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    2015 Extended School Year (Esy) Data Collection and Decision Making Form

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    api-249951378
    This document is a data collection form and decision making form for determining if a student qualifies for extended school year (ESY) services. It includes sections to identify the student's target goals and objectives from their IEP, collect baseline and progress data from September to April, and criteria the IEP team must consider to determine if the student meets the standards for ESY services. The standards addressed are regression and recoupment of skills, nature and severity of the student's disability, and critical stages of learning essential for the student's independence. Assistant directors are available to help staff complete the data collection.

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    2015 Extended School Year (Esy) Data Collection and Decision Making Form

    Uploaded by

    api-249951378
    473 views2 pages
    This document is a data collection form and decision making form for determining if a student qualifies for extended school year (ESY) services. It includes sections to identify the student's target goals and objectives from their IEP, collect baseline and progress data from September to April, and criteria the IEP team must consider to determine if the student meets the standards for ESY services. The standards addressed are regression and recoupment of skills, nature and severity of the student's disability, and critical stages of learning essential for the student's independence. Assistant directors are available to help staff complete the data collection.

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    2015 extended school year (esy) data collection and decision making form

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    This document is a data collection form and decision making form for determining if a student qualifies for extended school year (ESY) services. It includes sections to identify the student's target goals and objectives from their IEP, collect baseline and progress data from September to April, and criteria the IEP team must consider to determine if the student meets the standards for ESY services. The standards addressed are regression and recoupment of skills, nature and severity of the student's disability, and critical stages of learning essential for the student's independence. Assistant directors are available to help staff complete the data collection.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    473 views2 pages

    2015 Extended School Year (Esy) Data Collection and Decision Making Form

    Uploaded by

    api-249951378
    This document is a data collection form and decision making form for determining if a student qualifies for extended school year (ESY) services. It includes sections to identify the student's target goals and objectives from their IEP, collect baseline and progress data from September to April, and criteria the IEP team must consider to determine if the student meets the standards for ESY services. The standards addressed are regression and recoupment of skills, nature and severity of the student's disability, and critical stages of learning essential for the student's independence. Assistant directors are available to help staff complete the data collection.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    EXTENDED SCHOOL YEAR (ESY)

    DATA COLLECTION FORM AND DECISION MAKING FORM


    DUE BY FRIDAY, APRIL 17, 2015

    Student Name: _____________________ School (during current school year): _____________________ Case Manager/Contact #: _________________
    Assistant Directors will offer support to staff members who need assistance with data collection.

    TARGET GOAL/OBJECTIVE:
    CRITERIA
    FROM IEP

    SEPTEMBER
    BASELINE

    NOVEMBER
    DATA COLLECTION

    DECEMBER
    DATA COLLECTION

    FEBRUARY

    APRIL

    DATA COLLECTION

    DATA COLLECTION

    TARGET GOAL/OBJECTIVE:
    CRITERIA
    FROM IEP

    SEPTEMBER
    BASELINE

    NOVEMBER

    DECEMBER

    FEBRUARY

    APRIL

    DATA COLLECTION

    DATA COLLECTION

    DATA COLLECTION

    DATA COLLECTION

    TARGET GOAL/OBJECTIVE:
    CRITERIA
    FROM IEP

    SEPTEMBER
    BASELINE

    NOVEMBER

    DECEMBER

    FEBRUARY

    APRIL

    DATA COLLECTION

    DATA COLLECTION

    DATA COLLECTION

    DATA COLLECTION

    Identify target/critical IEP goals and objectives from the current school year.
    New annual goals are not developed for ESY services.
    ESY service(s) are only for those annual goals identified as areas of concern.
    ESY service(s) are not intended to duplicate all service(s) provided during the traditional school year.
    Please attach a copy of the ESY IEP.

    Use the data on page one to complete page two


    EXTENDED SCHOOL YEAR (ESY)
    DATA COLLECTION FORM AND DECISION MAKING FORM

    2015 Page 1 of 2

    What are the historical data, predictive expert opinion, parent input and/or prospective criteria established by the IEP Team to demonstrate that the following standards
    apply in this situation?
    STANDARD
    YES OR NO
    IF YES, EXPLAIN USING DATA FROM PAGE ONE.
    Regression and Recoupment

    This refers to the inability of the student to maintain an acquired skill in an


    identified goal area of concern when special education instruction or related
    services in an IEP goal area are interrupted and require an unreasonable amount
    of time for recoupment. When a students capacity to recover acquired skills
    that have regressed to a level demonstrated prior to the break in instruction.
    The IEP Team determines what a reasonable period of recoupment is for each
    student.

    This is a two-part question: (1) there must be serious potential for regression of
    skills related to the goal area(s) of concern, and (2) the potential period of
    recoupment must be beyond a reasonable amount of time. The IEP team
    determines what a reasonable period of recoupment is for the goal area(s) of
    concern for each student.

    Nature and Severity of Disability


    The students disability requires highly structured or consistent programming
    without substantial breaks in service in order to make progress in the identified
    goal area(s) of concern.

    If a student requires more consistent or highly structured programming


    techniques due to the severity of the disability, the student may be more
    vulnerable to the loss of essential skills when the school program is interrupted.
    A student with severe disabilities may revert to lower functioning levels or
    exhibit more behaviors, which interfere with learning after a long break in
    programming.
    A students mental, emotional, or physical health, or the chronic nature of his
    or her disability, may also indicate the need for ESY services in order to
    maintain skills that otherwise would be lost and not recovered in a reasonable
    amount of time.

    Critical Stages/Areas of Learning


    The students ability to function independently. For example, very young
    students with significant disabilities may require ESY services to prevent loss
    of critical language, behavior, or self-help skills they learned during the school
    year.
    This includes skills that are essential for the promotion and maintenance of the
    students self-sufficiency. Skills such as toileting and eating are essential for
    minimal independence; stable relationships, impulse control, and appropriate
    peer interactions are necessary for community living.

    Due By Friday, April 17, 2015

    2015 Page 2 of 2

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