EST Plan Need to refer to EST Coordinator: Phone: D. Educational Placement: Check the boxes to indicate previous, current, & proposed educational placements. Kind of Placement (check Previous Current Proposed all that apply) Regular Classroom or child care Regular Classroom + in-class support and/or accommodations Regular Classroom + specialized instruction or other supports outside regular classroom (may include school-based EEE, Headstart) Separate Classroom Independent School (Alternative School) Day Treatment Tutorial Residential School Homebound and/or Hospitalized Instruction Not in school - graduated Home Study (home schooled) Not in school - obtained General Educational Development (GED) Not in school - dropped out Not in school - suspended Not in school - expelled Other (describe): Please describe proposed educational placement: VII. Supports and Services for Child and Family All of this information is specific to the needs and voluntary for the family to provide child’s Agency Providing or Proposed Services Agency Proposed to Previous Current and by Provide when Child Care Services _______ After School Program _______ Mentoring _______ Outpatient Psychological Assessment _______ Behavior Support Services _______ Case Management/Service Coordination _______ Respite Services _______ Agency Providing or Proposed Services Agency Proposed to Previous Current and by Provide when
EST Plan Need to refer to EST Coordinator: Phone: D. Educational Placement: Check the boxes to indicate previous, current, & proposed educational placements. Kind of Placement (check all that apply) Previous Current Proposed Regular Classroom or child care Regular Classroom + in-class support and/or accommodations Regular Classroom + specialized instruction or other supports outside regular classroom (may include school-based EEE, Headstart) Separate Classroom Independent School (Alternative School) Day Treatment Tutorial Residential School Homebound and/or Hospitalized Instruction Not in school - graduated Home Study (home schooled) Not in school - obtained General Educational Development (GED) Not in school - dropped out Not in school - suspended Not in school - expelled Other (describe): Please describe proposed educational placement: VII. Supports and Services for Child and Family All of this information is specific to the child’s needs and voluntary for the family to provide Services Agency Providing or Agency Proposed to Provide Previous Current Proposed and by when Child Care Services _______ After School Program _______ Mentoring _______ Outpatient Psychological Assessment _______ Behavior Support Services _______ Case Management/Service Coordination _______ Respite Services _______ Services Agency Providing or Agency Proposed to Provide Previous Current Proposed and by when
FINAL-Revised%20CSP%20September%202018.docx