WAUPACA SCHOOL DISTRICT

EXTENDED SCHOOL YEAR CONSIDERATION

Name of Student: ______

District of Residence: ______

Date: ______

1.  What is the evidence (history of regression or indications of reasonable expectation of regression) that regression in excess of that experienced by nondisabled children will occur in the child's current levels of functioning as a result of the anticipated interruption in educational programming?

______

2.  In what ways will recoupment subsequent to the anticipated interruption in educational programming substantially impede learning so as to significantly jeopardize the benefits gained through the current levels of functioning?

______

3.  To what extent does the specific disability, including the nature, severity, or multiplicity of the disability, limit the child's recoupment capacity or lead to the child's withdrawal from the learning process?

______

4.  What are the crucial (crucial skills include such necessary life needs as toileting and eating) areas of learning that are targeted by the current IEP?

______

5.  What is the capacity of the parents to prevent regression? Would parental training or support services adequately alter the degree of regression?

______

6.  If ESY is determined by the IEP team to be necessary in order to maintain the child's current level of functioning without substantially impeding learning as a result of recoupment needs, what areas targeted by the current IEP must be addressed?

______

WAUPACA SCHOOL DISTRICT

EXTENDED SCHOOL YEAR

Name of Student: ______

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 if applicable, will be addressed during ESY)

______

Specify all needed services:

1. Special Education / Frequency/Amount / Location / Duration
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

revised 12/06