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Extended School Year Services Form

Extended School Year Services Form
Extended School Year Services Form
Extended School Year Services Form
Extended School Year Services Form
Product Description
This is an excel document that can be used in determining eligibility for ESY services by measuring if a student demonstrated regression/recoupment difficulties after an extended away from instruction. This document is fully editable.

This form allows you to do the following:
•Insert Student Name
•Insert School Year
•Track Regression/Recoupment over the Christmas/Summer Breaks for students you feel may be eligible for ESY services
•Allows you to insert up to 10 goal areas addressed for both Christmas/Summer Breaks
•Allows you to track percentages for 3 sessions prior to and following the breaks
•Averages the 3 sessions prior to break and following the break for you
•Has an area where you can indicate Yes or No for significant regression in a goal area
•Has a question area where you can answer questions that assist in determining eligibility
•Has the questions addressing the 7 factors outlined in Pennsylvania State Regulations for determining ESY. You can delete or change this to suite your needs.
•Has a spot to indicate whether the student DOES or DOES NOT qualify for ESY.
•If they do qualify, there is a section to indicate if they will or will not attend and the frequency/duration of services provided.

This is a great document for those times when parents or teachers are unsure as to why a student did or did not qualify for extended school year services.

Enjoy!


Determination of ESY services Form by Kara Christopher is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.
Total Pages
2 pages
Answer Key
N/A
Teaching Duration
N/A
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