Verification Report 9
Provider Report of School Age Students
Receiving Special Education Services as of October 6, 2010
As Reported by School Districts with CSE Responsibility

Below is a report of the number of school age students with disabilities (aged 4-21) who were receiving special education services in your program according to the least restrictive environment setting in which they are provided special education services and their age range as of October 6, 2010. These data were reported by the school districts that have CSE responsibility for these students as of October 6, 2010.

Directions: Please review your program’s record of the number of school age students with disabilities provided special education services from each school district against the numbers reported below by school districts. If there are discrepancies between your records and the school district’s records, please contact the special education office of each school district to resolve the discrepancy. If the school district’s record is inaccurate, they will need to resubmit their district files with the necessary corrections to the Regional Information Center (or the data warehouse for large cities) during the verification time period. These data should be consistent with the data provided by the approved special education programs to school districts on the SEDCAR-1 forms by November 26, 2010 for school age students to request a vendor per-pupil funding amount of IDEA funds.

School District: [SED Code] [Name]

Table 1: In regular school programs in buildings attended by disabled and nondisabled students

Line Number	Time INSIDE Regular Classroom	A	B	C	D	E	F
		Age Group
		4-5	6-11	12-13	14-17	18-21	Total
01	80% or more
02	40% to 79%
03	Less than 40%
04	Total

Table 2: In Separate Settings Outside of regular school facilities, in buildings that are attended by students with disabilities only. Line 4 includes students who are placed on home instruction by the CSE. Students who are home-schooled by parent choice are reported in Table 3.

Line Number	Time INSIDE Regular Classroom	A	B	C	D	E	F
		Age Group
		4-5	6-11	12-13	14-17	18-21	Total
01	Separate School
02	Residential Facility
03	Hospital (In-patient)
04	Home Placement by CSE
05	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 INSIDE Regular Classroom	A	B	C	D	E	F
		Age Group
		4-5	6-11	12-13	14-17	18-21	Total
01	Incarcerated in County Correctional Facilities Or Incarcerated in Correctional Facilities Operated by the Department of Corrections (DOCS) as reported by DOCS
02	Home Schooled at Parental Choice
03	Parentally Placed in Nonpublic School-Receiving Special Education
04	Parentally Placed in Nonpublic School-Not Receiving Special Education Services
05	Total

This report does not need to be certified