PD 2A/4 FORM CONTENTS:
Section A: Preschool-Age Special Education Programs and Services
Section B: School-Age Special Education Programs and Services
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PD 2A/4 FORM CONTENTS: |
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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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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) 474-7965 Fax (518) 408-3363 E-mail: dataquest@nysed.gov |
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To:
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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: September 2004 |
| 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, 2004 and the Settings in Which Special Education Services are Provided. Due between December 1, 2004 and December 17, 2004. | |
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 attending your school pursuant to Article 81 of the Education Law, on December 1, 2004. This report also requests the settings in which students with disabilities who attend your school 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, 2004. 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, 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
To be counted in this report, each student with a disability, on December 1, 2004, must meet both of the following criteria:
The student must be placed in your school and your school must implement the student’s Individualized Education Program (IEP) on December 1, 2004. A student with a disability whose placement in your school is discontinued before December 1, 2004, may not be included in the count for your school. A student who is initially placed in your school and provided special education after December 1, 2004 may not be included in the count for your school.
The student must be placed in your school by a New York State school district, or placed by a court or other agency in a Child Care Institution connected to your school and is provided special education services pursuant to Article 81, in accordance with State standards.
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 2003-2004, the PD-2A/4 report for 2004-2005 has been modified in the following ways:
Section A, Table 1 has been modified to collect information on preschool children with disabilities ages 2-4, not 2-5. All children who are 5 years of age on December 1, 2004 and receive special education services are "school-age" students with disabilities and as such must be reported in Section B and in Section C if appropriate, not in Section A.
Some instructions or explanatory notes are added to provide clarifications.
Please note that 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 States 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 Strategic Evaluation Data Collection, Analysis and Reporting (SEDCAR) Unit by using the contact information provided in the letterhead. Thank you.
Attachment
cc: Rebecca H. Cort
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, 2004 and the Settings in Which Special Education Services are Provided.
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Instructions: |
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School Information |
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(Enter 12-digit SED Code Below) |
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| SCHOOL NAME | ||||||||||||||
| ADDRESSS | ||||||||||||||
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Contact Person Information* |
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| NAME | ||||||||||||||
| TITLE | ||||||||||||||
| TELEPHONE | FAX | |||||||||||||
| E-MAIL ADDRESS | ||||||||||||||
*All correspondence from the address at the top of this page will be directed to the contact person reported in the PD web-based system at http://pd.nysed.gov. You may update the contact person at any time through the PD web-based system located at http://pd.nysed.gov.
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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, 2004. 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.
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__________________________ |
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Chief Administrative Officer Must Sign and Date on or after December 1, 2004 |
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Instructions and Definitions for Completing the PD-2A/4 Report
Approved private schools that do not provide educational services pursuant to Article 81, on December 1, 2004, should not complete this PD-2A/4 report. Instead, a PD-2 report should be completed and may be requested by calling our office.
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.
Wherever students are to be reported by age, please report age as of December 1, 2004.
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, 2004. 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 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):
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:
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.
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:____________ |
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Check here if no preschool students with disabilities are
provided special education services in your school on December 1, 2004
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, 2004. 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.
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Section A: Preschool-Age Special Education Programs and Services |
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Table 1: Number of preschool students with disabilities receiving special education programs and services in an approved preschool special education program pursuant to Section 4410 of the Education Law. Preschool students receiving evaluation services only are not to be counted. 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 on this report. |
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Ages 3-4* |
Age 2** |
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If this school operates an approved preschool special education program, report the count of students provided preschool special education programs and services on December 1, 2004 pursuant to Section 4410 of the Education Law. |
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*Students who are 5 years of age are "school-age" students and must be reported in Sections B and C of this report and not in Section A.
**Students who are 2 years old on December 1, 2004 (who will turn 3 years of age by December 31, 2004) and are receiving preschool special education services, pursuant to Section 4410 of the Education Law, should be included in the column for students age 2.
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Section B: School-age Special Education Programs and Services |
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Table 1: Provide an unduplicated count of all school-age students with disabilities (from New York State) provided special education, on December 1, 2004, by this school. |
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Line No. |
Report Each Student Only Once |
Age 4 to 21* |
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1 |
Count of school-age students with disabilities placed in this school by public school districts through a contract. |
See Note Below |
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2 |
Count of school-age students with disabilities provided special education services pursuant to Article 81 of the Education Law. These are students with disabilities placed by the courts or other agencies in a Child Care Institution connected to this school. The number entered for this line must match the number of students reported in Section C, Report 14. |
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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. |
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*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, 1999, 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, 2004.
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Section B: School District Placements of school-age Students with Disabilities |
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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, 2004 (i.e., a student who is 12 years and 10 months on December 1, 2004 is counted as age 12). Any student having both Deafness and Blindness must be reported as "Deaf- Blindness" on Line 12. |
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| Line No. | Disability Category |
Number of Students by Age on December 1, 2004 |
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| 4-5 Years* | 6-11 Years | 12-13 Years | 14-17 Years | 18-21 Years | Total | |||
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1 |
Autism | |||||||
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2 |
Emotional Disturbance | |||||||
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3 |
Learning Disability | |||||||
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4 |
Mental Retardation | |||||||
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5 |
Deafness | |||||||
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6 |
Hearing Impairment | |||||||
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7 |
Speech or Language Impairment | |||||||
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8 |
Visual Impairment (includes Blindness) | |||||||
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9 |
Orthopedic Impairment | |||||||
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10 |
Other Health Impairment | |||||||
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11 |
Multiple Disabilities | |||||||
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12 |
Deaf-Blindness | |||||||
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13 |
Traumatic Brain Injury | |||||||
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14 |
Total – Lines 1 through 13 |
See Note Below |
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*Only include 4-year-old students if they are in your
school-age program. See asterisk under Section B, Table 1.
Note: These two cells must
contain identical data: Section B - school-age Special Education Programs and
Services Line No.1 and Section B - School District Placements of school-age
Students with Disabilities - Line No. 14.
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Section B: Test Accommodations for Students with Disabilities - Article 81 Only |
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Table 3: Of the school-age students reported in Section B-Table 1, Line 2 (students provided special education services pursuant to Article 81) enter the number of students whose individualized education programs (IEPs) include one or more testing accommodations, by the appropriate age interval in Line 1. Students should be reported once, regardless of the number of testing accommodations listed in their IEPs. Also, all students should be reported regardless of whether they will be administered a State assessment during the 2004-2005 school year. Only include in this table, students with disabilities who are provided special education services pursuant to Article 81 of the Education Law. |
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Line No. |
Description |
Students Ages |
Students Ages 13 – 15 |
Students Ages 16 – 21 |
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1 |
Total number of students provided any type(s) of testing accommodations. |
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Section B: school-age Students with Disabilities who are also Students with Limited English Proficiency (Also referred to as English language learners.)- Article 81 Only |
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Table 4: Of the school-age students with disabilities reported in Section B-Table 1, Line 2 (students provided special education services pursuant to Article 81), report the subset of such students having limited English proficiency (LEP) in Line 1. Such students should be reported based on LEP designation, regardless of the extent or type(s) of LEP services provided. Only include in this table, students with disabilities who are provided special education services pursuant to Article 81 of the Education Law. Students determined to have a disability pursuant to Section 504 only, and do not have an IEP developed by a Committee on Special Education, should not be reported in this section, regardless of LEP status. |
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Line No. |
Description |
4 – 5 |
6 – 11 |
12 – 13 |
14 – 17 |
18 – 21 |
Total |
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1 |
school-age LEP Students with Disabilities |
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Section B: Population and Poverty Counts |
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Table 5: The numbers provided in this table will be used to determine a portion of this school’s federal sub-allocation under IDEA, Sections 611 and 619. |
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Line 1: Provide the total enrollment of all school-age students (disabled and non-disabled) who were provided education services on December 1, 2004. |
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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. |
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Section B: School-age Students with Disabilities by Grade or Age- Article 81 Only |
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Table 6: For all students with disabilities reported in Section B, Table 1, Line 2 report the number of students by grade level in Part 1 below. For students with disabilities who are not enrolled in a grade, report them in Part 2 below by age. Each student with a disability is to be reported in only one Line of either Part 1 or Part 2. Assignment of students with disabilities should be reported by grade if students attend classes with a particular grade. If students with disabilities attend classes with more than one grade, report them in the grade that they attend for majority of their classes, or the grade with which they identify. Please note the total number of students with disabilities in Line 14 of Part 1 plus the total number of students with disabilities in Line 16 of Part 2 must equal the total number of students with disabilities reported in Section B, Table 1, Line 2. Only include in this table, students with disabilities who are provided special education services pursuant to Article 81 of the Education Law. |
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Part 1 - Number of Students with Disabilities in Each Grade-Regardless of Age |
Part 2 – Number of Students with Disabilities who are not Assigned to a Grade, by Age as of 12/01/04 |
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Line # |
Grade |
Number of Students with Disabilities |
Line # |
Age |
Number of Students with Disabilities |
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1 |
Kindergarten |
1 |
Age 4 |
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2 |
Grade 1 |
2 |
Age 5 |
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3 |
Grade 2 |
3 |
Age 6 |
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4 |
Grade 3 |
4 |
Age 7 |
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5 |
Grade 4 |
5 |
Age 8 |
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6 |
Grade 5 |
6 |
Age 9 |
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7 |
Grade 6 |
7 |
Age 10 |
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8 |
Grade 7 |
8 |
Age 11 |
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9 |
Grade 8 |
9 |
Age 12 |
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10 |
Grade 9 |
10 |
Age 13 |
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11 |
Grade 10 |
11 |
Age 14 |
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12 |
Grade 11 |
12 |
Age 15 |
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13 |
Grade 12 |
13 |
Age 16 |
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14 |
Total |
14 |
Age 17 |
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15 |
Ages 18-21 |
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16 |
Total |
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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, 2004
(Consultant Teacher, Resource Room, Special Class, et. al.)Table1: In Regular School-Based Programs in buildings attended by disabled and non-disabled students
| A | B | C | D | E | F | ||
| Line Number | Time OUTSIDE Regular Classroom |
Age Group |
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4-5 |
6-11 |
12-13 |
14-17 |
18-21 |
Total |
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01 |
20% or less |
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02 |
21% to 60% |
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03 |
More than 60% |
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04 |
Total |
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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 |
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4-5 |
6-11 |
12-13 |
14-17 |
18-21 |
Total |
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01 |
Special Public Day School |
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02 |
Special Private Day School |
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| 03 | Public Residential Facility | ||||||
| 04 | Private Residential Facility | ||||||
| 05 | Home | ||||||
| 06 | Hospital or Other Non-school | ||||||
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07 |
Total |
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Report 2: Report of Students with Emotional Disturbance as of
December 1, 2004
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 |
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4-5 |
6-11 |
12-13 |
14-17 |
18-21 |
Total |
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01 |
20% or less |
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02 |
21% to 60% |
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| 03 | More than 60% | ||||||
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07 |
Total |
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Table 2: In Separate Settings
| A | B | C | D | E | F | ||
| Line Number | Time OUTSIDE Regular Classroom |
Age Group |
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4-5 |
6-11 |
12-13 |
14-17 |
18-21 |
Total |
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01 |
Special Public Day School |
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02 |
Special Private Day School |
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| 03 | Public Residential Facility | ||||||
| 04 | Private Residential Facility | ||||||
| 05 | Home | ||||||
| 06 | Hospital or Other Non-school | ||||||
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07 |
Total |
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Report 3: Report of Students with Learning Disabilities as of
December 1, 2004
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 |
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4-5 |
6-11 |
12-13 |
14-17 |
18-21 |
Total |
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01 |
20% or less |
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02 |
21% to 60% |
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| 03 | More than 60% | ||||||
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07 |
Total |
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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 |
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4-5 |
6-11 |
12-13 |
14-17 |
18-21 |
Total |
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01 |
Special Public Day School |
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02 |
Special Private Day School |
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| 03 | Public Residential Facility | ||||||
| 04 | Private Residential Facility | ||||||
| 05 | Home | ||||||
| 06 | Hospital or Other Non-school | ||||||
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07 |
Total |
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Report 4: Report of Students with Mental Retardation as of
December 1, 2004
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 |
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4-5 |
6-11 |
12-13 |
14-17 |
18-21 |
Total |
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01 |
20% or less |
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02 |
21% to 60% |
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| 03 | More than 60% | ||||||
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07 |
Total |
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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 |
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4-5 |
6-11 |
12-13 |
14-17 |
18-21 |
Total |
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01 |
Special Public Day School |
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02 |
Special Private Day School |
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| 03 | Public Residential Facility | ||||||
| 04 | Private Residential Facility | ||||||
| 05 | Home | ||||||
| 06 | Hospital or Other Non-school | ||||||
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07 |
Total |
||||||
Report 5: Report of Students with Deafness as of December 1,
2004
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, 2004
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, 2004
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, 2004
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, 2004
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, 2004
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, 2004
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, 2004
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, 2004
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, 2004
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, 2004, 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 |
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) |
|
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, 2004, 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, 2004 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 |
|
Black (not of Hispanic origin) |
|
White (not of Hispanic origin) |
Total |
||
| 01 |
Students with Disabilities, |
