Note: If this box is checked, please complete this page only and return it to the address at the top of this page.

*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.

1. This report should be completed in consultation with school districts of residence personnel to confirm the exit status of students with disabilities who were enrolled in your school and provided special education services and who left your school during the reporting period.

2. In Section A, Table 1, Column A, Line 7, report the number of students, ages 4-13 who were declassified. In Column A, Line 9, report the number of school-age students, ages 4-13, who were returned to school district special education programs. In Section A, Table 1, Columns B-I, report the number of school age students (ages 14-21) who exited special education through the basis listed. In Section B, report the postsecondary education and employment plans of students with disabilities who have completed their program or dropped out.

3. The total number of students with disabilities for each exit category in Section B must equal the total number of such students reported in Table 1 of Section A.

4. The total number of students for whom race/ethnicity is provided in Section A, Table 1, Columns K-0 must equal the total number of students reported in Column I of the same table.

5. Wherever data are requested by student age, the age should be reported as of December 1, 2004 (e.g., a student who is 14 years and 10 months of age on December 1, 2004, should be reported as age 14).

6. When reporting race/ethnicity of students, report the number which appear to belong, identify with, or are regarded in the community as belonging to each race/ethnic group. Please report the race/ethnicity of students with disabilities consistently on all Department data collection instruments and consistently with how resident school districts report the race/ethnicity of such students on all Department data collection instruments. Each student should be counted once, in one of the following categories:
   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.

7. In general, exiting students with disabilities should be reported once, with few exceptions. The following examples are provided for purposes of clarification.

• A student who is declassified and returned to general education several times, should be reported once each year that he or she is returned to general education on Line 7 of Table 1, on page 5.

• A student who receives a local diploma with a Regents endorsement should be reported in either Line 1 (Regents Diploma-Honors) or Line 2 (Regents Diploma-Regular) on page 5, Table 1.

• A student who receives an IEP Diploma (Line 5) and Local Certificate (line 6) should be reported in Line 5 only, on page 5, Table 1. Please note, Local Certificates may not be issued after February 1, 2005.

• A student, who previously received an IEP Diploma or Local Certificate, has continued in the special education program and does not receive a higher diploma should NOT be reported again.

• A student who previously received an IEP Diploma or Local Certificate has continued in their special education program and received a Regents, Local or High School Equivalency (HSE) Diploma, should be included in the count for the given diploma (Lines 1-4) on page 5, Table 1.

• A student who previously dropped out of school, re-entered this program, and received a diploma or certificate should be reported in the count for the given diploma or certificate (Lines 1-6) on page 5, Table 1. If, however, the same student dropped out again, in a different school year, without receiving a diploma or certificate, the student should not be reported again.

8. 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 Unit by telephoning (518) 474-7965, or e-mail your questions to dataquest@nysed.gov

For all students with disabilities reported in Section A, Table 1 (ages 14-21), indicate their intended postsecondary plans. (Programs are not required to verify that such plans were actually achieved/implemented by students.) Students should be reported once by their primary plan. (Students intending to enter postsecondary education programs and employment should be reported in the appropriate postsecondary education category.) The total number of students entered in this section should be equal to the total number of students in Section A, Table 1 (ages 14-21) who exited with a Regents Diploma-Honors, Regents Diploma-Regular, Local Diploma, High School Equivalency (HSE) Diploma, Individualized Education Program (IEP) Diploma, Local Certificate, Reached Maximum Age, or Dropped Out.