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?