C D E F
Gender for Ages 6-21 Limited English Proficiency (LEP)
Status for Ages 6-21
Male Female Total Yes No 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. Students who are home-schooled by parent choice should be reported in Table 3.
Line Number Time OUTSIDE Regular Classroom A B C D E F
Gender for Ages 6-21 Limited English Proficiency (LEP)
Status for Ages 6-21
Male Female Total Yes No Total
01 Special Public Day School            
02 Special Private Day School            
03 Public Residential Facility            
04 Private Residential Facility            
05 Home Placement            
06 Hospital or Other Non-school            
07 Total            

Table 3: In Other Specific Settings. School districts do not place students in these settings. Instead, students are in these settings because of court decisions or parental choice.
Line Number Time OUTSIDE Regular Classroom A B C D E F
Gender for Ages 6-21 Limited English Proficiency (LEP)
Status for Ages 6-21
Male Female Total Yes No Total
01 Incarcerated in Correctional Facilities            
02 Home Schooled at Parental Choice            
03 Parentally Placed in Nonpublic School            
04 Total            

Report 17A: Report of All School-Age Students with Disabilities as of December 1, 2006, According to Race/Ethnicity Category and Type of Disability – Ages 4-5

In the table below, report race/ethnicity data by disability and age group 4-5 for all students reported in Tables 1,2 and 3, age group 4-5 of Reports 1 to 13.

The total reported below in Column G for each disability must match the sum of totals reported in Tables 1, 2 and 3 under the corresponding disability and age group 4-5 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, 2 and 3 of Report 15A.

Line Number Disability Racial/Ethnic Group for Students Ages 4-5
A B C D E F G
American
Indian or
Alaska
Native
Asian
or
Pacific
Islander
Black
(Not of
Hispanic
Origin)
Hispanic
or Latino
White
(Not of
Hispanic
Origin)
Multi-
Racial
(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 17B: Report of All School-Age Students with Disabilities as of December 1, 2006, According to Race/Ethnicity Category and Type of Disability – Ages 6-21

In the table below, report race/ethnicity data by disability and (age group 6-21) for all students reported in Tables 1,2 and 3 (age group 6-21) of Reports 1 to 13.

The total reported below in Column G for each disability must match the sum of totals reported in Tables 1, 2 and 3 under the corresponding disability and age group 6-21 in Reports 1 to 13. Also, the total reported in Line 14 of each column must match the sum of corresponding columns of Tables 1, 2 and 3 of Report 15B.

Line Number Disability Racial/Ethnic Group for Students Ages 6-21
A B C D E F G
American
Indian or
Alaska
Native
Asian
or
Pacific
Islander
Black
(Not of
Hispanic
Origin)
Hispanic
or Latino
White
(Not of
Hispanic
Origin)
Multi-
Racial
(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 18: Report of All School-Age Students with Disabilities who are 14 to 21 Years of Age as of December 1, 2006 According to Race/Ethnicity Category.

(These students are also reported in Reports 15B,16B and 17B 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 G of this report must be the same as the total number of students reported in Report 14, Tables 1, 2, and 3 in Columns D and E combined.

Line Number Disability A B C D E F G
American
Indian or
Alaska
Native
Asian
or
Pacific
Islander
Black
(Not of
Hispanic
Origin)
Hispanic
or Latino
White
(Not of
Hispanic
Origin)
Multi-
Racial
(Not of
Hispanic
Origin)
Total
01

Students with
Disabilities,
Ages 14-21

             

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