Edgefield County School District
Office of Exceptional Children
Service Plan
For Special Education Students
Voluntarily Enrolled by Parents in a Private School
School Year: ___________
Name: ________________________________________
Date of Meeting: _________________________________
Primary Disability: _____________________ DOB: __________________ Initiation Date: ________________________
Other Disability: ________________________ Gender: ________________ Grade: _____________________________
Anticipated Annual Review: ______________________ Service Plan Ending Date: ______________________________
Reevaluation Due Date:___________________________
Present Levels of Performance: (specific to the area(s) that will be addressed in this Service Plan)
Area of
Assessment
Method
Date
Findings
Annual Goal: _______________________________________________________________________________________
Objective: _________________________________________________________________________________________
Objective: _________________________________________________________________________________________
Objective: _________________________________________________________________________________________
Evaluation Method: _________________________________________________________________________________
Progress: __________________________________________________________________________________________
Annual Goal: _______________________________________________________________________________________
Objective: _________________________________________________________________________________________
Objective: _________________________________________________________________________________________
Objective: _________________________________________________________________________________________
Evaluation Method: _________________________________________________________________________________
Progress: __________________________________________________________________________________________
Progress toward annual goals will be reported to the parents each nine weeks.
Edgefield County School District
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Related Services
Is transportation necessary to implement this Service Plan?
Yes
No
If yes, how will transportation be provided?
__________________________________________________________________________________________________
Describe any related service to be provided:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Modifications to Regular Education
Extent of this student’s participation in academic, nonacademic, and extracurricular activities in the regular educational
environment: _____________ hours/week.
Supplementary Aides and Services will be provided to, or on behalf of, the student, to support this student’s
participation in academic, nonacademic, and extracurricular activities in the regular educational environment, as
follows:
Service
Location
Description
Supplementary Aids
Location
Frequency
Committee Members
The following individuals have attended the Service Plan /LRE meeting and participated as equal members in the
development of this Service Plan. Consideration has been given to the following, as appropriate to the individual
student:
Notice of Rights under the Individuals with Disabilities Education Act
(IDEA) that will transfer to the student at the age of 18 have been given to the student who will
become 17 during the effective dates of the Service Plan.
N/A
Edgefield County School District
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By signing below, we agree with the education and related services to be provided to this student as delineated in the
Service Plan. Our LRE recommendations and this student’s placement are based on the completed Service Plan and
the regulations set forth by the Individuals with Disabilities Education Act (IDEA).
Signature
Position
Date
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
I have been given an opportunity to attend and participate as an equal member in the Service Plan meeting. I have
read the Service Plan documents, or had them read to me, and understand the contents and the Service Plan process;
and
I agree with the educational services to be provided in this Service Plan, or
I choose not to accept the educational services in this Service Plan.
I understand that if I plan to enroll my child in Edgefield County School District, an IEP meeting will be
convened to discuss the provisions of a free appropriate education in that setting.
__________________________________________________________________________________________________
Signature of Parent/Legal Guardia/Surrogate Parent
Date
Student (if appropriate)
Edgefield County School District
Date
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