Page G Date: Name: Page of Special Education Services, continued Yes No Are extended school year (ESY) services required? If yes, specify the goals that require ESY services and describe the services. Yes describe. No Are specialized transportation services required that are related to the disability? If yes, Special route (outside normal attendance area or transportation not typically provided based on distance from school) Attendant services Physical Education: goal(s) Specially equipped vehicle General Other Modified - describe below Specially designed - requires You should consider if it is appropriate to use the same AT used in instruction for assessment. Indicate how this individual will participate in district-wide assessments. accommodations With accommodations achievement and functional performance. Without Describe accommodations necessary to measure academic Testing will take place in a small group setting with extended time. Portions of the test may be read aloud. Through the state alternate assessment. Why can't the individual participate in the general assessment? Why is this alternate assessment appropriate for this student? District-wide assessment is not given at this grade level correctional facility. The student is incarcerated in an adult Additional Considerations Address the following questions. Yes environments? If no explain: No Will this individual receive all special education services in general education AT can be used to support participation in extracurricular activities. Yes No Will this individual participate in nonacademic activities with nondisabled peers and have the same opportunity to participate in extracurricular activities as nondisabled peers?