EXTENDED SCHOOL YEAR SERVICES
Yes
No
Extended school year services are needed. The IEP team must document the consideration of the need for extended school year services and the basis for the determination.
If yes, the IEP must indicate the type, amount and duration of services to be provided.
SPECIAL EDUCATION
SERVICE(S)
LOCATION
AMOUNT/FREQUENCY OF SERVICES
INITIATION OF SERVICES
DURATION OF SERVICES
GOAL(S) ADDRESSED
STUDENT NAME:__________________________________________DATE OF MEETING:_______________________
MANIFESTATION DETERMINATION (AS APPROPRIATE)
Complete when determining whether a student’s behavior was a manifestation of her/his disability.