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
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16 KB|2 pages
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.


Determination of ESY services Form by Kara Christopher is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.
Total Pages
2 pages
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