Name: ______________________ Data ID#: ___________________ DOB: _____________________ Date: ___________________

Resident District: __________ District of Attendance: _______ Building of Attendance: _______ Autism Scholarship? ________

Grade Level: ____________________ Race: ________________________ Disability Category: _____________

**** Refer to Master Code Sheet on page 3 for codes and explanations!!!

A.  Date Type Codes: Activity (GE100)	Event Date from PR-XX form (GE 110)	Outcome (GE 120)						Begin Date (GE 140)	End Date (GE 150)	Compliance
1. PSTC (Preschool Transition -transition from Help Me Grow)		N/A								N/A
2. RFRL (Referral for Evaluation  - after the child is suspected of having a disability)		N/A								N/A
3. CNST (Parent Consent for Evaluation -on or after referral date)		CNGI	CNGR	CNGO	CNRF	CNNA	CNDP
4. IETR (Initial Evaluation Team Report -Completion due 60 days from consent)		ETNE    ETDP
		Disability Category (circle): ET01   ET02   ET03   ET04   ET05   ET06   ET08   ET09 ET10      ET12   ET13   ET14   ET15   ET16
5. IIEP (Initial IEP -  30 days from ETR Completion; by third birthday if PSTC)		IENS      IEPR       IEDP    LRE codes (circle):
		IE13    IE14 IE15    IE16    IE17   IE18   IE19     IE20    IE38     IE39   IE51   IE53   IE55   IE56   IE60    IE62     IE64 IE70     IE72
6. RETR  (Reevaluation Team Report - 3 years from prior ETR)		ETDP    ETEX         Disability Category (circle):
		ET01    ET02   ET03   ET04   ET05   ET06   ET08   ET09    ET10   ET12   ET13   ET14   ET15   ET16
7. RIEP  (Periodic Review of IEP - 1 year from previous IEP)		IENS      IEPR       IEDP
		LRE codes (circle) IE13 IE14 IE15 IE16 IE17 IE18 IE19 IE20 IE38 IE39 IE 51 IE55 IE56 IE60 IE62 IE64 IE70 IE72
8. TETR (Transfer Student ETR Adoption)		ET01   ET02   ET03   ET04   ET05   ET06   ET08   ET09 ET10      ET12   ET13   ET14   ET15   ET16
9. TIEP (Transfer Student IEP Adoption)		LRE codes (circle) IE13       IE14     IE15       IE16       IE17        IE18     IE19         IE20        IE38     IE39         IE51      IE53     IE55   IE56 IE60         IE62        IE64      IE70        IE72								NA
10. FIEP (Final IEP meeting prior to graduation)
11. CIEP (Consent for services withdrawn by parent)										NA

B. Has the child’s learning environment (LRE) been changed in lieu of expulsion as a result of discipline?     EMIS program code 211001 (circle if appropriate)
C. Secondary Planning Element (Transition Plan reported for students 14 yrs or older)** (GE 170)		****    TPNP   TFYG     TMYG    TPCE
							Start Date			End Date
D. Services (2150XX) Record any and only those services described on IEP. Make sure to include any IEP required “speech and language services” for students whose disability category is “speech.”		215001		Adaptive Physical Education
		215002		Aide
		215003		Attendant
		215004		Audiology
		215006		Interpreting
		215007		Medical.
		215008		Occupational Therapy
		215009		Orientation and Mobility
		215010		Physical Therapy
		215011		Reader Services
		215012		Psychological
		215013		Speech-language Pathology
		215015		Rehabilitation counseling
		215017		Parent counseling and training
		215018		Counseling
		215020		Recreational
		215021		Special Transportation
		215022		Social Work
		215026		School health services
		215027		School nurse services
		215023		Other
E. Preschool Itinerant Services (a teacher)		220100    Provider:
F. Testing Requirements	TEST TYPE required by IEP:   ALT              STR             STA		Accommodations required:   **       NO     Y1       Y2         Y3		Passing OGT Required for Graduation?
					M	R		S	SS		W

This child was parentally placed in a non-public school, and educated according to an ISP. Please make sure the following elements are reported correctly:

How Received='6'

This is the date of the preschool transition conference arranged by the Early Intervention Service Coordinator (Department of Health) with the school district. The conference is for a student who is suspected of having a disability and may be transitioning from Part C (Early Intervention/Help Me Grow) to Part B preschool special education services. It is federally mandated that the district attend this conference. The conference generally occurs between 90 and 120 days before the child’s 3rd birthday. This option can be only used for preschool students that are suspected of having a disability and may be transitioning from Part C (Early Intervention /Help Me Grow) to Part B preschool special education, NOT to be used for school-age children.

RFRL - Referral for Evaluation Date

The District receives the date the PR04-Referral for Evaluation form. This date should be reported for all students referred for evaluation since the last reporting cycle.

CNST - Parent/Guardian Consent for Evaluation Date

The date the parent/guardian grants/refuses consent for evaluation, from PR05-Parent Consent for Evaluation Part 1 (Grant Consent) or Part 2 (Refuse Consent). This element should be reported with an Outcome ID to indicate status (e.g., Consent Granted, Consent Refused, etc.).

IETR - Evaluation Team Report Completion Date-Initial

The date the PR06-Evaluation Team Report is completed (from Part B, PR06). This element should be reported with an Outcome ID to indicate status (e.g., Student was determined to be eligible for services; Student was determined to NOT be eligible for services, etc.). If the Evaluation Team Report initial completion date does not meet mandated federal time lines then a Non-compliance ID is required.

RETR - Evaluation Team Report Completion Date-Reevaluation

The date the PR06-Evaluation Team Report is completed (from Part B, PR06). This element should be reported with an Outcome ID to indicate status (e.g., Student was determined to NOT be eligible for services, student was determined to have Autism, etc.). If the Evaluation Team Report reevaluation completion date does not meet mandated federal time lines then a Non-compliance ID is required.

TETR - Transfer Evaluation Team Report Completion Date

Date the district adopted an ETR developed by another public educational entity WITHOUT modification. This element should be reported with an Outcome ID to indicate status.

IIEP - IEP Completion Date-Initial

The meeting date when the Individualized Education Program was completed. From page 1, PR07-Individualized Education Program meeting date. If the Individualized Education Program initial completion date does not meet mandated federal time lines, then a Non-compliance ID is required.

RIEP - IEP Completion Date-Periodic Review or Review Other than Annual Review

The meeting date when the Individualized Education Program was completed. From page 1, PR07-Individualized Education Program meeting date. If the Individualized Education Program reevaluation completion date does not meet mandated federal time lines, then a Non-compliance ID is required.

TIEP - Transfer Student IEP Adoption Date

Date the district adopted an IEP developed by another public educational entity WITHOUT modification. IF district chose to modify the IEP for a transfer student they should report the date the IEP was modified as an “IEP Completion Date-Periodic Review” (RIEP).

FIEP - Final IEP Team Meeting Prior to Graduation

A meeting of the IEP team that takes place within two months of graduation. In this meeting, a new IEP is NOT completed, since the student has met graduation requirements, will graduate, and the content in the existing IEP is appropriate for the days remaining until graduation.

CIEP - IEP consent withdrawn by parent

The date the parent/guardian withdraws consent for a previously written IEP that is still in effect. When reporting CIEP, the only valid outcome id is IEPR.

CNDP	Consent Moved to Due Process
CNGI	Consent Granted for Initial valuation (IETR)
CNGR	Consent Granted for a Reviewed Evaluation (RETR)
CNGO	Consent Granted for Other Special Education Activity (Neither IETR nor RETR)
CNNR	Consent Not Returned
CNRF	Consent Refused
ETDP	ETR Resulted in Due Process
ETEX	Exiting Special Education.  THIS CODE IS TO BE USED WHEN THE IEP TEAM determines a child no longer requires specialized instruction or related services.  It is NOT to be used if a student graduates or withdraws or a parent revokes consent
ETNE	Not Eligible for Services
ET01	Multiple Disabilities (other than Deaf-Blind)
ET02	Deaf-Blindness
ET03	Deafness (Hearing Impairment)
ET04	Visual Impairments
ET05	Speech and Language Impairments
ET06	Orthopedic Impairments
ET08	Emotional Disturbance (SBH)
ET09	Cognitive Disabilities (Formerly Mental Retardation or Developmentally Handicapped)
ET10	Specific Learning Disabilities
ET12	Autism
ET13	Traumatic Brain Injury (TBI)
ET14	Other Health Impaired (Major)
ET15	Other Health Impaired (Minor)
ET16	Developmental Delay (students ages 3 - 5 only)
IEDP	IEP Resulted in Due Process
IENS	IEP Complete – Not Served
IEPR	IEP Complete – Parental Refusal

Activity	In an average week, minutes spent in a setting not defined as “special education” that serves all students	In an average week, minutes spent in a setting that serves only SWD	Total	Percent in typical
Related services (OT, PT, speech, counseling) required by IEP
Core academic coursework
Other coursework (music, PE, art)
Non-course activities (homeroom, lunch, recess)
Work/study experiences
Total

IE13 - Special Education outside the regular class less than 21% of the day. Student with a disability receiving special education and related services outside the regular classroom for less than 21% of the school day. This may include placement in:

• Regular classes with special education/related services provided within the regular classes;
• Regular classes with special education/related services provided outside regular classes;
• Regular classes with special education services provided in resource rooms.

IE14 - Special education outside the regular class at least 21% of the day and no more than 60% of the day. This may include placement in:

• Resource rooms with special education/related services provided within the resource room;
• Resource rooms with part-time instruction in a regular class.

IE15 - Special education outside the regular class more than 60% of the day. Student with a disability receiving special education and related services outside the regular classroom for more than 60% of the school day. Students who receive education programs in public or private separate day or residential facilities should NOT be reported with this code. This category may include:

• Self-contained special classrooms with part-time instruction in a regular class;
• Self-contained special classrooms with full-time special education instruction on a regular school campus;
• Students with disabilities whose parent(s) have opted to home-school them and who receive special education at public expense.

IE16 - Public Separate School. Student with a disability receiving special education and related services, at public expense, for greater than 50% of the school day in public separate schools. This may include:

• Students with disabilities attending County Boards of MR/DD;
• Ohio School for the Deaf, Ohio State School for the Blind (if the student does not reside there during the week);
• Public day schools for students with disabilities;
• Public day schools for students with disabilities for a portion of the school day (greater than 50%) and in regular school buildings for the remainder of the school day
• This does not include students being educated at a Community School.

IE17 - Private Separate School. A student with a disability receiving education programs in private separate day school facilitates. This includes children with disabilities receiving special education and related services, at public expense, for greater than 50% of the school day in private separate schools. This may include:

• Private day schools for students with disabilities;
• Private day schools for students with disabilities for a portion of the school day (greater than 50%) and in regular school buildings for the remainder of the school day;
• Private residential facilities, if the student does not live at the facility.

IE18 - Public Residential Facility. A student with a disability receiving education programs and living in a public residential facility during the school week. This includes children with disabilities receiving special education and related services for greater than 50% of the school day in public residential facilities. This may include children placed in:

• Ohio School for the Deaf, Ohio State School for the Blind (if the student resides there during the week);
• Public residential schools for students with disabilities;
• Public residential schools for students with disabilities for a portion of the school day (greater than 50%) and in separate day schools in regular school buildings for the remainder of the school day.
• Do not include students who received education programs at the facility, but do not live there during the week (see public separate facility).

IE19 - Private Residential Facility. A student with a disability receiving education programs and living in a private residential facility during the school week. This includes children with disabilities receiving special education and related services, at public expense, for greater than 50% of the school day in public residential facilities. This may include children placed in:

• Private residential schools for students with disabilities;
• Private residential schools for students with disabilities for a portion of the school day (greater than 50%) and in separate day schools or regular school buildings for the remainder of the school day.
• Do not include students who received education programs at the facility and not living there.

IE20 - Homebound/Hospital. A student with a disability receiving education programs in a homebound/hospital environment, includes children with disabilities placed in and receiving special education and related services in:

• Hospital programs;
• Homebound programs.

Do not include children with disabilities whose parents have opted to home-school them and who receive special education at public expense.

IE38 - A student with a disability placed in a state-approved nonpublic school by a public school district and receives services through an IEP.

IE39 - A student with a disability who was enrolled by his/her parent(s) or guardian(s) in a regular parochial or other state-approved nonpublic or private school and whose basic education is paid for through private resources and who receives special education and related services at public expense from an LEA under a Services Plan. Include children whose parents chose to home school them but who receive special education and related services at the nonpublic school at public expense. Do not include children who are placed in private schools by the LEA. There will be very few students with this code reported, as these students have ISPs, not reported in EMIS, instead of IEPS.

IE51 - Services Regular Early Childhood Program (More Than 10 Hours) Children attending a regular early childhood program at least 10 hrs per week and receiving the majority of special education and related services in the regular early childhood program

IE53 - Services Regular Early Childhood Program (Less Than 10 Hours)Children attending a regular early childhood program less than 10 hrs per week and receiving the majority of special education and related services in the regular early childhood program

IE55 - Other Location Regular Early Childhood Program (More Than 10 Hours) Children attending a regular early childhood program at least 10 hrs per week and receiving the majority of special education and related services in some other location

IE56 - Other Location Regular Early Childhood Program (Less Than 10 Hours)Children attending a regular early childhood program less than 10 hrs per week and receiving the majority of special education and related services in some other location

IE60 - Preschool Special Education Program - Separate Class. A preschool special education program where a special education student is in a class with 51% or more students with disabilities. Do not report if student is also enrolled in Regular Early Childhood Program.

IE62 - Preschool Special Education Program - Separate School. A special education program in which a student receives all of his/her special education and related services in an educational program in public or private day schools designed specifically for children with disabilities. Do not report if student is also enrolled in Regular Early Childhood Program.

IE64 - Special Education Program - Residential Facility. A special education program in which a student receives all of his/her special education and related services in a publicly or privately operated residential school or in a residential medical facility on an in-patient basis. Do not report if student is also enrolled in Regular Early Childhood Program.

IE70 - Preschool at Home. A program in which a child receives all of his/her special education and related services in the principle residence of the child’s family or caregivers and who did not attend an early childhood program or a special education program provided in a special class, separate school, or residential facility. Included are children who receive special education BOTH at home AND at a service provider location.

IE72 - Preschool Service Provider Location. A program in which a student receives all of his/her special education and related services from a service provider and did not attend an early childhood program or special education program provided in a separate class, separate school, or residential facility. For example, speech instruction is provided in private clinicians’ offices, clinicians’ offices located in school buildings, hospital facilities on an outpatient basis, libraries, and other public locations.

Note. The event date for Outcome ID Element ETEX is considered the date on which the student exited Special Education as a result of the IEP team decision. ETEX is NOT reported when a student graduates or withdraws. Once a student has exited Special Education "**" are reported in the Disability Condition Element on the Student Attributes-Effective Date Record (FD).

The code for removal to alternate setting in lieu of expulsion remains a program code, 211001.This code is used for when a child is placed temporarily in an appropriate setting determined by the child’s IEP team or a hearing officer for no more than 45 school days. This setting enables the child to continue to receive educational services and participate in the general education curriculum (although in another setting) and to progress toward meeting the goals set out in the IEP. As appropriate, the setting includes a functional behavioral assessment and behavioral intervention services and modifications to address the behavior violation so that it does not recur.

Non-Compliance ID Element

**	Not Applicable
01	No Identified Reason (Includes weather related delays)
02	Staff Not Available-Summer Months
03	Staff Not Available-School Year
04	Scheduling conflicts with family
05	Parental Choice
06	Parent Refused Consent (OR repeatedly didn’t show up at scheduled meeting)
07	Child’s Health
08	Student’s Incarceration
09	District in compliance with due process time lines, but incorrect/missing data reported in EMIS in a prior reporting period

Secondary Planning Element

****	Not Applicable
TPN	Transition Plan Not in Place
TFYG	(FYG-Four-Year Grad) Transitio Plan in Place. Student plans to meet graduation requirements four years after entering ninth grade.
TMYG	(MYG- Multi-Year-Grad) Transition Plan in Place. Student plans meet graduation requirements more than four years after entering ninth grade.
TPCE	(CPE - Planned Continuation of Ed services) Transition Plan in Place, student has met graduation requirements but needs additional education services prior to enrollment in college or employment and will continue to be enrolled and receive service as a Grade 23 student

Reporting Instructions. Determining when a student will have completed coursework and will graduate, or will have completed coursework but needs additional education services in preparation for employment or enrollment in college, is a decision made by the IEP team and documented on the transition plan.

The decision can be made any time PRIOR to the start of the student’s last year.

This decision may include, but is not limited to, IEPs that specify the student will need more than one year to complete the requirements for a single grade level. For example, option TMYG would be used if a student’s IEP specifies that the student needs two years to complete the coursework that is needed to move from ninth to tenth grade.

For a student to be reported with a grade level 23 in September, the IEP meeting date should precede the graduation date of the district, or for practical purposes, prior to Yearend (N) reporting. The IEP must include special education services. For example, a student with OHI disability can’t simply be code 23, and take all courses via PSEO.

Services Program Codes

0215001	Adapted Physical Education
215002	Aide
215003	Attendant
215004	Audiology
215006	Interpreting
215007	Medical
215008	Occupational Therapy
215009	Orientation and Mobility
215010	Physical Therapy
215011	Reader Services
215012	Psychological
215013	Speech-language Pathology
215015	Rehabilitation counseling
215017	Parent counseling and training
215018	Counseling
215020	Recreational
215021	Special Transportation
215022	Social Work
215026	School health services
215027	School nurse services
215023	Other

Assessment Codes
Required Test Type Element
Reminder - the test type and accommodations are based on the needs of the student as determined by the IEP team, and NOT the potential of the student’s score helping or hurting a district’s AYP performance. In general, the test type required by an IEP affects all tests to be taken by the student, including both classroom assessments and standardized tests such as the OAT.

STR	Standard (regular)
ALT	Alternate Assessment (Standards-based alternate assessment) as required by IEP
STA	Standard with Accommodations

Accommodations

Y1	504 plan accommodations
Y2	IEP accommodations
Y3	LEP accommodations other than the use of a dictionary and/or extended time