Student Name: / D.O.B.
Disability:
Grade:
Student#:

Meeting Date

Meeting Type

CSE & Sub-CSE Meeting Log

Address / Phone
Current Placement / Current Program

Individuals in attendance:

Name / Relationship to Student
Director of Special Education
School Psychologist
Parent Representative
Special Education Teacher
Regular Education Teacher
Speech Teacher
Student
Parent
Parent
OT Therapist
PT Therapist
School Physician
ErieCounty Health Dept. Representative
School Counselor
Janet / Took attendance, explained the purpose for the meeting, made introductions, and explained the meeting is being recorded
Academic Social Physical
Management

PLEPS

Evaluations/Reports –

1:1 Aide Rationale OT Evaluation

Audio logical Evaluation OT Progress Summary

Auditory Processing Evaluation Physical Examination

Behavior Intervention Plan (BIP) PT Evaluation

CAP Evaluation PT Progress Summary

Classroom Observation Psychological Evaluation

Counseling Evaluation Report Card

Counseling Progress Summary Social History

Functional Behavior Assessment (FBA) Speech/Language Evaluation

Hearing Evaluation Speech/Language Progress Summary

Level 1 Assessment Statement of Substantial Regression

Medical Health Records Vision Assessment

Multi-Disciplinary Review Vision Evaluation

Nursing Service Summary Vision Progress Summary

Effect of Student Needs:

Review Effect of Student Needs statement

Student Needs Relating To Special Factors:

Yes No Does the student need strategies, including positive behavioral

Interventions, supports and other strategies to address behaviors

That impedes the student’s learning or that of others?

Yes No Does the student need a Behavior Intervention Plan?

Yes No For a student with limited English proficiency, does he/she need

Not applicable a special education service to address his/her language needs as

they relate to the IEP?

Yes No For a student who is blind or visually impaired, does he/she need

Not Applicable instruction in Braille and the use of Braille?

Yes No Does the student needs a particular device/service to address

His/her communication needs?

Yes No In the case of a student who is deaf or hard of hearing, does the

Not Applicable student need a particular device/service in consideration of the

Student’s language and communication needs, opportunities for

Direct communications with peers and professional personnel in

The student’s language and communication mode, academic level,

And full range of needs, including opportunities for direct

Instruction in the student’s language and communication mode?

Yes No Does the student need an assistive technology device and/or

Service?

Yes No If yes, does the Committee recommend that the device(s) be used

in the student’s home?

Measurable Post-Secondary Goals (Age 15 or above):

Applicable Not Applicable

Transition Needs:

Needs –

Course of Study –

Measurable Annual Goals:

Reporting Progress To Parents As Same Schedule as Report Cards

(Times per year):

3

4

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Classification

BOE Date / Date of Initiation
Continue with current IEP and program through the end of June 2014
10 Month Placement / Provider / Frequency/Duration / Location
Related Service / Provider / Frequency / I / G / Duration / Location
ESY Placement / Provider / Frequency/Duration / Location
Related Service / Provider / Frequency / I / G / Duration / Location

ST

OT

PT
Counseling
TVI
HI
Other

Special Transportation

/ None / Aide / Mini / Lift / Rationale
Student needs transportation to/from special classes/programs at another site: Yes No
Harkness
Potter Road

Second Language

/ Not Exempt

State Testing

/ Regents
Local
NYSAA

Assistive Technology

Devices / Services

Program Modifications

Testing Accommodations

Regular Education

Physical Education
Extra & Co-Curricular Activities
Special Alerts