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

Jonathon -page 3
7/1999
Revised 8/2004
Page ____ of ____
EXTENDED SCHOOL YEAR FOR ____________________ (I-15)
_____________________ SCHOOL DISTRICT
Does the child require extended school year (ESY) services to receive a free and appropriate
public education (FAPE)?
� Yes � No
If no, explain reasons rejected:
If yes, identify which annual goals, including benchmarks or short term objectives, will be
addressed during ESY:
Goal: To initiate verbal interaction and approximate vowel/consonant sounds.
Objective: Develop emerging communication skills in the production of consonants
such as: /m, b, p/ with 20% consistency
Objective: Maintain eye contact 50% of the time Jonathon is in the act of
communicating.
Objective: Increase peer interaction from parallel play to interactive play 50% of
the time
Specify all needed services:
I. Special Education
Instruction in expressive language skills
Social Skills
II. Related services
III. Supplementary aids and services - aids, services, and
other supports provided to or on behalf of the student in
regular education or other educational settings
IV. Program modifications or supports for school personnel
that will be provided
Frequency/
Amount
4 hours per
week
Location
Community
Preschool
Duration
(beginning and
ending dates)
June 15 -
August 15
CESA #9: 1999 Determining ESY Services, Revised 2004 40