Page of 2017--2018 DATA SHEET ~ CONFIDENTIAL School: Local Code: DUE DATE TYPE OF PLEASE USE THE FOLLOWING ABBREVIATIONS WHEN COMPLETING THIS FORM August18th January 19th Inclusion Low-Incidence Inclusion Autism AUT Ment. Dis Mild Mil Specific Dis. SLD LEAP L21 – Deaf-Blindness D-B Ment. Dis Mod. Mod Speech Imp. Artic. SIA LEAP September22nd February16th Resource (Choose One) (Choose One) – – Connect Dev. DD Ment. Dis Sev. Sev. Speech Imp. Lang. SIL L21-C – – November 15th March 23rd Self-Contained HI/VI CMC EOC Emotional Dist. ED Multiple Dis. MD Traumatic Brain Inj. TBI EOC May 2nd ED Inclusion Support HISET Hearing Imp. Deaf HID Orthopedic Imp. OI Visual Imp. Blind VIB – – Autism Co-Teaching DSC Hearing Imp. Hard HIH Other Health Imp. OHI Visual Imp. Partial VIP DSC – – Moderate ECSE Severe/Profound Celt Teacher’s Full Name: Class Room #: Paraprofessional’s CLS Aide: EIN or Substitute#: Total # Students in Class: Paraprofessional’s Inclusion Aide: Certified Teacher Substitute Retired Teacher PTU Aide : Our Signature verify the information listed has been reviewed and is accurate. PTU Aide: I.S. /Lead Teacher Signature: Child Specific Paraprofessional’s Full Name: For: Principal’s Signature: Child Specific Paraprofessional’s Full Name: For: Addn’l Support Paraprofessional’s Full Name: For: Date -EOC in Alt. Date Week Plan 80% 40% DSC Week – Bus ID Except. 6 / Proposed Date M Birth / ≥ Plan < Only) 833 Except. 40-79% Name & IEP HI VI of or OT PT AC BIP Per APE Min. Entered Grade O EXC Connect LEAP Speech Handwriting ACT Student’s Unique HISET, Full JCAMPUS Evaluation Health Counseling Assessment Special Date Review (ECSE Brigance Regular Regular – Date Transportation Regular AT Primary Current Emergency SpEd Secondary LEAP Last Roll-Back
Page of 2017--2018 DATA SHEET ~ CONFIDENTIAL School: Local Code: DUE DATE TYPE OF PLEASE USE THE FOLLOWING ABBREVIATIONS WHEN COMPLETING THIS FORM August18th January 19th Inclusion Low-Incidence Inclusion Autism Deaf-Blindness Dev. Emotional Dist. Hearing Imp. – Deaf Hearing Imp. – Hard AUT D-B DD ED HID HIH Ment. Dis – Mild Ment. Dis – Mod. Ment. Dis – Sev. Multiple Dis. Orthopedic Imp. Other Health Imp. Mil Mod Sev. MD OI OHI Specific Dis. Speech Imp. – Artic. Speech Imp. – Lang. Traumatic Brain Inj. Visual Imp. – Blind Visual Imp. – Partial SLD SIA SIL TBI VIB VIP LEAP LEAP Connect EOC HISET DSC L21 L21-C EOC DSC September22nd February16th Resource (Choose One) (Choose One) November 15th March 23rd Self-Contained HI/VI CMC May 2nd ED Inclusion Support Autism Co-Teaching Moderate ECSE Severe/Profound Celt Teacher’s Full Name: Class Room #: Paraprofessional’s CLS Aide: EIN or Substitute#: Total # Students in Class: Paraprofessional’s Inclusion Aide: Certified Teacher Substitute Retired Teacher PTU Aide : Our Signature verify the information listed has been reviewed and is accurate. PTU Aide: I.S. /Lead Teacher Signature: Child Specific Paraprofessional’s Full Name: For: Principal’s Signature: Child Specific Paraprofessional’s Full Name: For: Addn’l Support Paraprofessional’s Full Name: For: EXC 6 Student’s Full Name Unique ID Grade Date of Birth Date Entered in JCAMPUS SpEd Min. / Week Regular ≥ 80% Regular 40-79% Regular < 40% Per Week (ECSE Only) BIP Primary Except. Secondary Except. LEAP – LEAP Connect -EOC – HISET, DSC ACT 833 Brigance / Alt. Assessment Last Evaluation Date Current IEP Date Roll-Back or Proposed Review Date Speech APE OT PT AC AT Handwriting HI VI O & M Health Plan Emergency Plan Counseling Special Bus Transportation
Class%20Data%20sheet%202017-2018.docx