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PD-2A/4 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: | 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: October 2006 |
From: | Inni Barone |
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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, 2006 and the Settings in Which Special Education Programs and/or Services are Provided. Important: Due Date between December 1 and December 15, 2006. |
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 provided special education programs and/or services
pursuant to Article 81 of the Education Law, on December 1, 2006. This report
also requests the settings in which students with disabilities who are provided
special education programs and/or services pursuant to Article 81 are provided
special education programs and/or 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/or services pursuant to section 4410 of the Education Law, on December 1,
2006. 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, 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
To be counted in this report, each student with a disability, on December 1,
2006, must meet both of the following criteria:
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
campuses 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 report (i.e., PD-2A/4 form) must be submitted to SED.
Compared to the PD-2A/4 report for 2005-2006, the PD-2A/4 report for 2006-2007
has been modified in the following ways:
Please note that 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 Strategic Evaluation Data Collection, Analysis and
Reporting (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 |
FAX | ||||||||||||||
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 New York State students with disabilities served on December 1, 2006. 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 programs and/or services pursuant to Article 81 of the Education Law. Also, all special education programs and/or services are provided in accordance with Individualized Education Programs and in accordance with State standards.
__________________________ |
___________________ |
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Chief Administrative Officer Must Sign and Date on or after December 1, 2006 |
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Section C, Reports 1-14: There are three tables for each disability category-
Table 1, Table 2, and Table 3. 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/or services on December 1, 2006. 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 programs and/or 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 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 programs and/or 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):
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 programs and/or 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:
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 programs and/or services in buildings, which include disabled and nondisabled 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 programs and/or services in buildings that include disabled and nondisabled 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 programs and/or services based on their unique needs.
Table 3: Report the number of students with disabilities for whom the school district has CSE responsibility and who are educated in the specific settings described below.
Incarcerated in Correctional Facilities - Use this setting to report students with disabilities who are incarcerated in county correctional facilities, secure detention facilities or in State correctional facilities.
Home Schooled - Use this setting to report students with disabilities who are home-schooled at parent choice, but who are provided special education programs or services at public expense.
Parentally Placed in Non Public Schools - Use this setting to report students with disabilities who are parentally placed in non-public schools at private expense, but who are provided special education services at public expense.
School/Agency Name: _______________________________ SED Code: _________________
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Check here if no preschool students with disabilities are provided special
education programs and/or services in your school/agency on December 1, 2006
pursuant to Section 4410 of the Education Law. If so, skip Section A. |
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Check here if no school-age students with disabilities are provided special education programs and/or services in your school/agency on December 1, 2006. 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 from to the address printed on the top of page 1.
Table 1: If this school/agency operates an approved
preschool special education program pursuant to section 4410 of the
Education Law, in Line 1 report the number of preschool children
provided full-time or part-time special class programs and/or special
education itinerant teacher (SEIT) services on December 1, 2006. In Line
2, report the number of preschool children provided related services
only on December 1, 2006. If children are provided related services as
well as special class services and/or SEIT services, they should be
included in Line 1 only. Report children by age as of December 1, 2006. Do not include preschool children receiving evaluation services only in this table. 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 in this report. |
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Line No. | Type of Preschool Special Education Service | Ages 3-4* | Age 2** |
---|---|---|---|
1 | Count on December 1, 2006 of preschool children provided full-time or part-time special class services or special education itinerant teacher (SEIT) services pursuant to section 4410 of the Education Law. If children receive special class or SEIT services as well as related services, count them in this line, not in Line 2. | ||
2 | Count on December 1, 2006 of preschool children provided related services only pursuant to section 4410 of the Education Law. | ||
3 | Total |
*Students who are 5 years of age on December 1 are “school-age” children and
must be reported in Section B of this report and not in Section A.
**Students who are 2 years old on December 1, 2006 (who will turn 3 years of age
by December 31, 2006) and are receiving preschool special education programs
and/or services, pursuant to section 4410 of the Education Law, should be
included in the column for students age 2.
Table 1: Provide an unduplicated count of all school-age students with disabilities (from New York State) provided special education, on December 1, 2006, by this school/agency. | ||
Line No. |
Report Each Student Only Once |
Ages 4-21* |
1 | Count of school-age students with disabilities placed in this school/agency by public school districts through a contract. | ** |
2 | Count of school-age students with disabilities placed in a child care institution connected to this school/agency and provided special education programs and/or services pursuant to Article 81 of the Education Law. The number entered for this line must match the number of students reported in Section C, Report 14. | |
3 | 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. |
*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, 2001, 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, 2006.
**This cell must contain the identical information reported in Section B: School
District Placements of School-age Students with Disabilities, Line No. 14
(below).
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, 2006 (i.e., a student who is 12 years and 10 months on December 1, 2006 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, 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 | ** |
* Only include 4-year-old students if they are in your school-age program.
See asterisk under Section B, Table 1.
**This cell must contain the identical information reported in Section B:
School-age Special Education Programs and/or Services, Line No. 1 (above).
Table 3: The numbers provided in this table will be used to determine a portion of this school’s federal aid allocation under IDEA, under Sections 611 and 619. | ||
1 | Line 1: Provide the total enrollment of all school-age students (disabled and nondisabled) who were provided educational services in Kindergarten through grade 12 programs, on December 1, 2006. Do not include individuals who are of school-age but are not enrolled in a special education and/or general education program. | |
2 | 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. |
Directions: Please review directions and definitions for completing reports
1-14 beginning on page 2. In all the 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, in reports 15A and 15B, in reports 16A and 16B and in reports 17A
and 17B must be equal to the total number of students reported in Section B,
Table 1, Line 2.
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
The three sections below aggregate the data reported in Reports 1 to 13 to facilitate State and local data verification procedures. Completing these tables will facilitate the reporting of race/ethnicity, gender, and limited English proficiency data in Reports 15A, 16A and 16B, 17A and 17B.
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 |
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 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
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 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Non-Public School | ||||||
04 | Total |
For all students reported in Tables 1, 2 and 3 of Report 14 in Column A (age group 4-5), enter the number, which 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 G) for each Line in this Report must match the number reported in Column A of each corresponding Line in Report 14.
Line Number | Time OUTSIDE Regular Classroom | A | B | C | D | E | F | G |
---|---|---|---|---|---|---|---|---|
Race/Ethnicity of School-Age Students Ages 4-5 | ||||||||
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (Not of Hispanic Origin) |
Hispanic or Latino |
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 |
Line Number | Type of Setting | A | B | C | D | E | F | G |
---|---|---|---|---|---|---|---|---|
Race/Ethnicity of School-Age Students Ages 4-5 | ||||||||
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (Not of Hispanic Origin) |
Hispanic or Latino |
White (Not of Hispanic Origin) |
Multi- Racial (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 Placement | |||||||
06 | Hospital or Other Non-school | |||||||
07 | Total |
Line Number | Type of Setting | A | B | C | D | E | F | |
---|---|---|---|---|---|---|---|---|
Race/Ethnicity of School-Age Students Ages 4-5 | ||||||||
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (Not of Hispanic Origin) |
Hispanic or Latino |
White (Not of Hispanic Origin) |
Multi- Racial (Not of Hispanic Origin) |
Total | ||
01 | Incarcerated in Correctional Facilities | |||||||
02 | Home Schooled at Parental Choice | |||||||
03 | Parentally Placed in Non-Public School | |||||||
04 | Total |
For all students reported in Tables 1, 2 and 3 of Report 14 in Columns B-E (age group 6-21), enter the number, which 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 G) for each Line in this Report must match the number reported in Column B-E of each corresponding Line in Report 14.
Line Number | Time OUTSIDE Regular Classroom | A | B | C | D | E | F | G |
---|---|---|---|---|---|---|---|---|
Race/Ethnicity of School-Age Students Ages 6-21 | ||||||||
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (Not of Hispanic Origin) |
Hispanic or Latino |
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 |
Line Number | Type of Setting | A | B | C | D | E | F | |
---|---|---|---|---|---|---|---|---|
Race/Ethnicity of School-Age Students Ages 6-21 | ||||||||
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (Not of Hispanic Origin) |
Hispanic or Latino |
White (Not of Hispanic Origin) |
Multi- Racial (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 Placement | |||||||
06 | Hospital or Other Non-school | |||||||
07 | Total |
Line Number | Type of Setting | A | B | C | D | E | F | |
---|---|---|---|---|---|---|---|---|
Race/Ethnicity of School-Age Students Ages 6-21 | ||||||||
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (Not of Hispanic Origin) |
Hispanic or Latino |
White (Not of Hispanic Origin) |
Multi- Racial (Not of Hispanic Origin) |
Total | ||
01 | Incarcerated in Correctional Facilities | |||||||
02 | Home Schooled at Parental Choice | |||||||
03 | Parentally Placed in Non-Public School | |||||||
04 | Total |
For all students reported in Tables 1, 2 and 3 in the 4-5 year old age group of Report 14, enter the number, by gender and limited English proficient status. The Totals (Columns C and F) for each Line in this Report must match the Total (Column A) on each Line of Report 14.
Line Number | Time OUTSIDE Regular Classroom | A | B | C | D | E | F |
---|---|---|---|---|---|---|---|
Gender for Ages 4-5 | Limited English
Proficiency (LEP) Status for Ages 4-5 |
||||||
Male | Female | Total | Yes | No | Total | ||
01 | 20% or less | ||||||
02 | 21% to 60% | ||||||
03 | More than 60% | ||||||
04 | Total |
Line Number | Time OUTSIDE Regular Classroom | A | B | C | D | E | F |
---|---|---|---|---|---|---|---|
Gender for Ages 4-5 | Limited English
Proficiency (LEP) Status for Ages 4-5 |
||||||
Male | Female | Total | Yes | No | Total | ||
01 | Special Public Day School | ||||||
02 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
Line Number | Time OUTSIDE Regular Classroom | A | B | C | D | E | F |
---|---|---|---|---|---|---|---|
Gender for Ages 4-5 | Limited English
Proficiency (LEP) Status for Ages 4-5 |
||||||
Male | Female | Total | Yes | No | Total | ||
01 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Nonpublic School | ||||||
04 | Total |
For all students reported in Tables 1, 2 and 3 in the 6-21 year old age group of Report 14, enter the number, by gender and limited English proficient status. The Totals (Columns C and F) for each Line in this Report must match the Total of Columns B-E combined on each Line of Report 14.
Line Number | Time OUTSIDE Regular Classroom | A | B | C | D | E | F |
---|---|---|---|---|---|---|---|
Gender for Ages 6-21 | Limited English
Proficiency (LEP) Status for Ages 6-21 |
||||||
Male | Female | Total | Yes | No | Total | ||
01 | 20% or less | ||||||
02 | 21% to 60% | ||||||
03 | More than 60% | ||||||
04 | Total |
Line Number | Time OUTSIDE Regular Classroom | A | B | C | D | E | F |
---|---|---|---|---|---|---|---|
Gender for Ages 6-21 | Limited English
Proficiency (LEP) Status for Ages 6-21 |
||||||
Male | Female | Total | Yes | No | Total | ||
01 | Special Public Day School | ||||||
02 | Special Private Day School | ||||||
03 | Public Residential Facility | ||||||
04 | Private Residential Facility | ||||||
05 | Home Placement | ||||||
06 | Hospital or Other Non-school | ||||||
07 | Total |
Line Number | Time OUTSIDE Regular Classroom | A | B | C | D | E | F |
---|---|---|---|---|---|---|---|
Gender for Ages 6-21 | Limited English
Proficiency (LEP) Status for Ages 6-21 |
||||||
Male | Female | Total | Yes | No | Total | ||
01 | Incarcerated in Correctional Facilities | ||||||
02 | Home Schooled at Parental Choice | ||||||
03 | Parentally Placed in Nonpublic School | ||||||
04 | Total |
In the table below, report race/ethnicity data by disability and age group
4-5 for all students reported in Tables 1,2 and 3, age group 4-5 of Reports 1 to
13.
The total reported below in Column G for each disability must match the sum of
totals reported in Tables 1, 2 and 3 under the corresponding disability and age
group 4-5 in Reports 1 to 13. Also, the total reported in Line 14 for each
column must match the sum of corresponding columns of Tables 1, 2 and 3 of
Report 15A.
Line Number | Disability | Racial/Ethnic Group for Students Ages 4-5 | ||||||
---|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | G | ||
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (Not of Hispanic Origin) |
Hispanic or Latino |
White (Not of Hispanic Origin) |
Multi- Racial (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) |
In the table below, report race/ethnicity data by disability and (age group
6-21) for all students reported in Tables 1,2 and 3 (age group 6-21) of Reports
1 to 13.
The total reported below in Column G for each disability must match the sum of
totals reported in Tables 1, 2 and 3 under the corresponding disability and age
group 6-21 in Reports 1 to 13. Also, the total reported in Line 14 of each
column must match the sum of corresponding columns of Tables 1, 2 and 3 of
Report 15B.
Line Number | Disability | Racial/Ethnic Group for Students Ages 6-21 | ||||||
---|---|---|---|---|---|---|---|---|
A | B | C | D | E | F | G | ||
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (Not of Hispanic Origin) |
Hispanic or Latino |
White (Not of Hispanic Origin) |
Multi- Racial (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) |
(These students are also reported in Reports 15B,16B and 17B of this report.)
In the table below, report race/ethnicity data for students with disabilities
ages 14-21 for whom the school district has CSE Responsibility. The total number
of students reported in Column G of this report must be the same as the total
number of students reported in Report 14, Tables 1, 2, and 3 in Columns D and E
combined.
Line Number | Disability | A | B | C | D | E | F | G |
---|---|---|---|---|---|---|---|---|
American Indian or Alaska Native |
Asian or Pacific Islander |
Black (Not of Hispanic Origin) |
Hispanic or Latino |
White (Not of Hispanic Origin) |
Multi- Racial (Not of Hispanic Origin) |
Total | ||
01 |
Students with |