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PD-1C/4C FORM CONTENTS: |
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Section C |
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THE STATE EDUCATION DEPARTMENT THE UNIVERSITY OF THE STATE OF NEW
YORK / ALBANY, NY 12234 |
To: | Data Managers of Approved Charter
Schools Chief School Administrators of Approved Charter Schools |
Date: October 2006 |
From: | Inni Barone |
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Subject: | PD-1C/4C- Charter School Report: Number of Students with Disabilities Provided Special Education on December 1, 2006 and the Settings in which Students with Disabilities are Provided Special Education Services. Important: Due Date between December 1 and December 15, 2006. |
Attached is the PD-1C/4C form to be used to report your December 1, 2006
count of students with disabilities. This report is due to the State Education
Department between December 1, 2006 and December 15, 2006 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, 2006, also by December 15, 2006.
There are three main purposes for collecting these data:
To be counted in this report, each student with a disability, on December 1,
2006, must meet all of the following criteria.
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 and/or services.
The New York State Education Department (NYSED) 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, 2014. 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 2006-2007 PD1C/4C report is modified as follows:
During 2006-2007, Strategic Evaluation Data Collection Analysis and Reporting 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:
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
The University of the State of New York
THE STATE EDUCATION DEPARTMENT
Office of Vocational and Educational Services for Individuals with Disabilities
(VESID)
Strategic Evaluation Data Collection, Analysis and Reporting
One Commerce Plaza - Room 1613
Albany, NY 12234-0001
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School Information |
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(Enter 12-digit
SED Code Below) |
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SCHOOL
NAME |
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ADDRESS (include building name,
room number, or mail stop information) |
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CITY | STATE | ZIP | |||||||||||||
Contact Person Information* |
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NAME |
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TITLE |
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TELEPHONE (include area code) |
FAX | ||||||||||||||
E-MAIL
ADDRESS |
E-MAIL ADDRESS |
*All correspondence from SEDCAR will be directed to the contact person identified in the PD web based data entry system at http://pd.nysed.gov. Please keep the contact person information current, including the e-mail address as most communication will occur via e-mail.
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, 2006. I further certify that the students reported were enrolled in
this Charter School, had a current Individualized Education Program and received
special education programs and/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.
__________________________ |
___________________ |
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Chief School Administrator must sign and date on or after December 1, 2006 |
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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 nondisabled school-age students. "Regular classes" are classes for both disabled and nondisabled 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 nondisabled 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 transitional support services.
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:
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.
Charter School Name:
__________________________________________ SED Code: ___________________
Provide an unduplicated count of all school-age students
with disabilities enrolled in this Charter School on December 1, 2006,
and provided special education services in accordance with
Individualized Education Programs (IEPs).
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Line No. | Report Each Student Only Once | Ages 4-5 | Age 6-21 |
1 | Count of school-age students with disabilities enrolled in this Charter School and provided special education programs and/or services by personnel employed or contracted by the Charter School. | ||
2 | Count of school-age students with disabilities enrolled in this Charter School and provided special education programs and/or services by personnel employed or contracted by the public school district. | ||
3 | Count of all school-age students with disabilities enrolled in this Charter School (Sum of Lines 1 and 2). | ||
4 | Total count of school-age students with disabilities (ages 4-21) (Sum of the two columns of Line 3) enrolled in this Charter School. | * | |
5 | Of the count of all school-age students with disabilities reported in line 4 above, report the number of such students who are 14 years of age or older, on December 1, 2006. | ||
6 | Count of all school-age students (ages 4-21) enrolled in this Charter School on December 1, 2006. (This count includes students with disabilities, general education students, gifted students, etc.). |
*Please note: The Subtotal of Section A, Table 1, Line 4 must be identical to the Total of Section A, Table 2, Line 14 on the next page.
Charter School Name: __________________________________________ SED Code: ___________________
For students reported in Section A, Table 1, Line 4 (i.e. all school-age students with disabilities enrolled in this Charter School), provide the same count by age and disability. Please group students counted by their actual age on December 1, 2006 (e.g., a student who is 12 years and 10 months on December 1, 2006 is counted as age 12). Any student classified as both Deaf and Blind must be reported as “Deaf–Blindness” on Line 12. | |||||||
Line No. | Report Each Student Only Once | Number of Students by Age on December 1, 2006 | |||||
4-5 Years |
6-11 Years |
12-13 Years | 14-17 Years | 18-21 Years | Total | ||
1 | Autism | ||||||
2 | Emotional Disturbance | ||||||
3 | Learning Disability | ||||||
4 | Mental Retardation | ||||||
5 | Deafness | ||||||
6 | Hearing Impairment | ||||||
7 | Speech or Language Impairment | ||||||
8 | Visual Impairment (includes Blindness) | ||||||
9 | Orthopedic Impairment | ||||||
10 | Other Health Impairment | ||||||
11 | Multiple Disabilities | ||||||
12 | Deaf-Blindness | ||||||
13 | Traumatic Brain Injury | ||||||
14 | Total – Lines 1 through 13 | * |
* Please note: The Total of Section A, Table 2, Line 14 must be identical to the Subtotal in Section A, Table 1, Line 4 on the previous page.
The University of the State of New York
THE STATE EDUCATION DEPARTMENT
Office of Vocational and Educational Services for Individuals with Disabilities
CHARTER SCHOOL PD – 1C/4C REPORT OF
STUDENTS PROVIDED SPECIAL EDUCATION ON
December 1, 2005
Charter School Name: __________________________________________ SED Code: ___________________
Charter School Address:
_______________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Charter School Contact Person: __________________________________________________________________________________
Charter School Contact Person's Telephone: ________________________________________________________________________
Charter School Contact Person's Telefacsimile Number: _______________________________________________________________
Charter School Contact Person's E-Mail Address: _____________________________________________________________________
Enter special education child count information for all school-age students with disabilities enrolled in this Charter School, according to each public school district in which such students reside on December 1, 2006. Information contained in this Table should be submitted to each school district in which students with disabilities reside. Information contained in this table will assist school districts to sub-allocate federal funds under IDEA, Sections 611 and 619 to the Charter Schools. Please duplicate this page if your Charter School serves students with disabilities from more than one school district. Also, please note, the total number of students reported below, by school district in Line 5, must equal the total number reported in Section A, Table 1, Line 4.
1. | Public School District Name: |
BEDS Code: |
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2. | School-age students with disabilities, provided special education by Charter School | Ages 4-5 | Ages 6-21 |
3. | School-age students with disabilities, enrolled in the Charter School but provided special education by the public school district. | ||
4. | Count of all school-age students with disabilities, (Sum of Lines 2 and 3) | ||
5. | Total count of all school-age students with disabilities, ages 4-21. (Sum of both columns of Line 4). |
Please duplicate this page and complete it for each school district of residence of students with disabilities. The total number of students reported on all such pages combined should be equal to the number of students with disabilities reported in Section A, Table 1, Line 4.
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 and/or 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 combined below must be equal to the number of school-age students reported in Section A, Table 1, Line 4 of this report.
Table 1: 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.)
Line Number | Time OUTSIDE Regular Classroom | A | B | C | D | E | F |
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% | ||||||
04 | Total |
Table 2: In Separate Settings - In buildings attended by students with disabilities only (outside of regular school facilities).
Line Number | Type of Setting | A | B | C | D | E | F |
Age Group | |||||||
4-5 | 6-11 | 12-13 | 14-17 | 18-21 | Total | ||
01 | Special Public Day School | ||||||
02 | Total |
Note:
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 G) of each line in this report must match the Total
(Column F) of each line in Report 1 on the previous page.
Table 1: In Regular School-Based Programs - In buildings attended by both general
education students and students with disabilities.
Line # | Time OUTSIDE Regular Classroom |
A | B | C | D | E | F | G |
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (not of Hispanic origin) |
Hispanic | White (not of Hispanic origin) |
Multi- Racial (not of Hispanic origin) |
Total | ||
01 | 20% or less | |||||||
02 | 21% to 60% | |||||||
03 | More than 60% | |||||||
04 | Total |
Table 2: In Separate Settings - In buildings attended by students with disabilities only (outside of regular school facilities).
Line # | Type of Setting |
A | B | C | D | E | F | G |
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (not of Hispanic Origin) |
Hispanic | White (not of Hispanic Origin) |
Multi- Racial (not of Hispanic Origin) |
Total | ||
01 | Special Public Day School |
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02 | Total |
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.
Line # | Disability | Race/Ethnicity Category | ||||||
A | B | C | D | E | F | G | ||
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (not of Hispanic Origin) |
Hispanic | White (not of Hispanic origin) |
Multi- Racial (not of Hispanic Origin) |
Total | ||
01 | Autism | |||||||
02 | Emotional Disturbance |
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03 | Learning Disability |
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04 | Mental Retardation |
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05 | Deafness | |||||||
06 | Hearing Impairment |
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07 | Speech or Language Impairment |
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08 | Visual Impairment (includes Blindness) |
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09 | Orthopedic Impairment |
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10 | Other Health Impairment |
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11 | Multiple Disabilities |
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12 | Deaf-Blindness | |||||||
13 | Traumatic Brain Injury |
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14 | Total (Lines 1-13) |
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.
Line # | Category of Students |
Race/Ethnicity Category | ||||||
A | B | C | D | E | F | G | ||
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (not of Hispanic Origin) |
Hispanic | White (not of Hispanic origin) |
Multi- Racial (not of Hispanic Origin) |
Total | ||
01 | Students with Disabilities Ages 14-21 |