Program Definition
Insert responses after each question. For further guidance, consult the planning manual.
Facility & Host Agency Overview
1. List the address of the school.
2. Provide the mission statement of the host agency.
3. Provide a description of the institution.
4. Describe the purpose of the host agency.
5. Provide a line drawing of the educational facilities. Include the dimensions of each classroom and other
areas used for educational purposes.
Treatment and Other Programs
6. Describe the treatment program at your facility.
7. How does the treatment program at your facility impact the education program?
8. List the educational programs at your facility considered essential to treatment. Describe how these
programs are part of the overall treatment program.
9. Identify and describe areas where the school collaborates with the treatment program to provide
programming.
Population & Student Demographics
10. Placement Criteria: What are the placement criteria for residents of your facility?
11. Placing Agency: Who is the placing agency for residents of your facility?
12. Do your students have special characteristics?
1
Facility: _________________________
13. Special Populations: What are the special populations at your facility?
14. What percentage of your population needs special education services?
15. What is the range of stay and average length of stay for residents?
16. What must students do to exit your facility? Be specific concerning behavioral changes.
17. Where are the students going when they leave your facility?
Performance Outcomes
18. List performance outcomes that indicate the achievement of the OIEP mission at your school.
Program Components
19. Provide a daily schedule for your school.
20. List the course offerings at your school.
a. Juvenile Facilities: List courses and WVEIS codes.
b. Adult Facilities: Review and edit the program matrix. Identify any new programs not listed.
21. List all certifications available through participation in your programs.
22. List the diplomas available through participation in your programs.
23. Describe any educational programs facilitated by your host agency.
24. List your partners in education, including businesses, advocacy groups, other education agencies, etc.
25. Describe the nature of support from your community.
2
Facility:________________________
26. Describe any of the following offered at your institution and indicate if they are facilitated through
education:
a. Literacy Programs
b. Peer tutoring
c. Community Service learning
d. Work Experience Programs
27. List courses that provide career development.
Student Assessments
28. Identify the instruments and methodologies used for assessing academic achievement, identification of
special needs, career/vocational interests and aptitudes, technological literacy, social skills, etc.
Transition Services & Curriculum
29. Describe how your school delivers the transitions curriculum.
30. Describe your process for transitioning students into the community.
31. Who is responsible for transition services in your school?
32. Do students attend public school while living at your facility?
33. (Adult Facilities) Do you assist students in obtaining the critical documents?
Technology
34. Describe how the school uses technology for instruction.
35. List the software utilized by students.
36. List the learning programs utilized by students.
3
Facility: _____________________________
Staff Directory
(Insert rows as necessary)
Name
F.T.E
Title
Endorsements & Grade
levels
4