Building Project Space Form

For Reference Purposes Only - a printable copy of the form may be downloaded in word format

INSTRUCTIONAL SPACE REVIEW

NOTE: This form is to be completed for all capital projects involving the creation of NEW INSTRUCTIONAL SPACE ONLY and submitted as part of the district's preliminary approval documentation (not necessary for new bus garages, administration buildings or other noninstructional space).

School District:	.
Building Name & Address:	.
Project Control #:	¨ ¨ -¨ ¨ -¨ ¨ -¨ ¨ -¨ -¨ ¨ ¨ -¨ ¨ ¨
Project Manager, Office of Facilities Planning:	.	Phone Number: (518) 474-3906
District Contact:	..	Phone Number: ( )
Title:	.	Phone Number: ( )

To be Completed by SED Regional Associate
Regional Associate (please print):	Date Received:
Address:	Phone Number: ( )

If this is a revised form, please check this box: o

Note: This form was designed by VESID Special Education Quality Assurance with the cooperation of the Office of Facilities Planning. It is intended to meet the needs of the Department as well as other interested parties by providing information relative to special education classrooms in all schools undertaking capital projects that will create new instructional space.

These tables are for reference purposes only - a printable copy of the form may be downloaded in word format

1) How many students currently in separate site placements¹will be redirected to integrated placements² as a result of this project?

2) Indicate information on special education classrooms, including BOCES-operated classrooms, in the chart below:

Name of Building

Type of Classroom Teacher/Student Ratio	Grade Level³	Pre-Construction⁴	Post-Construction⁵
Type of Classroom Teacher/Student Ratio	Grade Level³	Existing Building	Existing Building	New Building or Addition
15:1
12:1+1
8:1+1
6:1+1
12:1+4
Preschool
Resource Room
Related Services
Office
Other (District)

FOR NEW INSTRUCTIONAL SPACES ONLY

Minimum Guidelines for Special Education Room Sizes

15:1

12:1+1

8:1+1

6:1+1

12:1+4

770 square feet

550 square feet

450 square feet

900 square feet

Resource Room

Preschool

300 square feet

50 sq. ft./child or 60 sq. ft./child for classrooms serving children who are nonambulatory

These tables are for reference purposes only - a printable copy of the form may be downloaded in word format

3) Does this project provide special education space located in age-appropriate areas and integrated within the school? o Yes ¨ No
Please explain your answer in narrative form, on a separate page, including timelines for implementation, benchmarks achieved, justification for plan, etc.

¹ In buildings attended by students with disabilities only.

² In buildings attended by both disabled and nondisabled students.

³ Please use letter "E" for elementary, "M" for middle school and "S" for secondary.

⁴ Pre-Construction – as the building is currently being used.

⁵ Post-Construction – as the building will be used when the project is completed.

Certification of Instructional Space Review by Superintendent of
Schools, District Superintendent and Special Education Regional Associate

The Superintendent of Schools has conferred with the District Superintendent and the Quality Assurance Regional Associate, and they agree that the proposed project is consistent with: (1) the continual allocation of appropriate space within the district for special education programs; (2) the district’s long-range plan for educational facilities; and (3) the District Superintendent’s approved five-year Special Education Space Requirements Plan. In addition, the Superintendent of Schools certifies by signing below that the appropriate special education spaces indicated under Item 2 on page 2 will be reflected on the actual floor plans submitted to the Office of Facilities Planning. (Note: Should the final floor plan not agree with Item 2 on page 2, the Superintendent of Schools must submit a revised copy of this form to the Regional Associate, who will review it for approval. After discrepancies are reconciled, the RA will return this form to the Project Manager in Facilities Planning with appropriate explanation.)

Project Control Number: ¨ ¨ -¨ ¨ -¨ ¨ -¨ ¨ -¨ -¨ ¨ ¨ -¨ ¨ ¨

Name of School District:
Name of Building:
Name of Superintendent (print or type):
Signature:	Date:

Name of District Superintendent (print or type):

¨ Approval ¨ Disapproval

If disapproved, explain reason(s):

Signature of District
Superintendent:	Date:

Name of Special Education Regional Associate (print or type):

Recommendation to Facilities Planning: ¨ Approval ¨ Disapproval

If disapproval is recommended, explain reason(s):

Signature of Regional Associate:

Date:

For reference purposes only - a printable copy of the form may be downloaded in word format

VESID SPECIAL EDUCATION QUALITY ASSURANCE

Dr. Rebecca H. Cort, Statewide Coordinator (718) 722-4558
Daniel H. Johnson, Upstate Regional Coordinator (518) 473-1185
Patricia Shubert, New York City Regional Coordinator (718) 722-4544

WESTERN REGIONAL OFFICE NYS Education Department VESID Special Education Quality Assurance 2A Richmond Avenue Batavia, NY 14020 (585) 344-2112, ext. 420 (585) 343-2660 (fax)	HUDSON VALLEY REGIONAL OFFICE NYS Education Department VESID Special Education Quality Assurance 1950 Edgewater Street Yorktown Heights, NY 10598 (914) 245-0010 (914) 245-2952 (fax)
CENTRAL REGIONAL OFFICE NYS Education Department VESID Special Education Quality Assurance State Tower Building 109 South Warren Street, Suite 304 Syracuse, NY 13202 (315) 471-4796 (315) 471-4795 (fax)	LONG ISLAND REGIONAL OFFICE NYS Education Department VESID Special Education Quality Assurance The Kellum Educational Center 887 Kellum Street Lindenhurst, NY 11757 (631) 884-8530 (631) 884-8540 (fax)
EASTERN REGIONAL OFFICE NYS Education Department VESID Special Education Quality Assurance Room 1623 One Commerce Plaza Albany, NY 12234 (518) 486-6366 (518) 486-7693 (fax)	NEW YORK CITY OFFICE NYS Education Department VESID Special Education Quality Assurance 55 Hanson Place, Room 545 Brooklyn, NY 11217-1580 (718) 722-4544 (718) 722-2032 (fax)