Attached is the PD-1C/4C form to be used to report your December 1, 2004 count of students with disabilities. This report is due to the State Education Department between December 1, 2004 and December 17, 2004 and should be submitted to:

New York State Education Department
Office of Vocational and Educational Services for Individuals with Disabilities
Strategic Evaluation Data Collection, Analysis and Reporting
Room 1613, One Commerce Plaza
Albany, New York 12234

A copy of Section B, Table 1 of this report must be provided to each public school district in which your students reside on December 1, 2004, also by December 17, 2004.

There are three main purposes for collecting these data:

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

2. To collect statistical data regarding the total enrollment in this Charter school of school-age students with disabilities and non-disabled students who are provided education services on December 1, 2004, and the settings in which school-age students with disabilities are provided educational services.

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

• Notify public school districts of the number of resident students with disabilities who are enrolled in the Charter School, according to student age spans;

• Provide public school districts and the Charter School a basis for appropriately budgeting for the sub-allocation of proportionate shares of IDEA funds from the public school districts to the Charter School; and

• Ensure that public school districts and Charter Schools maintain consistent information regarding student age and enrollment in the Charter School.

To be counted in this report, each student with a disability, on December 1, 2004, must meet all of the following criteria.

• The student must be enrolled in this Charter School. A student with a disability who withdraws from your Charter School and enrolls in a public, private or State program before December 1, 2004, may not be included in the count for your Charter School. A student who enrolls in this Charter School after December 1, 2004 may not be included in the count for your Charter School.

• The student must have an Individualized Education Program (IEP) and be provided special education programs and services in accordance with State standards.

Federal law and regulation require that State education agencies ensure an unduplicated count of students with disabilities. Before submitting the PD-1C/4C report, please complete local verification procedures to ensure that each student is counted only once. Such verification procedures may include visual scans, computer scans or other methods; and are especially important for Charter Schools having several school buildings and for students receiving multiple special education programs or services.

The State Education Department (SED) will confirm the accuracy of information included in this report as part of the program review process, or as is otherwise indicated. To facilitate such review for your school, please maintain a list (hard copy or other readily retrievable format) of all students included in this child count until June 30, 2011. Upon completing local verification procedures, if it is determined that one or more counts are incorrect a revised child count (i.e., PD-1C/4C form) must be submitted to SED and a revised Section B, Table 1 must be provided to the appropriate school district(s).

Compared to last year’s PD-1C/4C form, the 2004-2005 PD1C/4C report is modified in the following ways:

• Section C, Reports 1-2, Table 2, Lines 2 and 3 (Home, and Hospital or Other Non-School) settings are deleted since students with disabilities who are provided educational services by Charter Schools are not provided services in these settings.

• Some notes have been added and directions clarified.

During 2004-2005, Strategic Evaluation Data Collection, Analysis and Reporting (SEDCAR) personnel may be available to conduct a limited number of regional training programs regarding the various special education data forms (i.e., the PD forms). If you feel that such training would be useful, please contact your local Special Education Training and Resource Center (SETRC). The data collected through the PD forms are used in the following reports and activities:

• Annual Performance Report for Special Education

• Pocketbook of Goals and Results for Individuals with Disabilities

• Chapter 655 Report to the Governor and the Legislature on the Status of the State's Schools

• Special Education Quality Assurance Reviews

• School Report Cards

• BOCES Report Cards

• Charter School Report Cards

• Calculations to identify instances of possible race/ethnicity disproportionality

• Other reports required by State or federal statutes

• Summary reports for public information, to be placed on the Department's website

• Evaluation of programs and policies

If you have any questions or are in need of assistance in completing this report, please contact the SEDCAR Unit by using the contact information provided in the letterhead. Thank you.

Attachment
cc: Rebecca H. Cort

I have reviewed the information reported on this form and certify that this is a complete and accurate count of students with disabilities served on December 1, 2004. I further certify that the students reported were enrolled in this Charter School, had a current Individualized Education Program and received special education programs or services in accordance with State standards.

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

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

__________________________ Original Ink Signature	___________________ Date Signed		Chief School Administrator Must Sign and Date on or after December 1, 2004
__________________________________ Name of Chief School Administrator (Please Type or Print)

 

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1. Report information for all preschool and school-age students with disabilities enrolled in your approved charter school on December 1, 2004.

2. Wherever information is requested regarding students' race/ethnicity, please use the definitions below to assist in determining the most appropriate category for reporting students. Also, the race/ethnicity of students must be reported consistently on all Department data collection instruments.
   American Indian/Alaskan Native: A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment.
   Asian or Pacific Islander: A person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. The Pacific Islands include Hawaii, Guam, and Samoa.
   Black or African American (not Hispanic): A person having origins in any of the Black racial groups of Africa.
   Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race.
   White (not Hispanic): A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.

3. Wherever students are to be reported by age, please report age as of December 1, 2004.

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

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

Section C, Report 1, Table 1: Report the number of students with disabilities who are educated in regular school buildings and removed from regular classes for "Less than 20%", "21% to 60%", or "More than 60%" of the school day or school week. "Regular school buildings" are buildings for both disabled and non-disabled school-age students. "Regular classes" are classes for both disabled and non-disabled 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 non-disabled 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):

• Students who are receiving transition support services.

• 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 that include only students with disabilities for the rest of the day or week.

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

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

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

• All Alternative High School programs that are attended by both disabled and non-disabled students.

• 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:

• A student who attends a resource room for one period each day in which special education services are provided to a group of students with disabilities would be counted in Table 1, Line 1 since one period outside of regular classroom would constitute 20 percent or less of the school day.

• A student who is assigned a full-time, one-to-one teacher aide, but who attends regular classrooms for 80 percent or more of the school day should be included in Line 1 of Table 1.

• A student who receives special education services for two hours per day outside of regular classrooms would be reported on Table 1, Line 2. If the two hours of special education services are provided in the regular classroom, the student should be reported in Table 1, Line 1.

• A student whose first period begins at 8:30 a.m. and last period ends at 2:30 p.m. would have a six-hour day or 30-hour week. If the student attended a special class for four 45-minute periods daily and participated in the general education environment for the remainder of the day, that student’s "time outside regular classroom" would be 15.0 hours per week or 50 percent of the week. Such a student would be reported in Table 1, Line 2.

• Special education services provided outside the normal school day (e.g., before school or after school) should not be considered time outside the regular classroom, regardless of the type of services or where they are provided. Such students should be counted in Table 1, Line 1.

• Students with disabilities who receive special education programs or services in regular classes that include non-disabled students should be reported in Table 1. This includes regular classrooms in which consultant teachers provide special education programs and services or regular classes in which special class programs are located.

Section C, Report 1, Table 2: Report the number of students with disabilities who are educated in separate educational settings. These are settings that are attended by students with disabilities only. The definition of each separate educational setting follows:

Special Public Day Schools- Include public day schools that are attended by students with disabilities only. These schools include public school district or Charter School or BOCES buildings that are attended by students with disabilities only.

Report 1: Report of All School-Age Students with Disabilities Placed as of December 1, 2004

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

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

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

Table 2: In Separate Settings - In buildings attended by students with disabilities only (outside of regular school facilities).

Note:

• The totals for each line in Tables 1 and 2 above should be identical to the totals for each line in Tables 1 and 2 of Report 2 on the next page.

• The total for Table 1 plus Table 2 above should equal the total reported in Section C, Report 3, Line 14.

• The total number of students in Columns D and E of Table 1 and Table 2 above must be equal to Section A, Table 1, Line 5 and also equal to the total number of students in Section C, Report 4.

Report 2: Report of All Students with Disabilities as of December 1, 2004, by Race/Ethnicity Category and Type of Setting in which Educational Services are Provided

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

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

Table 2:  In Separate Settings - In buildings attended by students with disabilities only (outside of regular school facilities).         

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

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

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

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

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