The Special Education Student Information System Training Material. The Special Education Student Information System (SESIS). SESIS supports users in completing special education workflow processes from referral through IEP development.

1. Creating a Quality IEP in
SESIS
January 2014
Presented by:
Barbi Shames

2. Objectives:
• Review Work Flow in SESIS
• Develop clear guide for Present Level of Performance
• Discuss Management Needs (Academic and
Social/Emotional)
• How to Indicate Student involvement in General Education
• How to Indicate Recommended Services
• Useful tools to help develop a quality IEP
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3. 3
Starting the Work Flow in SESIS
1) Check the Home Page and view Referral Reports
2) Click on the report (s) and click the student
3) To start the process, choose the specific referral (e.g.
Initial Referral, Three Year review)
4) Proceed with the Assessment Planning document
5) Create a Draft and then (when complete) finalize all
assessments
6) Create Notice of IEP (choose the correct process-
Initial, Annual, Re-evalutaion)

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5. 5
In all cases, please complete and finalize the following documents in this specific
order:
For students who are not listed on this report (meaning their cases are not “in
process”), work should be started in SESIS. Like all data systems, transactions
need to be completed in a sequence. SESIS has a "work flow" sequence which
guides a user to complete the special education process. The work flow sequence
in SESIS is outlined below. It is imperative that staff adhere to the following work
flow sequence:
Initial Cases -
· If the parent is making the referral, begin by creating and finalizing the Initial
Referral
· If a professional staff member is making the referral, begin by creating and
finalizing the Request for Initial Referral.
1. Notice of Social History
2. Social History Package
3. Assessment Planning
4. All Necessary Assessments
5. Notice of IEP
6. IEP

6. 6
Annual Review Cases - Begin by creating and finalizing the Notice of IEP before
creating the IEP.
Mandated Three Year (Triennial) Cases - Begin by creating and finalizing the
Mandated Three Year Reevaluation and then continue with the Assessment
Planning document and all necessary assessments. Create and finalize the
Notice of IEP before you create the IEP.
Reevaluation Cases - Begin by creating and finalizing the Request for
Reevaluation and then continue with the Assessment Planning document and all
necessary assessments. Create and finalize the Notice of IEP before you create
the IEP.
Remember:
A. Complete and finalize Referral documents (e.g. Mandated Three Year
Reevaluation, Request for Initial Referral) before starting assessment documents.
B. Complete and finalize Assessment documents (e.g. Assessment Planning,
Assessments) before starting the IEP.
C. Complete and finalize the Notice of IEP before starting the IEP.
SESIS

7. Creating an Initial Referral
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8. Cont’d Initial Referral
X
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9. Cont’d Initial Referral
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10. Cont’d Initial Referral
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11. Sending the Notice of Social History
When the principal or Committee on Special Education
(CSE) chairperson approves a request for referral for
evaluation for special education services, the Social
History meeting must be scheduled with the parent or
guardian. The psychologist, social worker, or other
authorized individual sends the Notice of Social
History to the parent or guardian with the proposed
date and time for the meeting.
If the parent or guardian did not respond to the first
Notice of Social History, a second Notice of Social
History must be created and sent.
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12. To send the Notice of Social History
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13. Cont’d Notice of Social History
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14. Cont’d Notice of Social History
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15. Cont’d Notice of Social History
In the Date/Time field, click the calendar icon and choose a date for the meeting.
Tip: This is the second Date field on the page. The first Date field reflects the
date the notice was sent.
In the Hour field, type the time you wish to schedule the meeting.
Review the meeting address and indicate whether you wish to change the location.
If yes, type a new address in the appropriate fields.
Indicate whether you wish to change the contact name. If yes, click the lookup link
to search for a different contact.
Verify the parent or guardian's mailing address and make any necessary changes.
In the Actions bar, click the Save, Done Editing button.
Click the Send/Print Letter link.
Click the OK button.
The event log appears.
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16. Cont’d Notice of Social History
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Note: The send/print date is automatically recorded and the description field is
automatically populated. No other fields are required.
Click the Accept/Print button.
The Print dialog box appears.
Choose the appropriate printer and click the Print button.
The document prints.
Click the Back to previous screen link.
From the Action bar, click More Actions.
From the pop-up menu, click Change the status of this Document.
From the Change Status from Draft to drop-down menu, choose Final.
Click the Accept button.
Click the OK button.

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In the Date field, verify that today's date is populated.
Note: If you are not sending the package on this date, change the date to the
correct date.
Verify that the family's contact information is accurate and make any necessary
adjustments.
Click the Save, Done Editing button.
Review the workflow prompts at the top of the page to determine if any
additional documents are needed. These can be completed during the social
history meeting.
Note: Any additional required documents are determined based on the student's
profile. For example, if the parent's primary language is not English, the Home
Language form must be completed.
Click the Print icon.
From the pop-up menu, click All Sections.
Choose the appropriate printer and click the Print button.
Click the Return to previous screen link

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Constructing the IEP
Present Levels of Performance and Individual Needs
Documentation of student's current performance and academic, developmental and functional needs
EVALUATION RESULTS (INCLUDING FOR SCHOOL-AGE STUDENTS, PERFORMANCE ON STATE AND DISTRICT-WIDE
ASSESSMENTS)
e.g.. Evaluation results/ curriculum based measures/ eclas/ running records/ ARIS/ State tests scores
ACADEMIC ACHIEVEMENT, FUNCTIONAL PERFORMANCE AND LEARNING CHARACTERISTICS
LEVELS OF KNOWLEDGE AND DEVELOPMENT IN SUBJECT AND SKILL AREAS INCLUDING ACTIVITIES OF DAILY
LIVING, LEVEL OF INTELLECTUAL FUNCTIONING, ADAPTIVE BEHAVIOR, EXPECTED RATE OF PROGRESS IN
ACQUIRING SKILLS AND INFORMATION, AND LEARNING STYLE:
STUDENT STRENGTHS, PREFERENCES, INTERESTS:
ACADEMIC, DEVELOPMENTAL AND FUNCTIONAL NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF
STUDENT NEEDS THAT ARE OF CONCERN TO THE PARENT:
*Hint …Can be obtained from social history report/ Parent can provide this information during the social history and/or IEP meeting
-DO NOT WRITE RELATED SERVICE INFORMATION IN THIS SECTION

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Four Need Areas:
The following section of the IEP provides the template
for documentation of the student’s present levels of
academic achievement and functional performance and
individual needs of the student according to each of the
following four need areas:
academic achievement, functional performance and
learning characteristics;
social development;
physical development; and
management needs

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Evaluation Results:
In developing the recommendations for the IEP, the Committee must consider the
results of the initial or most recent individual evaluation of the student as well as the
results of the student’s performance on any general State or district-wide
assessment programs. For students beginning with the first IEP to be in effect
when the student turns age 15, and annually thereafter, this section must include
information from the age appropriate transition assessment provided to the student
that is being considered in the development of the student’s IEP. This does not
mean that an updated transition assessment is required annually.
The following section of the IEP provides space for the Committee to document the
evaluation results considered. The example shows this section of the IEP
completed to include a list of the evaluations considered and a brief summary of the
results.

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Present Levels of Performance and Individual Needs
The student's 'Present Levels of Performance and Individual Needs' must include
documentation of information that is required to be considered in the development
of the student's IEP. Required considerations include:
Evaluation/assessment results.
The student’s current functioning and individual needs in academic achievement,
functional performance and learning characteristics; social development; physical
development; and management needs. These considerations must include the
strengths of the student and the concerns of the parent(s) for enhancing the
education of the child.
The affect the student's disability has on the student's participation and progress in
the general curriculum (or, for preschool students, in appropriate activities); and
Special considerations relating to behavior, communication, students with limited
English proficiency, use of Braille and instruction in the use of Braille and use of
assistive technology devices. The form includes templates to ensure the
Committee documents, as appropriate, its considerations for each of these areas.

24. Assessment Planning Documents
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25. Cont’d Assessment Planning
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26. Cont’d Assessment Planning
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27. Cont’d Assessment Planning
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SOCIAL DEVELOPMENT
THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S RELATIONSHIPS WITH PEERS AND ADULTS;
FEELINGS ABOUT SELF; AND SOCIAL ADJUSTMENT TO SCHOOL AND COMMUNITY ENVIRONMENTS:
Hint…Can be obtained from observations/ teacher reports/student interview / formal assessments/ student records /ATS
reports-Disciplinary Records/ORS
eg, Student gets along well with peers.
Student show difficulty sustaining attention and benefits from prompts to stay on task (examples can be provided)
STUDENT STRENGTHS:
Please note that all students have some social strength. (e.g. leadership qualities, strong understanding of rules and
regulations, humor, organizational skills)
SOCIAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT ARE OF
CONCERN TO THE PARENT:
Some information can be obtained from social history report, or from the student
Parent can provide this information during the social history and/or meeting

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PHYSICAL DEVELOPMENT
THE DEGREE (EXTENT) AND QUALITY OF THE STUDENT’S MOTOR AND SENSORY DEVELOPMENT, HEALTH,
VITALITY AND PHYSICAL SKILLS OR LIMITATIONS WHICH PERTAIN TO THE LEARNING PROCESS:
Remember, you can describe a disorder, or syndrome but you may not list any specific medication on an IEP.
STUDENT STRENGTHS:
e.g. For example , a recent physical exam indicated that the student is in good health or no significant health issues
reported.
Student is a good athlete / Student is an avid runner/ Student plays team sports
PHYSICAL DEVELOPMENT NEEDS OF THE STUDENT, INCLUDING CONSIDERATION OF STUDENT NEEDS THAT
ARE OF CONCERN TO THE PARENT:
Mention any specific parental concern s that are related to students health that can impact the students academic or social
development

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vv
MANAGEMENT NEEDS
THE NATURE (TYPE) AND DEGREE (EXTENT) TO WHICH ENVIRONMENTAL
AND HUMAN OR MATERIAL RESOURCES ARE NEEDED TO ADDRESS
NEEDS IDENTIFIED ABOVE:
Include Academic, Behavior, Social, and Health NEEDS in this section
e.g. Diagrams, graphs, story mapping
Red light, green light cues for behavior
Graphic organizers for written assignments
Marker to maintain place when reading
Use of assistive technology for written assignments (Alpha Smart)
FM Unit
Weighted vests
Preferential seating

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EFFECT OF STUDENT NEEDS ON INVOLVEMENT AND PROGRESS
IN THE GENERAL EDUCATION CURRICULUM OR, FOR A
PRESCHOOL STUDENT, EFFECT OF STUDENT NEEDS ON
PARTICIPATION IN APPROPRIATE ACTIVITIES
-Student is in a general education class and is pulled out for related service (Speech Therapy 2
times a week)
-Student is in a general education class and benefits from having a full time special education
teacher in class for some or all academic periods (Integrated Co-teaching) [e.g. Describe how
the special education service enables the student to participate in a particular class].
-Student exhibits academic deficits that cannot be addressed in a general education classroom
and he/she requires a class with a small student to teacher ratio (special Class). [e.g.
Describe the areas of weakness that were reported in the Present Levels of Performance,
and then indicate how the recommended service will help the student move towards meeting
grade level standards].

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Involvement and Progress in the General Curriculum / Appropriate Activities
The following section is used to document how the student’s disability affects
involvement and progress in the general education curriculum; or for preschool
students, as appropriate, how the disability affects the student’s participation in
appropriate activities. Consider the affect of the student’s disability needs as
they relate to each of the following: instructional content, instructional method,
method of assessment, instructional materials and physical environment.

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Special Considerations
Present levels of performance statements must also include documentation that
the Committee considered special factors in the development of the student’s IEP
as noted below. If any of the following special considerations are checked ‘Yes‘,
then the Committee must ensure that a device or service, including an intervention,
accommodation or other program modification needed for the student to receive a
free appropriate public education is indicated in the IEP under the applicable
section of the IEP.
‘Yes’, ‘No’ or ‘Not Applicable’ must be indicated for each consideration. If ‘Yes’
is indicated, then the IEP must identify the specific supports or other strategies
(e.g., counseling, special seating, speech and language therapy) under the
‘Recommended Special Education Programs and Services’ section of the IEP. If
'Yes‘ is checked indicating the need for a behavioral intervention plan, there is a
text field provided in this section where additional information, as applicable,
could be inserted

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Measurable Postsecondary Goals and Transition Needs
For students beginning with the first IEP to be in effect when the student is age 15
(and at a younger age, if determined appropriate) and updated each year, the IEP
must include measurable postsecondary goals (the student’s long-term goals for
living, working and learning as an adult) based on the student’s preferences and
interests, as they relate to transition from school to post-school activities. The IEP
must document measurable postsecondary goals in the areas of education and
training (e.g., career and technical education and training, continuing and adult
education, college), employment (e.g., integrated competitive employment), and
community living (e.g., adult services, independent living or community
participation).

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Measurable Annual Goals
The IEP must list measurable annual goals, consistent with the student’s needs and
abilities, to be followed during the period in which the IEP will be in effect. For each
annual goal, the IEP must indicate the evaluative criteria (the measure used to
determine if the goal has been achieved), evaluation procedures (how progress will
be measured) and schedules (when progress will be measured) to be used to
measure progress toward meeting the annual goal.

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For students who meet the eligibility criteria to take the New York State Alternate
Assessment (NYSAA) and for preschool students with disabilities, the IEP must
include a description of the short-term instructional objectives and/or benchmarks
that are the measurable intermediate steps between the student’s present levels of
performance and the measurable annual goals. A district may establish policy to
include short-term instructional objectives and/or benchmarks in other students’
IEPs (e.g., all elementary age students; all students recommended for special
classes).

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Reporting Progress to Parents
The IEP must identify when periodic reports on the progress the student is making
toward the annual goals will be provided to the student’s parent(s). The method or
combination of methods to inform the parents of their child’s progress is left to local
discretion. Based on the unique needs of the student, the manner selected to inform
parent(s) might vary from student to student.

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SPECIAL EDUCATION PROGRAM:
Indicate program (SETSS, ICT, Special Class)
Please indicate where a recommended program will be
implemented, (during Math, ELA, Science, etc)
- DO NOT INDICATE “ALL” for students that will receive
services in a Community School Setting.
Service Delivery Recommendations: Direct vs. Indirect Service, Group vs. Individual
Indicate Language (except for OT and PT, the language must be consistent for all services)
Frequency-Number of times per day, per week, or monthly (check school schedule to get an
exact idea of when the student is in a specific class). Indirect Service can be on daily,
weekly, or monthly basis
Duration: Length of session: Period
Location: Where service will be provided (Separate Location, General Education, or Special
Education Class)

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Recommended Special Education Programs
and Services
The IEP must indicate the recommended program and services, including related
services, as defined in law and regulation from the options set forth in sections
200.6 and 200.16 of the Regulations of the Commissioner of Education that will be
provided for the student. These options are provided in a drop-down format in the
IEP form for both preschool and school-age students to ensure the
recommendations are stated based on the State’s special education program and
services options. Any information typed into the text box that is also provided in
this section must be consistent with this requirement.

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The IEP must indicate the anticipated frequency, duration, location and initiation
date of each recommended special education program, related service,
supplementary aid and service, program modification or accommodation, use of an
assistive technology device and/or service and, if applicable, support for school
personnel.
The IEP must also indicate the projected beginning date of each recommended
program/service. In addition, because the Committee may recommend a
program/service for a limited time period, an end date of service may be
documented if appropriate.

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12-Month Service and/or Program
The IEP form must identify if the Committee recommends that the student receive
special education services during the months of July and August. If so, the IEP must
include:
the identity of the provider of services during the months of July and August; and
for a preschool student, the reason(s) the student requires special education
programs and services during July and August.
If the program/services recommended for July and August are not the same as
recommended for the 10-month school year, the July and August recommendations
must be documented in the following section of the IEP.

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TESTING ACCOMMODATIONS (TO BE COMPLETED FOR PRESCHOOL CHILDREN ONLY
IF THERE IS AN ASSESSMENT PROGRAM FOR NONDISABLED PRESCHOOL CHILDREN)
-For example, Pre-School students with IEP’s who may need testing accommodations for
gifted and talented programs.
INDIVIDUAL TESTING ACCOMMODATIONS, SPECIFIC TO THE STUDENT’S DISABILITY
AND NEEDS, TO BE USED CONSISTENTLY BY THE STUDENT IN THE RECOMMENDED
EDUCATIONAL PROGRAM AND IN THE ADMINISTRATION OF DISTRICT-WIDE
ASSESSMENTS OF STUDENT ACHIEVEMENT AND, IN ACCORDANCE WITH
DEPARTMENT POLICY, STATE ASSESSMENTS OF STUDENT ACHIEVEMENT.
Please reference:
http://www.p12.nysed.gov/specialed/publications/policy/testaccess/policyguide.htm

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Testing Accommodations
The IEP must indicate the individual testing accommodations needed by the student, if any,
to be used consistently by the student in his or her recommended education program, in the
administration of district-wide assessments of student achievement and consistent with
Department policy, in State assessments of student achievement that are needed by the
student to participate in the assessment. This section would only be completed for
preschool students if there is an assessment program for nondisabled preschool students.
The State form provides testing accommodation drop-down options. These options
include the following: extended time; breaks; multiple day administration; revised test
format; revised test directions; use of aids/assistive technology device; separate
location/room; adaptive or special equipment; special lighting; special acoustics; location
with minimal distractions; preferential seating; additional paper for math calculations; use of
scribe; on-task focusing prompts; waive spelling requirements; waive paragraphing
requirements; waive punctuation requirements; use of calculator; use of abacus; use of
arithmetic tables; use of spell check device; and use of grammar check device.
However, since the list of testing accommodations is not finite, text boxes allow entry of
other testing accommodation recommendations as appropriate. For each recommended
testing accommodation, the Committee must, as applicable, identify the conditions or types
of tests that will require testing accommodations (e.g., type, length, purpose of test) as well
as any implementation recommendations (e.g., amount of extended time, duration and
interval of breaks).

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Coordinated Set of Transition Activities
Beginning with the first IEP to be in effect when the student is age 15 (and at a
younger age, if determined appropriate) and updated annually, the IEP must
include a statement of needed transition services. These services focus on
improving the academic and functional achievement of the student with a
disability to facilitate the student’s movement from school to post-school
activities.
All recommended transition services and activities are documented here to
show the coordinated nature of the services and activities that are designed to
promote movement from school to post-school opportunities before the student
leaves the school setting. For each activity, the IEP must include a statement of
the responsibilities of the school district and, when applicable, participating
agencies for the provision of transition services.

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Participation in State and District-Wide Assessments
All students with disabilities must be included in State or district-wide assessment
programs. If the Committee determines that the student will participate in an
alternate assessment on a particular State or district-wide assessment of student
achievement, the IEP must provide a statement of why the student cannot
participate in the regular assessment, and why the particular alternate assessment
selected is appropriate for the student.

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Participation with Students without Disabilities
The following section of the IEP is used to document the extent to which a
student’s disability precludes his/her participation with students without
disabilities, including:
an explanation of the extent, if any, to which a student will not participate in regular
class and/or extracurricular and nonacademic activities, or, for preschool students,
in appropriate activities, with age-appropriate nondisabled peers. This may be
indicated as the percent of the school day or by identifying particular activities that
the student will not participate in with his/her nondisabled peers.
the extent to which the student will participate in specially-designed physical
education; and
when the Committee recommends that a student be exempt from the language
other than English (LOTE) requirement because the student's disability affects
his/her ability to learn a language.

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Participation with Students without Disabilities
Participation with Students without Disabilities : REMOVAL FROM THE GENERAL EDUCATION ENVIRONMENT
OCCURS ONLY WHEN THE NATURE OR SEVERITY OF THE DISABILITY IS SUCH THAT, EVEN WITH THE USE
OF SUPPLEMENTARY AIDS AND SERVICES, EDUCATION CANNOT BE SATISFACTORILY ACHIEVED.
FOR THE PRESCHOOL STUDENT:
Explain the extent, if any, to which the student will not participate in appropriate activities with age-appropriate nondisabled
peers (e.g., percent of the school day and/or specify particular activities): (e.g. a student with limited mobility )
Explain the extent, if any, to which the student will not participate in appropriate activities with age-
appropriate nondisabled peers (e.g., percent of the school day and/or specify particular activities):
FOR THE SCHOOL-AGE STUDENT:
Explain the extent, if any, to which the student will not participate in regular class, extracurricular and other nonacademic
activities (e.g., percent of the school day and/or specify particular activities): (e.g. specify cognitive, social or
physical/medical disability that precludes participation with non-handicapped peers)
If the student is not participating in a regular physical education program, identify the extent to which the student will
participate in specially-designed instruction in physical education, including adapted physical education:
Removal from the general education environment occurs only when the nature or severity of the disability is
such that, even with the use of supplementary aids and services, education cannot be satisfactorily achieved.
EXEMPTION FROM LANGUAGE OTHER THAN ENGLISH DIPLOMA REQUIREMENT:
No/Yes - The Committee has determined that the student's disability adversely affects his/her ability to learn a
language and recommends the student be exempt from the language other than English requirement.

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Transportation/ Placement Recommendation
Transportation:
What to consider when offering transportation:
*Please indicate where the program will be located (e.g. NYC DOE community school,
specialized school, NYC Approved non-public school)
-Student may be eligible for general education transportation which would not be
indicated on the IEP.
Placement Recommendation
In order to ensure proper placement , this section needs to clearly indicate where (e.g.
community school, specialized school, etc) the service will be implemented. This
must be indicated in the location section of the IEP.

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Special Transportation
The IEP must include recommendations to address each of the student’s
disability-related special transportation needs, as appropriate. The IEP must
specify any special transportation, including any specialized transportation
equipment (e.g., special or adapted buses, lifts and ramps), needed by the student
based on his or her unique needs related to the student’s disability to travel to and
from school (including such school-related programs as work programs and
settings other than the school where the student receives education or special
education services); and, as appropriate, in and around the school.

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Placement Recommendation
The IEP must indicate the recommended placement of the student. The student’s
placement is the educational setting in which the student’s IEP will be implemented.
Placement should indicate the type of setting where the student will receive special
education services (e.g., public school district, BOCES class, approved private
school).
Placement Recommendation
The IEP must indicate the recommended placement of the student. The student’s
placement is the educational setting in which the student’s IEP will be implemented.
Placement should indicate the type of setting where the student will receive special
education services (e.g., public school district, BOCES class, approved private
school).

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Identifying Information
This section of the IEP includes identifying information for the student and identifies
the disability classification for the student (which must be selected from the options
that appear in the drop down menu).
Disability Classification:
•For all preschool students, select ‘Preschool Student with a Disability’
•For school-age students, select one of the following disability classifications:
Autism
Deafness
Deaf-blindness
Emotional disturbance
Hearing impairment
Intellectual disability
Learning disability
Multiple disabilities
Orthopedic impairment
Other health-impairment
Speech or language impairment
Traumatic brain injury
Visual impairment (which includes blindness)

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SUMMARY
STUDENT INFORMATION
Student Name:
NYC ID:
DOB:
Gender:
Parents Language(s) Spoken/Mode Communication:
IEP INFORMATION
Date of IEP Meeting:
IEP Amendment: Yes No
Reconvene of IEP Meeting: Yes No
INSTRUCTIONAL/FUNCTIONAL LEVELS
Reading:
Math:

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PROMOTION CRITERIA
Current Year : Standard or Modified
Next Year : Standard or Modified
Parent Concerns:
Please complete this section. This information can be taken directly from the Present Levels of Performance .
OTHER PROGRAMS CONSIDERED:
General Education
Related Service Only
Special Education Teacher Support Services (SETSS)
Integrated Co-Teaching Services
Special Class in a Community School
Home Instruction
Other Please Specify:
Reason for Rejection: Please indicate two programs that were considered if you consider a general
education setting please make sure that a general education teacher is present at the meeting (unless you
have a signed mandated member excusal form completed prior to the meeting ).

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To Do:
Review Due Process Rights Before Every IEP meeting.
Enter all data on the IEP (all Pink areas need to be completed).
Check the IEP before you Finalize any section.
Make sure the Present Levels of Performance aligns with the
Measurable Annual Goals.
Please collaborate with teachers, related service providers, parents,
and students on a regular basis.
Have a draft IEP prepared before the meeting takes place.

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12 Month School Year Consent form
Aligning Goals to Recommended Programs and Services
Attendance Page
Behavior Intervention Plan
Coordinated set of transition activities
Cover Page
Emotional Disability Justification form
Functional Behavior Assessment
Home Instruction Referral form
Measurable Annual Goals
Measurable Postsecondary Goals
Participation in State & District-Wide Assessments
Participation with Students without Disabilities
Present Levels of Performance and Individual Needs
Recommended Special Education Programs/Services
Reporting Progress to Parents
Special Transportation/Placement Recommendation
Specific Learning Disability Justification form
Student Needs Relating to Special Factors
Summary Page
Testing Accommodations
Twelve Month Service and/or Program
Note: For Turning 5 students, the Child Outcomes Summary form must be completed before
the IEP can be finalized.

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General Directions to Use the State’s Student Exit Summary Model Form
(April 2012)
Student Exit Summary (Attachment 2)
The Student Exit Summary (Attachment 2) is provided as a sample form to meet the
documentation requirements that must accompany the award of the Skills and Achievement
Commencement Credential (Attachment 1). For students with disabilities eligible for the
New York State Alternate Assessment (NYSAA), the Student Exit Summary is a model form
that also satisfies the Individuals with Disabilities Education Act section 614(c)(5) and State
regulation (section 200.4(c)(4)) requirements that the local educational agency provide a
student with a disability with an exit summary of the student’s academic achievement and
functional performance that includes recommendations on how to assist the student in
meeting his or her post-secondary goals. The model form may be used immediately to
satisfy the requirements for the exit summary for students taking NYSAA.
The Student Exit Summary was developed in collaboration with parents, employers, adult
service agencies, teachers and administrators with expertise in the area of students with
severe disabilities. Skills included in the exit summary are based on the Career
Development and Occupational Studies (CDOS) learning standards (Career Development;
Integrated Learning and Universal Foundation Skills) and aligned with the Alternate Grade
Level Indicators (AGLIs) in English language arts (ELA), mathematics, science, and social
studies which measure performance for students taking NYSAA.

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77. Useful Links
http://schools.nyc.gov/Academics/SpecialEducation/ParentResources/default.htm
http://intranet.nycboe.net/TeachingLearning/SpecialEducation/SOPMLetters/default.htm
http://www.nysed.gov/
http://www.p12.nysed.gov/specialed/publications/iepguidance.htm
https://portal.nycenet.edu/SpecialPopulations/SESIS/default.htm
http://schools.nyc.gov/NR/rdonlyres/5F3A5562-563C-4870-871F-
BB9156EEE60B/0/03062009SOPM.pdf
http://www.p12.nysed.gov/apda/nysaa/
http://schools.nyc.gov/RulesPolicies/default.htm
http://www.p12.nysed.gov/apda/accommodations/
J:My DocumentsIEP INFOExit summary NYSED.mht
see http://www.vesid.nysed.gov/specialed/
publications/iepguidance.htm.
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