Verification Report 3
School Age Students by Disability and Race/Ethnicity
(Receiving Special Education Services as of October 5, 2011)
Ages 4-5

To view the description of the report including SIRS codes please click here.

Directions: Please review the data below to verify that students’ disability and race/ethnicity are displayed accurately for all school age students with disabilities (aged 4-5) for whom your district has CSE responsibility and who were receiving special education services on the snapshot date. The links below the numbers in each cell provide a list of students that meet the criteria to be included in the report. Also, please review your school district’s report of students excluded from this report. If corrections are needed to this report, please resubmit your district files with the necessary corrections to the Regional Information Center (or the data warehouse for large cities) before the certification due date.

Line Number	Disability (As of Snapshot Date	A	B	C	D	E	F	G	H
		Hispanic or Latino	American Indian or Alaska Native (Not of Hispanic Origin)	Asian (Not of Hispanic Origin)	Black or African American (Not of Hispanic Origin)	Native Hawaiian or Other Pacific Islander (Not of Hispanic Origin)	White (Not of Hispanic Origin)	Two or More Races (Not of Hispanic Origin )	Total
01	Autism
02	Emotional Disturbance
03	Learning Disability
04	Intellectual Disability1
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)

¹Mental Retardation was changed to Intellectual Disability in the 2010-11 school year.

Verification Report 3
School Age Students by Disability and Race/Ethnicity
(Receiving Special Education Services as of October 5, 2011)
Ages 6-21

Directions: Please review the data below to verify that students’ disability and race/ethnicity are displayed accurately for all school age students with disabilities (aged 6-21) for whom your district has CSE responsibility and who were receiving special education services on the snapshot date. The links below the numbers in each cell provide a list of students that meet the criteria to be included in the report. Also, please review your school district’s report of students excluded from this report. If corrections are needed to this report, please resubmit your district files with the necessary corrections to the Regional Information Center (or the data warehouse for large cities) before the certification due date.

Line Number	Disability	A	B	C	D	E	F	G	H
		Hispanic or Latino	American Indian or Alaska Native (Not of Hispanic Origin)	Asian (Not of Hispanic Origin)	Black or African American  (Not of Hispanic Origin)	Native Hawaiian or Other Pacific Islander (Not of Hispanic Origin)	White (Not of Hispanic Origin)	Two or More Races (Not of Hispanic Origin)	Total
01	Autism
02	Emotional Disturbance
03	Learning Disability
04	Intellectual Disability1
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)

¹Mental Retardation was changed to Intellectual Disability in the 2010-11 school year.

I certify that my school district's data are complete and accurate.

I cannot certify that my district’s data are complete and accurate, however I understand:

• I must make any remaining changes in SIRS to report complete and accurate data;
• The PD Data System will not be refreshed to display additional changes; and
• Submission of complete and accurate data within State established timelines is a federal compliance requirement (IDEA, section 613(a)(7); section 618(a); 34 CFR sections 300.640 to 300.644).

Please note that these buttons are inactive and are shown for display purposes only. In order to certify a report you need to do so through the PD Data System. The verification reports 1-9 are certified at the same time, if you certify 1 you are certifying them all.