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Extended School Year Services (ESY) - The Special Education Team

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Beau - page 3<br />

7/1999<br />

Revised 8/2004<br />

Page ____ of ____<br />

EXTENDED SCHOOL YEAR FOR ____________________ (I-15)<br />

_____________________ SCHOOL DISTRICT<br />

Does the child require extended school year (<strong>ESY</strong>) services to receive a free and appropriate<br />

public education (FAPE)?<br />

� Yes � No<br />

If no, explain reasons rejected:<br />

No significant signs of regression in relation to Beau’s IEP goals.<br />

No skills considered to be emerging.<br />

<strong>The</strong> Behavior Management approach currently in place is considered adequate for<br />

dealing with Beau’s behavior concerns.<br />

If yes, identify which annual goals, including benchmarks or short term objectives, will be<br />

addressed during <strong>ESY</strong>:<br />

Specify all needed services:<br />

I. <strong>Special</strong> <strong>Education</strong><br />

II. Related services<br />

III. Supplementary aids and services - aids, services, and<br />

other supports provided to or on behalf of the student in<br />

regular education or other educational settings<br />

IV. Program modifications or supports for school personnel<br />

that will be provided<br />

Frequency/<br />

Amount<br />

Location Duration<br />

(beginning and<br />

ending dates)<br />

CESA #9: 1999 Determining <strong>ESY</strong> <strong>Services</strong>, Revised 2004 24

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