What

Student Last grade Transportation Transportation

Name ? Company needs ESY Program

wheelchair
Student 1 6 First Student accessible Multiple Disabilities Support

Student 2 K N/A N/A Other

Itinerant Services (students who

need some academic support but not
Student 3 6 N/A N/A full day)

Student 4 8 Levy curb to curb Autistic Support 2 (2:1)

Student 5 3 N/A N/A Other

Student 6 2 Levy N/A Other

wheelchair
Student 7 10 First Student accessible Multiple Disabilities Support

Itinerant Services (students who

need some academic support but not
Student 8 2 N/A N/A full day)
ESY Itinerant Services ESY related services

N/A

Teacher - Itinerant-MDS- 2
hrs/wk N/A

Itinerant teacher 2.5 hours per

week N/A

N/A

Teacher - Itinerant-MDS- 2
hrs/wk

I selected Other, because I'm Speech Therapy

not sure which service to individual, OT individual,
request. PT individual

OT Group, PT individual

1 hour of math N/A

 All data
Recommended ESY related Services collected Approved

Y Y

Y Y

Y Y

Y Y

Y Y

PT - 30 minutes per week

Speech/Language - 30 minutes per week
OT - 30 minutes per week Y Y

OT- 4 sessions / 15 min. for esy.

PT- initially 1- 30 min. session to establish walking program
with staff. Y Y

Y Y
 Teacher NOREP Parent
Type of service NOREP sent notified returned Approved

Full-time center based

(MDS) 3/27/2017 Y Y

Teacher - Itinerant-MDS- 2
hrs/wk 3/27/2017 Y Y Y

Itinerant instruction in the

home 2.5 hours per week 3/28/2017 Y Y

Full-time center based (AS

2) 3/27/2017 Y

Teacher - Itinerant-MDS- 2
hrs/wk 3/27/2017 Y Y Y

Proposed - Full-time center

based along with the
recommended related
services 3/27/2017 Y Y N

Center Based (MDS) with

related services 3/27/2017 Y Y Y

Itinerant Math
Computation, 2 hours per
week for 5 weeks 3/27/2017 Y Y Y