When recommending a student for Extended Year Services, please complete the ESY WORKSHEET

Answer the following major questions:

• Regression of Critical Skills

  • • Is the student’s skill development at a critical stage, so that a “window of opportunity” will be lost if ESY services are not given?

    • There are periods in a student’s life and skill development that present an optimal opportunity for significant gains in a particular emerging skill.

    • If CCC members believe that a significant window of opportunity would be lost at the point in which crucial progress of critical skills is being made, then check YES, and carefully document the reasons on the ESY worksheet.

• Will the student’s ability to function be significantly impaired by the loss of critical skills?

  • • Considering the critical skills of the student, the CCC must determine if the student will be significantly impaired in his/her functioning by the loss of these skills.

    • If YES, carefully document the reasons on the ESY worksheet.

• Does available information predict a significant regression of skills AND recoupment time if ESY services are not provided?

  • • If YES, carefully document this on the ESY worksheet.

    • If no significant regression has occurred, does the CCC believe that the student will require a more restrictive environment if ESY services are not given?

    • The CCC must determine if the student will require a more restrictive environment or significant change in goals/objectives if ESY services are not given.

    • If YES, carefully document this on the ESY worksheet.

• Special or Unusual Circumstances

  • • Are there any unusual circumstances that are possible factors for ESY services?

    • Occasionally there are circumstances that warrant special consideration for ESY services.

    • An example of this might be if a student has missed a great deal of school due to having been hospitalized for medical reasons.

Send a copy of the IEP downtown:

• Place an asterisk by the objectives to be worked on during ESY.

• Call the Special Education Department (574-393-6119) for an ESY enrollment form and attach to the IEP.

• The TOR is responsible for sending the needed materials for the student to the ESY site.

• Fill out the ESY Worksheet and send in with the IEP.

Instructions:

• The following corresponds to the ESY worksheet.

• Student: List the student’s name.

• Student ID #: List the student’s SBCSC and STN identification numbers.

• Conference Date: (mm/dd/yy).

• Age: List the student’s age.

• Define Critical Skills:

  • • List the “critical skills” for the student.

    • These are ones which represent knowledge or performance of tasks that are essential to the progress of the student and lead to independent functioning.

• Data showing regression:

  • • Provide specific data taken during the school year that shows regression of the critical skills.

    • Pay particular attention to whether or not the student regresses after vacations.

    • Documentation included/attached: check the appropriate information that is attached or included that documents regression.

• Recouping lost skills: Document how long it takes the student to recoup lost skills.

  • • IEP addended to address regression: Was the IEP revised to address/revise the IEP to address regression? If yes, describe.

    • Environments in which critical skills will be necessary: List the types of environments in which the student’s critical skills will be necessary.

    • Assistance required: Does the student require the assistance of another adult to perform the skill? If so, describe.

• Describe the critical stage and why the window of opportunity would be lost: Document the reason the CCC believes the window of opportunity for the student would be lost if extended services are not offered.

  • • Describe how the student’s ability to function will be significantly impaired by the loss of skills: Document the reasons the CCC believes this to be true.

    • If no significant regression, describe the need for a more restrictive environment if extended services are not given: Document the need for the more restrictive environment.

• Describe any unusual circumstances: Document any unusual factors necessitating the provision of ESY services.

• Case Conference Committee Recommendation: Indicate the committee’s recommendation for ESY services.

• SBCSC IEP Effective Dates: List the dates the IEP will be in effect.