Special Education

General Directions to Use the State’s Student Exit Summary Model Form

Attachment 3 - General Directions to Use the State’s Student Exit Summary Model Form (April 2012) - Word word document (79 KB)

Student Exit Summary (Attachment 2)

The Student Exit Summary (Attachment 2) is provided as a sample form to meet the documentation requirements that must accompany the award of the Skills and Achievement Commencement Credential (Attachment 1). For students with disabilities eligible for the New York State Alternate Assessment (NYSAA), the Student Exit Summary is a model form that also satisfies the Individuals with Disabilities Education Act section 614(c)(5) and State regulation (section 200.4(c)(4)) requirements that the local educational agency provide a student with a disability with an exit summary of the student’s academic achievement and functional performance that includes recommendations on how to assist the student in meeting his or her post-secondary goals.  The model form may be used immediately to satisfy the requirements for the exit summary for students taking NYSAA.

The Student Exit Summary was developed in collaboration with parents, employers, adult service agencies, teachers and administrators with expertise in the area of students with severe disabilities. Skills included in the exit summary are based on the Career Development and Occupational Studies (CDOS) learning standards (Career Development; Integrated Learning and Universal Foundation Skills) and aligned with the Alternate Grade Level Indicators (AGLIs) in English language arts (ELA), mathematics, science, and social studies which measure performance for students taking NYSAA.

Districts and nonpublic schools may use and/or modify the attached model form, or develop their own form, provided that the locally developed form includes documentation of the student’s:

  • achievement of the CDOS learning standards https://www.p12.nysed.gov/cte/cdlearn/;   
  • level of academic achievement and independence as measured by NYSAA;
  • skills, strengths, and interests; and
  • as appropriate, other achievements and accomplishments. 

Documentation should be concise yet descriptive enough to provide the employer, adult service agency and/or parent with an accurate and meaningful description of the student.  Information may be provided in narrative and/or or bullet form.

Page 1

Page 1 of the Student Exit Summary includes:

  1. Demographic information such as the student name; school name; student identification number; name and title of person completing form and date completed.
  2. A summary of the student’s skills, strengths and interests.  In this section, the district should include information that identifies the skills, strengths and interests of the student that relate to postsecondary education and training, employment and independent living.
  3. Documentation of any relevant community, school and work-based learning experiences in which the student participated.  These may include, but are not limited to, career exploration, career assessment, training, transition activities and other volunteer and/or service learning experiences.  
  4. Information on the student’s academic performance in the areas of ELA, math, social studies and science as measured by NYSAA.  Include an informative description of the student’s functional academic skills and knowledge in each of these areas.
  5. Other achievements, awards and honors the student may have earned, including but not limited to those relating to extracurricular activities, sports, community groups, recreational activities, and school clubs in which the student participated.

Pages 2-5

Pages 2-5 of the Student Exit Summary describe the extent to which the student has achieved the CDOS learning standards for each of the following areas:

  1. Career Development (Learning Standard 1):  Knowledge about the world of work, career options, personal skills, aptitudes, and abilities relating to future career decisions.
  2. Integrated Learning (Learning Standard 2):  Application of academic knowledge and skills to school, community, and home settings.
  3. Universal Foundation Skills (Learning Standard 3a):  Skills and competencies essential for success in the workplace, including:
    • Basic Academic Skills (reading, writing, listening, speaking and math);
    • Thinking Skills (ability to use ideas and information to make decisions and solve problems);
    • Personal Qualities (ability to self-manage, plan, organize and take independent action);
    • Interpersonal Skills (ability to work independently or as part of a team and relate to different people across settings);
    • Technology (ability to use different types of technology and resources to satisfy personal and societal needs and wants);
    • Managing Information (ability to access and use information);
    • Managing Resources (ability to apply financial and human resources and manage time and materials to successfully carry out a planned activity); and
    • Systems (ability to understand how a system operates and identify where to obtain information and resources within that system).

The form includes skills/abilities demonstrated by the student in each of the competency areas.  Space is provided to add other student specific skills.  While examples are provided for some of those skills, it is important that the district not be limited by those examples when documenting evidence of student specific skills/abilities.

The form also includes levels of independence that describe the type and levels of supports and supervision the student requires to successfully complete a task and demonstrate competency in a skill area.  The key provided describes four levels of support with decreasing intensity ranging from extensive support (2) to independent (5).  For each competency, choose the number which best describes the level of support necessary for the student to demonstrate that task/skill.  Not Applicable (1) is also included in the key and should be used only when the student has not had an opportunity to or been observed to attempt or complete a task.  Not Applicable should be used infrequently as it is expected that students will be provided with instruction in and opportunities to demonstrate these skills.

Written comments should be added, as appropriate, for each of the competency areas to:

  • clarify the students level of achievement;
  • provide additional detail as to the student’s specific skills; and
  • identify the specific supports, environmental modifications, accommodations and assistive technology the student requires for successful completion of that task.

Page 6

Page 6, Recommendations to Assist Student to Meet Post-secondary Goals, requires documentation of the student’s goals for postsecondary education/training, employment and independent living (if appropriate) and recommendations to assist the student in meeting those goals.

The student’s Post-Secondary Goals include the Measurable Post-Secondary Goal statements from the student’s last IEP (revised as appropriate) to ensure that they reflect the student’s goals upon school exit.

Recommendations to assist the student in meeting post-secondary goals should be directly tied to the students’ post-school plans for education/training, employment, and independent living and reflect the students’ skills, abilities, needs and level of support as documented in the other sections of the Student Exit Summary.

Districts should provide a narrative description or list of specific recommendations for the student.  The form includes several supports for consideration to inform the development of appropriate and meaningful recommendations that assist the student in achieving his/her individual post-school plans.  Districts may indicate Not Applicable if a particular support is not relevant for the student.  These supports include, but are not limited to, a description of:

  • specific accommodations (e.g., breaks at predetermined intervals, directions with pictures or diagrams);
  • assistive technology/adaptive equipment (e.g., wheelchair, communication device, FM amplification system, pencil grips);
  • environmental supports (e.g., accessible workstation, materials secured to work area, physical support or positioning);
  • specific skills that may require further development, including additional or increased opportunities recommended, for the student to achieve his/her intended goals; and 
  • information regarding referral to and/or contact for adult agencies and/or others that may have a role facilitating achievement of the students post school goals.

Process for Completing Skills and Achievement Exit Summary

It is strongly recommended that the Student Exit Summary be completed through a team process that includes the student, family and several school personnel including the special education teacher, general education teacher, and/or related services personnel who know the student best.  With parental consent or consent of a student 18 years of age or older, adult agency personnel should be included in discussions if appropriate.  Districts should establish a system to manage this process to ensure a quality document is completed.

Documentation should be based on multiple measures with information gathered over time across a variety of settings, including but not limited to, observation, coursework, community, school and work experiences, career assessments, Career Plan, Level I Career Assessments; other functional vocational assessments, and transition assessments.  It is recommended that the form be used when transition planning begins (at age 15, or earlier, if appropriate) and be updated annually.  A student’s progress toward attaining skills should be monitored and used to help inform instruction and provide opportunities and appropriate experiences necessary to develop the targeted skills.  A Student Exit Summary, with the aforementioned components, must be provided upon school exit when a student is awarded the Skills and Achievement Commencement Credential.


Additional resources to assist in the development of the Student Exit Summary:

Last Updated: October 22, 2013