Archived Information

TABLE 3

PART B, INDIVIDUALS WITH DISABILITIES EDUCATION ACT

IMPLEMENTATION OF FAPE REQUIREMENTS

2001-2002 SCHOOL YEAR

Paperwork Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number for this
information collection is 1820-0517. The time required to complete this
information collection is estimated to average 18 hours per LEA and 25
hours per SEA response, including the time to review instructions,
search existing data resources, gather the data needed, and complete and
review the information collection. If you have any comments concerning
the accuracy of the time estimate(s) or suggestions for improving this
form, please write to: U.S. Department of Education, Washington, D.C.
20202-4651. If you have comments or concerns regarding the status of
your individual submission of this form, write directly to: Office of
Special Education Programs, U.S. Department of Education,
600 Independence Avenue, SW, Washington, D.C. 20202-4651.

Authorization: 20 U.S.C. 1411(d)(2), 1418(a)(1)(A)(iii),
1418(a)(1)(A)(iv), and 1418(a)(2)

Due Date: **November 1, 2002**

Sampling Allowed: Yes

Send Form to: Patricia J. Guard, Acting Director

> Office of Special Education Programs
>
> U.S. Department of Education
>
> Program Support Services Group
>
> Mail Stop 2642
>
> 400 Maryland Avenue, SW
>
> Washington, D.C. 20202-2642
>
> Attn: Cheryl Broady

General Instructions

In Section A, enter an unduplicated count of all children with
disabilities ages 3-5 served under the IDEA, Part B program, by age and
educational placement. In Section B, enter an unduplicated count of all
children with disabilities ages 3-5 served under the IDEA, Part B
program, by educational placement and

disability category. [^1] In Section C, enter an unduplicated count of
all children with disabilities ages 6-21 served under the IDEA, Part B
program, by age category and educational placement. Data on children
ages 6-21 must be provided by disability category.^1^

This table does not require a separate, certified count of children.
*However, it is intended to reflect the number of the children receiving
services, reported by the appropriate placement category, on the date of
the child count*. States have the option of using one of two child count
dates: the last Friday in October or December 1. States *must* use the
same date for reporting placement data that is used in reporting the
child count for that year.

All counts should represent the setting in which children with
disabilities have been placed for educational services. *The counts
reported in Sections D and E must be included in counts of Section C*.

Place zeros in categories where cells contain no numeric values. Enter
(-9) in categories where data are missing.

[Sampling Guidelines]{.underline}

States may use sampling to obtain these data. When sampling is used, a
description of the sampling methodology, including a statement about how
the design will yield valid and reliable estimates *must* be submitted
to OSEP for approval. The level of precision of the estimates to be
obtained must be specified. States must submit sampling plans to OSEP
for approval by September 30, 2001.

OSEP will evaluate the validity of the sampling plans using the
guidelines below.

1\. The sampling framework may include all school districts or a sample
of districts If a State chooses to sample districts, all districts with
average daily memberships of over 25,000 must be included in the sample
with one exception. If a State has more than 25 districts with ADMs over
25,000, the State must include all districts with over 50,000 ADM and
sample the districts under 50,000 ADM. The total number of districts
sampled *must* equal or exceed 100. If the total number districts in the
State is 100 or fewer, data must be collected from all districts.

2.  When sampling students, whether for all districts or for a sample of
    districts, data must be collected separately for each Federal
    disability category. All students whose domicile is in a district
    must be eligible for the sample including those students served in
    cooperatives and/or intermediate units or in residential programs
    out of the district.

3\. A minimum sample of 100 children *must* be used by all districts,
except where the total number in a disability category is less than 100.
In such a case, data *must* be collected for all students in that
category.

States that use sampling will provide OSEP with weighted rather than
unweighted data. A description of the final sample sizes and the weights
used should also be provided at the time the data are provided

[Specific Instructions]{.underline}

[Section A: Educational Placement of Children with Disabilities Ages
3-5]{.underline}

ENTER AN UNDUPLICATED COUNT OF ALL CHILDREN WITH DISABILITIES AGES 3-5
SERVED UNDER IDEA, PART B, BY DISCRETE AGE YEAR AND EDUCATIONAL
ENVIRONMENT.

Row A. Early Childhood Setting. *Unduplicated* total who received all of
their special education and related services in educational programs
designed primarily for children without disabilities. No education or
related services are provided in separate special education settings.
This may include, but is not limited to:

-   regular kindergarten classes;

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-   public or private preschools;

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-   Head Start Centers;

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-   child care facilities;

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-   preschool classes offered to an eligible pre-kindergarten population
    by the public school system;

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-   home/early childhood combinations;

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-   home/Head Start combinations; and

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-   other combinations of early childhood settings.

Row B. Early Childhood Special Education Setting. *Unduplicated* total
who received all of their special education and related services in
educational programs designed primarily for children with disabilities
housed in regular school buildings or other community-based settings. No
education or related services are provided in early childhood settings.
This may include, but is not limited to:

-   special education classrooms in regular school buildings;

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-   special education classrooms in child care facilities, hospital
    facilities on an outpatient basis, or other community-based
    settings; and

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-   special education classrooms in trailers or portables outside
    regular school buildings.

Row C. Home. *Unduplicated* total who received all of their special
education and related services in the principal residence of the
child\'s family or caregivers.

Row D. Part-Time Early Childhood/Part-Time Early Childhood Special
Education Setting. *Unduplicated* total who received services in
multiple settings, such that: (1) general and/or special education and
related services are provided at home or in educational programs
designed primarily for children *without* disabilities, and (2) special
education and related services are provided in programs designed
primarily for children *with* disabilities. This may include, but is not
limited to:

-   home/early childhood special education combinations;

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-   Head Start, child care, nursery school facilities, or other
    community-based settings with special education provided outside of
    the regular class;

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-   regular kindergarten classes with special education provided outside
    of the regular class;

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-   separate school/early childhood combinations; and

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-   residential facility/early childhood combinations.

Row E. Residential Facility. *Unduplicated* total who received all of
their special education and related services in publicly or privately
operated residential schools or residential medical facilities on an
inpatient basis.

Row F. Separate School. *Unduplicated* total who received all of their
special education and related services in educational programs in public
or private day schools designed specifically for children with
disabilities.

Row G. Itinerant Service Outside the Home (OPTIONAL). *Unduplicated*
total who received all of their special education and related services
at a school, hospital facility on an outpatient basis, or other location
for a short period of time (i.e., no more than 3 hours per week). (This
row does not include children receiving services at home; those children
are reported in row C.) These services may be provided individually or
to a small group of children. This may include, but is not limited to:
speech instruction up to 3 hours per week in a school, hospital, or
other community-based setting. Children receiving all of their special
education and related services at a school, hospital facility on an
outpatient basis, or other location for longer than 3 hours must be
reported under early childhood special education setting or early
childhood setting, depending on whether the program was designed
primarily for students with or without disabilities.

Row H. Reverse Mainstream Setting (OPTIONAL). *Unduplicated* total who
received all of their special education and related services in
educational programs designed primarily for children with disabilities
but that include 50 percent or more children without disabilities.

Row I. Total. The sum of rows A through H.

The order of the categories for preschoolers ages 3-5 does *not* reflect
a continuum from least to most restrictive. The categories are
alphabetical, with optional categories listed last.

**[Section B: Education Placement of Children with Disabilities Ages 3-5
by Disability]{.underline}**

ENTER AN UNDUPLICATED COUNT OF ALL CHILDREN WITH DISABILITIES AGES 3-5
SERVED UNDER IDEA, PART B, BY EDUCATIONAL PLACEMENT AND DISABILITY
CATEGORY. The categories reported in this section must sum to the total
reported in Section A.

Use the placement categories defined under Section A.

[Section C:  Educational Placement of Children with Disabilities Ages
6-21]{.underline}

*ENTER AN UNDUPLICATED COUNT OF ALL CHILDREN WITH DISABILITIES AGES 6-21
SERVED UNDER THE IDEA, PART B PROGRAM, BY AGE CATEGORY AND EDUCATIONAL
PLACEMENT. THE TOTAL LINE ON EACH TABLE MUST EQUAL THE SUM OF THE
DISABILITY CATEGORIES*.

**To calculate the percentage of time outside the regular classroom,
divide the number of hours the youth receives special education and
related services outside the regular classroom by the *total number of
hours in the school day*.**

Column A. Special education outside regular class less than 21 percent
of day. *Unduplicated* number of children with disabilities receiving
special education and related services outside the regular classroom for
less than 21 percent of the school day. This may include children with
disabilities placed in:

-   regular class with special education/related services provided
    within regular classes;

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-   regular class with special education/related services provided
    outside regular classes; or

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-   regular class with special education services provided in resource
    rooms.

Column B. Special education outside regular class at least 21 percent of
day and no more than 60 percent of day. *Unduplicated* total includes
children with disabilities receiving special education and related
services outside the regular classroom for at least 21 percent but no
more than 60 percent of the school day. This may include children placed
in:

-   resource rooms with special education/related services provided
    within the resource room; or

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-   resource rooms with part-time instruction in a regular class.

Column C. Special education outside regular class more than 60 percent
of day. *Unduplicated* total includes children with disabilities
receiving special education and related services outside the regular
classroom for more than 60 percent of the school day. Do not include
children who received education programs in public or private separate
day or residential facilities. This category may include children placed
in:

-   self-contained special classrooms with part-time instruction in a
    regular class; or

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-   self-contained special classrooms with full-time special education
    instruction on a regular school campus.

Column D. Public separate facility. *Unduplicated* total who received
education programs in public separate day school facilities includes
children with disabilities receiving special education and related
services for greater than 50 percent of the school day in public
separate facilities. This may include children placed in:

-   public day schools for students with disabilities; or

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-   public day schools for students with disabilities for a portion of
    the school day (greater than 50 percent) and in regular school
    buildings for the remainder of the school day.

Column E. Private separate facility. *Unduplicated* total who received
education programs in private separate day school facilities includes
children with disabilities receiving special education and related
services, at public expense, for greater than 50 percent of the school
day in private separate facilities. This may include children placed in:

-   private day schools for students with disabilities; or

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-   private day schools for students with disabilities for a portion of
    the school day (greater than 50 percent) and in regular school
    buildings for the remainder of the school day.

Column F. Public residential facility. *Unduplicated* total who received
education programs in public residential facilities includes children
with disabilities receiving special education and related services for
greater than 50 percent of the school day in public residential
facilities. This may include children placed in:

-   public residential schools for students with disabilities; or

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-   public residential schools for students with disabilities for a
    portion of the school day (greater than 50 percent) and in separate
    day schools or regular school buildings for the remainder of the
    school day.

Column G. Private residential facility. *Unduplicated* total who
received education programs in private residential facilities includes
children with disabilities receiving special education and related
services, at public expense, for greater than 50 percent of the school
day in private residential facilities. This may include children placed
in:

-   private residential schools for students with disabilities; or

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-   private residential schools for students with disabilities for a
    portion of the school day (greater than 50 percent) and in separate
    day schools or regular school buildings for the remainder of the
    school day.

Column H. Homebound/Hospital. *Unduplicated* total who received
education programs in homebound/hospital placement includes children
with disabilities placed in and receiving special education and related
services in:

-   hospital programs, or

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-   homebound programs.

[Section D:  Duplicative Count of Children with Disabilities
Served in Correctional Facilities]{.underline}

Indicate for each type of disability category the number of children
reported in Sections A and B who are receiving special education in
correctional facilities. *DATA REPORTED IN SECTION C ARE A DUPLICATED
COUNT OF SECTIONS A AND B*. These data are intended to be a count of all
children receiving special education in:

-   short-term detention facilities (community-based or residential), or

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-   correctional facilities.

[Section E:  Duplicative Count of Children with Disabilities
Enrolled in Private Schools Not Placed or Referred by Public
Agencies]{.underline}

*ENTER THE TOTAL NUMBER OF CHILDREN WITH DISABILITIES REPORTED IN
SECTION A AND B* who have been enrolled by their parents or guardians in
regular parochial or other private schools and whose basic education is
paid through private resources and who receive special education and
related services at public expense from a local educational agency or
intermediate educational unit under a service plan.[^2] (See 34 CFR
300.452.)

[Sections F and G:  Race/Ethnicity of Children with Disabilities Served
under IDEA, Part B]{.underline}

*ENTER AN UNDUPLICATED COUNT OF ALL CHILDREN WITH DISABILITIES SERVED
UNDER IDEA, PART B BY RACE/ETHNICITY AND EDUCATIONAL PLACEMENT. THE
TOTAL DATA REPORTED ON EACH LINE IN SECTION F MUST EQUAL THE TOTAL DATA
REPORTED IN THE CORRESPONDING EDUCATIONAL ENVIRONMENT IN SECTION A, AND
THE TOTAL DATA REPORTED ON EACH LINE IN SECTION G MUST EQUAL THE TOTAL
DATA REPORTED IN THE CORRESPONDING EDUCATIONAL ENVIRONMENT IN
SECTION C.*

In November 1997, OMB announced its decision concerning the revision of
Race and Ethnic Standards for Federal Statistics and Administrative
Reporting. In that announcement, OMB reported that there would be five
racial categories \-- American Indian or Alaska Native, Asian, Black or
African American, Native Hawaiian or Other Pacific Islander, and White
\-- and one ethnic category \-- Hispanic or Latino. Additionally, OMB
announced that individuals would be allowed to select as many
race/ethnicity categories as were applicable. Under the new reporting
requirements a single, multi-racial category cannot be used. OSEP is
currently working with OMB and other offices within ED to develop
reasonable categories for capturing aggregated data. OSEP expects to use
the new categories in the coming years.

The race/ethnicity categories are defined as follows:

  --------------------- -------------------------------------------------
  American Indian or    A person having origins in any of the original
  Alaska Native         peoples of North and South America (including
                        Central America) and who maintains tribal
                        affiliation or community recognition.

  Asian or Pacific      A person having origins in any of the original
  Islander              peoples of the Far East, Southeast Asia, the
                        Indian subcontinent, or the Pacific Islands. This
                        area includes, for example, China, India, Japan,
                        Korea, the Philippine Islands, and Samoa.

  Black (not Hispanic)  A person having origins in any of the Black
                        racial groups of Africa.

  Hispanic              A person of Mexican, Puerto Rican, Cuban, Central
                        or South American, or other Spanish culture or
                        origin, regardless of race.

  White (not Hispanic)  A person having origins in any of the original
                        peoples of Europe, North Africa or the Middle
                        East.

  Total                 The unduplicated total across the race/ethnicity
                        designations.
  --------------------- -------------------------------------------------

Note that children can only be reported in [one]{.underline}
race/ethnicity category.

[Section H: Duplicative Count of the Race/Ethnicity of Children with
Disabilities Served under IDEA, Part B in Correctional Facilities and
Parent-Initiated Private Schools]{.underline}

ENTER THE RACE/ETHNICITY DATA FOR STUDENTS REPORTED IN SECTIONS D AND E.

Use the race/ethnicity categories defined under Sections F and G. Note
that children can only be reported in one race/ethnicity category.

U.S. DEPARTMENT OF EDUCATION PAGE 1 OF 10

OFFICE OF SPECIAL EDUCATION TABLE 3

AND REHABILITATIVE SERVICES OMB NO.: 1820-0517

OFFICE OF SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES
EDUCATION ACT

PROGRAMS IMPLEMENTATION OF FAPE REQUIREMENTS FORM EXPIRES:

2000-2001 SCHOOL YEAR

STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SECTION A: EDUCATIONAL PLACEMENT OF CHILDREN WITH DISABILITIES AGES 3-5

+-------------------------------------+-------+-------+-------+-------+
| EDUCATIONAL PLACEMENT:              | AGE   |       |       |       |
+-------------------------------------+-------+-------+-------+-------+
|                                     | 3     | 4     | 5     | Total |
+-------------------------------------+-------+-------+-------+-------+
| \(A\) EARLY CHILDHOOD SETTING       |       |       |       |       |
+-------------------------------------+-------+-------+-------+-------+
| \(B\) EARLY CHILDHOOD SPECIAL       |       |       |       |       |
| EDUCATION SETTING                   |       |       |       |       |
+-------------------------------------+-------+-------+-------+-------+
| \(C\) HOME                          |       |       |       |       |
+-------------------------------------+-------+-------+-------+-------+
| \(D\) PART‑TIME EARLY               |       |       |       |       |
| CHILDHOOD/PART‑TIME EARLY CHILDHOOD |       |       |       |       |
| SPECIAL                             |       |       |       |       |
|                                     |       |       |       |       |
| EDUCATION SETTING                   |       |       |       |       |
+-------------------------------------+-------+-------+-------+-------+
| \(E\) RESIDENTIAL FACILITY          |       |       |       |       |
+-------------------------------------+-------+-------+-------+-------+
| \(F\) SEPARATE SCHOOL               |       |       |       |       |
+-------------------------------------+-------+-------+-------+-------+
| \(G\) ITINERANT SERVICE OUTSIDE THE |       |       |       |       |
| HOME (OPTIONAL)                     |       |       |       |       |
+-------------------------------------+-------+-------+-------+-------+
| \(H\) REVERSE MAINSTREAM SETTING    |       |       |       |       |
| (OPTIONAL)                          |       |       |       |       |
+-------------------------------------+-------+-------+-------+-------+
| \(I\) TOTAL                         |       |       |       |       |
+-------------------------------------+-------+-------+-------+-------+

ED FORM: 869-4

> The order of the categories does not reflect a continuum from least to
> most restrictive. The categories are alphabetized, with the exception
> of the two optional categories, which are listed at the end.

U.S. DEPARTMENT OF EDUCATION PAGE 2 OF 10

OFFICE OF SPECIAL EDUCATION TABLE 3 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0517

OFFICE OF SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES
EDUCATION ACT

PROGRAMS IMPLEMENTATION OF FAPE REQUIREMENTS FORM EXPIRES:

2000-2001 SCHOOL YEAR

STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**SECTION B: EDUCATIONAL PLACEMENT OF CHILDREN WITH DISABILITIES AGES
3-5**

  -------------------- ------------- ------------- ------------- ---------------------
  **\                  **\           **\           **\           **(D)\
  \                    \             \             \             PART-TIME EARLY
  \                    (A)\          (B)\          \             CHILDHOOD/PART-TIME
  \                    EARLY         EARLY         (C)\          EARLY CHILDHOOD
  EDUCATIONAL          CHILDHOOD\    CHILDHOOD     HOME**        SPECIAL EDUCATION
  PLACEMENT:**         SETTING**     SPECIAL                     SETTINGS**
                                     EDUCATION                   
                                     SETTING**                   

  **DISABILITY**       **AGES 3-5**                              

  **MENTAL                                                       
  RETARDATION**                                                  

  **HEARING                                                      
  IMPAIRMENTS**                                                  

  **SPEECH OR LANGUAGE                                           
  IMPAIRMENTS**                                                  

  **VISUAL                                                       
  IMPAIRMENTS**                                                  

  **EMOTIONAL                                                    
  DISTURBANCE**                                                  

  **ORTHOPEDIC                                                   
  IMPAIRMENTS**                                                  

  **OTHER HEALTH                                                 
  IMPAIRMENTS**                                                  

  **SPECIFIC LEARNING                                            
  DISABILITIES**                                                 

  **DEAF-BLINDNESS**                                             

  **MULTIPLE                                                     
  DISABILITIES**                                                 

  **AUTISM**                                                     

  **TRAUMATIC BRAIN                                              
  INJURY**                                                       

  **DEVELOPMENTAL                                                
  DELAY\***                                                      

  **TOTAL:**                                                     
  -------------------- ------------- ------------- ------------- ---------------------

**ED FORM: 869-4**

> **\*States must have defined and established eligibility criteria for
> developmental delay in order to use this category for reporting.**

U.S. DEPARTMENT OF EDUCATION PAGE 3 OF 10

OFFICE OF SPECIAL EDUCATION TABLE 3 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0517

OFFICE OF SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES
EDUCATION ACT

PROGRAMS IMPLEMENTATION OF FAPE REQUIREMENTS FORM EXPIRES:

2000-2001 SCHOOL YEAR

STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**SECTION B (continued)**

  -------------------- ------------- ------------- -------------- --------------
  **\                  **\           **\           **(G)\         **\
  \                    \             \             ITINERANT      (H)\
  \                    (E)\          (F)\          SERVICE        REVERSE
  EDUCATIONAL          RESIDENTIAL   SEPARATE      OUTSIDE THE    MAINSTREAM
  PLACEMENT:**         FACILITY**    SCHOOL**      HOME           SETTING
                                                   (OPTIONAL)**   (OPTIONAL)**

  **DISABILITY**       **AGES 3-5**                               

  **MENTAL                                                        
  RETARDATION**                                                   

  **HEARING                                                       
  IMPAIRMENTS**                                                   

  **SPEECH OR LANGUAGE                                            
  IMPAIRMENTS**                                                   

  **VISUAL                                                        
  IMPAIRMENTS**                                                   

  **EMOTIONAL                                                     
  DISTURBANCE**                                                   

  **ORTHOPEDIC                                                    
  IMPAIRMENTS**                                                   

  **OTHER HEALTH                                                  
  IMPAIRMENTS**                                                   

  **SPECIFIC LEARNING                                             
  DISABILITIES**                                                  

  **DEAF-BLINDNESS**                                              

  **MULTIPLE                                                      
  DISABILITIES**                                                  

  **AUTISM**                                                      

  **TRAUMATIC BRAIN                                               
  INJURY**                                                        

  **DEVELOPMENTAL                                                 
  DELAY\***                                                       

  **TOTAL:**                                                      
  -------------------- ------------- ------------- -------------- --------------

**ED FORM: 869-4**

> **\*States must have defined and established eligibility criteria for
> developmental delay in order to use this category for reporting.**

U.S. DEPARTMENT OF EDUCATION PAGE 4 OF 10

OFFICE OF SPECIAL EDUCATION TABLE 3 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0517

OFFICE OF SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES
EDUCATION ACT

PROGRAMS IMPLEMENTATION OF FAPE REQUIREMENTS FORM EXPIRES:

2000-2001 SCHOOL YEAR

STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SECTION C: EDUCATIONAL PLACEMENT OF CHILDREN WITH DISABILITIES AGES 6-21

+------------------+-------+-------+-------+-------+-------+-------+
| EDUCATIONAL      | \(A\) |       |       | \(B\) |       |       |
| PLACEMENT:       |       |       |       |       |       |       |
|                  | CHI   |       |       | CHI   |       |       |
|                  | LDREN |       |       | LDREN |       |       |
|                  | WHO   |       |       | WHO   |       |       |
|                  | REC   |       |       | REC   |       |       |
|                  | EIVED |       |       | EIVED |       |       |
|                  |       |       |       |       |       |       |
|                  | SP    |       |       | SP    |       |       |
|                  | ECIAL |       |       | ECIAL |       |       |
|                  | EDUC  |       |       | EDUC  |       |       |
|                  | ATION |       |       | ATION |       |       |
|                  | OU    |       |       | OU    |       |       |
|                  | TSIDE |       |       | TSIDE |       |       |
|                  | THE   |       |       | THE   |       |       |
|                  | RE    |       |       | RE    |       |       |
|                  | GULAR |       |       | GULAR |       |       |
|                  | CLASS |       |       | CLASS |       |       |
|                  | LESS  |       |       | AT    |       |       |
|                  | THAN  |       |       | LEAST |       |       |
|                  | 21    |       |       | 21    |       |       |
|                  | PE    |       |       | PE    |       |       |
|                  | RCENT |       |       | RCENT |       |       |
|                  | OF    |       |       | OF    |       |       |
|                  | DAY   |       |       | DAY   |       |       |
|                  | BY    |       |       | BUT   |       |       |
|                  | AGE   |       |       | NO    |       |       |
|                  | CAT   |       |       | MORE  |       |       |
|                  | EGORY |       |       | THAN  |       |       |
|                  |       |       |       | 60    |       |       |
|                  |       |       |       | PE    |       |       |
|                  |       |       |       | RCENT |       |       |
|                  |       |       |       | OF    |       |       |
|                  |       |       |       | DAY   |       |       |
|                  |       |       |       | BY    |       |       |
|                  |       |       |       | AGE   |       |       |
|                  |       |       |       | CAT   |       |       |
|                  |       |       |       | EGORY |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DISABILITY       | \(1\) | \(2\) | \(3\) | \(4\) | \(5\) | \(6\) |
|                  |       |       |       |       |       |       |
|                  | 6-11  | 12-17 | 18-21 | 6-11  | 12-17 | 18-21 |
+------------------+-------+-------+-------+-------+-------+-------+
| MENTAL           |       |       |       |       |       |       |
| RETARDATION      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| HEARING          |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| SPEECH OR        |       |       |       |       |       |       |
| LANGUAGE         |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| VISUAL           |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| EMOTIONAL        |       |       |       |       |       |       |
| DISTURBANCE      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| ORTHOPEDIC       |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| OTHER HEALTH     |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| SPECIFIC         |       |       |       |       |       |       |
| LEARNING         |       |       |       |       |       |       |
| DISABILITIES     |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DEAF-BLINDNESS   |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| MULTIPLE         |       |       |       |       |       |       |
| DISABILITIES     |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| AUTISM           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| TRAUMATIC BRAIN  |       |       |       |       |       |       |
| INJURY           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DEVELOPMENTAL    |       |       |       |       |       |       |
| DELAY\*          |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| TOTAL:           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+

\* States must have defined and established eligibility criteria for
developmental delay in order to use this category for reporting.

ED FORM: 869-4

U.S. DEPARTMENT OF EDUCATION PAGE 5 OF 10

OFFICE OF SPECIAL EDUCATION TABLE 3 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0517

OFFICE OF SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES
EDUCATION ACT

PROGRAMS IMPLEMENTATION OF FAPE REQUIREMENTS FORM EXPIRES:

2000-2001 SCHOOL YEAR

STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SECTION C (continued)

+------------------+-------+-------+-------+-------+-------+-------+
| EDUCATIONAL      | \(C\) |       |       | \(D\) |       |       |
| PLACEMENT:       |       |       |       |       |       |       |
|                  | CHI   |       |       | CHI   |       |       |
|                  | LDREN |       |       | LDREN |       |       |
|                  | WHO   |       |       | WHO   |       |       |
|                  | REC   |       |       | REC   |       |       |
|                  | EIVED |       |       | EIVED |       |       |
|                  |       |       |       |       |       |       |
|                  | SP    |       |       | SP    |       |       |
|                  | ECIAL |       |       | ECIAL |       |       |
|                  | EDUC  |       |       | EDUC  |       |       |
|                  | ATION |       |       | ATION |       |       |
|                  | OU    |       |       | IN    |       |       |
|                  | TSIDE |       |       | P     |       |       |
|                  | RE    |       |       | UBLIC |       |       |
|                  | GULAR |       |       |       |       |       |
|                  | CLASS |       |       | SEP   |       |       |
|                  | FOR   |       |       | ARATE |       |       |
|                  | MORE  |       |       | FAC   |       |       |
|                  | THAN  |       |       | ILITY |       |       |
|                  | 60    |       |       | BY    |       |       |
|                  | PE    |       |       | AGE   |       |       |
|                  | RCENT |       |       | CAT   |       |       |
|                  | OF    |       |       | EGORY |       |       |
|                  | DAY   |       |       |       |       |       |
|                  | BY    |       |       |       |       |       |
|                  | AGE   |       |       |       |       |       |
|                  | CAT   |       |       |       |       |       |
|                  | EGORY |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DISABILITY       | \(7\) | \(8\) | \(9\) | \     | \     | \     |
|                  |       |       |       | (10\) | (11\) | (12\) |
|                  | 6-11  | 12-17 | 18-21 |       |       |       |
|                  |       |       |       | 6-11  | 12-17 | 18-21 |
+------------------+-------+-------+-------+-------+-------+-------+
| MENTAL           |       |       |       |       |       |       |
| RETARDATION      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| HEARING          |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| SPEECH OR        |       |       |       |       |       |       |
| LANGUAGE         |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| VISUAL           |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| EMOTIONAL        |       |       |       |       |       |       |
| DISTURBANCE      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| ORTHOPEDIC       |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| OTHER HEALTH     |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| SPECIFIC         |       |       |       |       |       |       |
| LEARNING         |       |       |       |       |       |       |
| DISABILITIES     |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DEAF-BLINDNESS   |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| MULTIPLE         |       |       |       |       |       |       |
| DISABILITIES     |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| AUTISM           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| TRAUMATIC BRAIN  |       |       |       |       |       |       |
| INJURY           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DEVELOPMENTAL    |       |       |       |       |       |       |
| DELAY\*          |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| TOTAL:           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+

\* States must have defined and established eligibility criteria for
developmental delay in order to use this category for reporting.

ED FORM: 869-4

U.S. DEPARTMENT OF EDUCATION PAGE 6 OF 10

OFFICE OF SPECIAL EDUCATION TABLE 3 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0517

OFFICE OF SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES
EDUCATION ACT

PROGRAMS IMPLEMENTATION OF FAPE REQUIREMENTS FORM EXPIRES:

2000-2001 SCHOOL YEAR

STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SECTION C (continued)

+------------------+-------+-------+-------+-------+-------+-------+
| EDUCATIONAL      | \(E\) |       |       | \(F\) |       |       |
| PLACEMENT:       |       |       |       |       |       |       |
|                  | CHI   |       |       | CHI   |       |       |
|                  | LDREN |       |       | LDREN |       |       |
|                  | WHO   |       |       | WHO   |       |       |
|                  | REC   |       |       | REC   |       |       |
|                  | EIVED |       |       | EIVED |       |       |
|                  |       |       |       |       |       |       |
|                  | SP    |       |       | SP    |       |       |
|                  | ECIAL |       |       | ECIAL |       |       |
|                  | EDUC  |       |       | EDUC  |       |       |
|                  | ATION |       |       | ATION |       |       |
|                  | IN    |       |       | IN    |       |       |
|                  | PR    |       |       | P     |       |       |
|                  | IVATE |       |       | UBLIC |       |       |
|                  |       |       |       |       |       |       |
|                  | SEP   |       |       | R     |       |       |
|                  | ARATE |       |       | ESIDE |       |       |
|                  | FAC   |       |       | NTIAL |       |       |
|                  | ILITY |       |       | FAC   |       |       |
|                  | BY    |       |       | ILITY |       |       |
|                  | AGE   |       |       | BY    |       |       |
|                  | CAT   |       |       | AGE   |       |       |
|                  | EGORY |       |       | CAT   |       |       |
|                  |       |       |       | EGORY |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DISABILITY       | \     | \     | \     | \     | \     | \     |
|                  | (13\) | (14\) | (15\) | (16\) | (17\) | (18\) |
|                  |       |       |       |       |       |       |
|                  | 6-11  | 12-17 | 18-21 | 6-11  | 12-17 | 18-21 |
+------------------+-------+-------+-------+-------+-------+-------+
| MENTAL           |       |       |       |       |       |       |
| RETARDATION      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| HEARING          |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| SPEECH OR        |       |       |       |       |       |       |
| LANGUAGE         |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| VISUAL           |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| EMOTIONAL        |       |       |       |       |       |       |
| DISTURBANCE      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| ORTHOPEDIC       |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| OTHER HEALTH     |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| SPECIFIC         |       |       |       |       |       |       |
| LEARNING         |       |       |       |       |       |       |
| DISABILITIES     |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DEAF-BLINDNESS   |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| MULTIPLE         |       |       |       |       |       |       |
| DISABILITIES     |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| AUTISM           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| TRAUMATIC BRAIN  |       |       |       |       |       |       |
| INJURY           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DEVELOPMENTAL    |       |       |       |       |       |       |
| DELAY\*          |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| TOTAL:           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+

\* States must have defined and established eligibility criteria for
developmental delay in order to use this category for reporting.

ED FORM: 869-4

U.S. DEPARTMENT OF EDUCATION PAGE 7 OF 10

OFFICE OF SPECIAL EDUCATION TABLE 3 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0517

OFFICE OF SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES
EDUCATION ACT

PROGRAMS IMPLEMENTATION OF FAPE REQUIREMENTS FORM EXPIRES:

2000-2001 SCHOOL YEAR

STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SECTION C (continued)

+------------------+-------+-------+-------+-------+-------+-------+
| EDUCATIONAL      | \(G\) |       |       | \(H\) |       |       |
| PLACEMENT:       |       |       |       |       |       |       |
|                  | CHI   |       |       | CHI   |       |       |
|                  | LDREN |       |       | LDREN |       |       |
|                  | WHO   |       |       | WHO   |       |       |
|                  | REC   |       |       | REC   |       |       |
|                  | EIVED |       |       | EIVED |       |       |
|                  |       |       |       |       |       |       |
|                  | SP    |       |       | SP    |       |       |
|                  | ECIAL |       |       | ECIAL |       |       |
|                  | EDUC  |       |       | EDUC  |       |       |
|                  | ATION |       |       | ATION |       |       |
|                  | IN    |       |       | IN    |       |       |
|                  | PR    |       |       | HOM   |       |       |
|                  | IVATE |       |       | EBOUN |       |       |
|                  |       |       |       | D/HOS |       |       |
|                  | R     |       |       | PITAL |       |       |
|                  | ESIDE |       |       |       |       |       |
|                  | NTIAL |       |       | PLAC  |       |       |
|                  | FAC   |       |       | EMENT |       |       |
|                  | ILITY |       |       | BY    |       |       |
|                  | BY    |       |       | AGE   |       |       |
|                  | AGE   |       |       | CAT   |       |       |
|                  | CAT   |       |       | EGORY |       |       |
|                  | EGORY |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DISABILITY       | \     | \     | \     | \     | \     | \     |
|                  | (19\) | (20\) | (21\) | (22\) | (23\) | (24\) |
|                  |       |       |       |       |       |       |
|                  | 6-11  | 12-17 | 18-21 | 6-11  | 12-17 | 18-21 |
+------------------+-------+-------+-------+-------+-------+-------+
| MENTAL           |       |       |       |       |       |       |
| RETARDATION      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| HEARING          |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| SPEECH OR        |       |       |       |       |       |       |
| LANGUAGE         |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| VISUAL           |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| EMOTIONAL        |       |       |       |       |       |       |
| DISTURBANCE      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| ORTHOPEDIC       |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| OTHER HEALTH     |       |       |       |       |       |       |
| IMPAIRMENTS      |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| SPECIFIC         |       |       |       |       |       |       |
| LEARNING         |       |       |       |       |       |       |
| DISABILITIES     |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DEAF-BLINDNESS   |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| MULTIPLE         |       |       |       |       |       |       |
| DISABILITIES     |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| AUTISM           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| TRAUMATIC BRAIN  |       |       |       |       |       |       |
| INJURY           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| DEVELOPMENTAL    |       |       |       |       |       |       |
| DELAY\*          |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+
| TOTAL:           |       |       |       |       |       |       |
+------------------+-------+-------+-------+-------+-------+-------+

\* States must have defined and established eligibility criteria for
developmental delay in order to use this category for reporting.

ED FORM: 869-4

U.S. DEPARTMENT OF EDUCATION PAGE 8 OF 10

OFFICE OF SPECIAL EDUCATION TABLE 3 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0517

OFFICE OF SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES
EDUCATION ACT

PROGRAMS IMPLEMENTATION OF FAPE REQUIREMENTS FORM EXPIRES:

2000-2001 SCHOOL YEAR

STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

+----------------+---------------+-------+-------------------+-------+
| SECTION D:     |               |       | SECTION E:        |       |
| *DUPLICATED    |               |       | *DUPLICATED       |       |
| COUNT* OF      |               |       | COUNT* OF         |       |
| CHILDREN WITH  |               |       | CHILDREN WITH     |       |
| DISABILITIES   |               |       | DISABILITIES      |       |
| SERVED IN      |               |       | ENROLLED IN       |       |
| CORRECTIONAL   |               |       | PRIVATE SCHOOLS   |       |
| FACILITIES     |               |       | NOT PLACED OR     |       |
|                |               |       | REFERRED BY       |       |
|                |               |       | PUBLIC AGENCIES   |       |
+----------------+---------------+-------+-------------------+-------+
|                |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| EDUCATIONAL    | CHILDREN WHO  |       | CHILDREN WITH     |       |
| PLACEMENT:     |               |       | DISABILITIES      |       |
|                | RECEIVED      |       | ENROLLED IN       |       |
|                | SPECIAL       |       | PRIVATE SCHOOLS   |       |
|                | EDUCATION     |       | NOT PLACED OR     |       |
|                |               |       | REFERRED BY       |       |
|                | IN            |       | PUBLIC AGENCIES   |       |
|                | CORRECTIONAL  |       |                   |       |
|                | FACILITIES    |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| DISABILITY     | THROUGH AGE   |       | AGES 3-21         |       |
|                | 21            |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| MENTAL         |               |       | TOTAL             |       |
| RETARDATION    |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| HEARING        |               |       |                   |       |
| IMPAIRMENTS    |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| SPEECH OR      |               |       |                   |       |
| LANGUAGE       |               |       |                   |       |
| IMPAIRMENTS    |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| VISUAL         |               |       |                   |       |
| IMPAIRMENTS    |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| EMOTIONAL      |               |       |                   |       |
| DISTURBANCE    |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| ORTHOPEDIC     |               |       |                   |       |
| IMPAIRMENTS    |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| OTHER HEALTH   |               |       |                   |       |
| IMPAIRMENTS    |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| SPECIFIC       |               |       |                   |       |
| LEARNING       |               |       |                   |       |
| DISABILITIES   |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| DEAF-BLINDNESS |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| MULTIPLE       |               |       |                   |       |
| DISABILITIES   |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| AUTISM         |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| TRAUMATIC      |               |       |                   |       |
| BRAIN INJURY   |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| DEVELOPMENTAL  |               |       |                   |       |
| DELAY\*        |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+
| TOTAL:         |               |       |                   |       |
+----------------+---------------+-------+-------------------+-------+

\* States must have defined and established eligibility criteria for
developmental delay in order to use this category for reporting.

ED FORM: 869-4

U.S. DEPARTMENT OF EDUCATION PAGE 9 OF 10

OFFICE OF SPECIAL EDUCATION TABLE 3 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0517

OFFICE OF SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES
EDUCATION ACT

PROGRAMS IMPLEMENTATION OF FAPE REQUIREMENTS FORM EXPIRES:

2000-2001 SCHOOL YEAR

STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SECTION F: RACE/ETHNICITY OF CHILDREN WITH DISABILITIES AGES 3-5 BY
EDUCATIONAL ENVIRONMENT

+-----------------+--------+-------+--------+-------+-------+-------+
| EDUCATIONAL     | RA     |       |        |       |       |       |
| ENVIRONMENT     | CE/ETH |       |        |       |       |       |
|                 | NICITY |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
|                 | AM     | ASIAN | BLACK  | HIS   | WHITE | TOTAL |
|                 | ERICAN | OR    |        | PANIC | (Not  |       |
|                 | INDIAN | PA    | (Not   |       | Hisp  |       |
|                 | OR     | CIFIC | His    |       | anic) |       |
|                 | ALASKA | ISL   | panic) |       |       |       |
|                 | NATIVE | ANDER |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(A\) EARLY     |        |       |        |       |       |       |
| CHILDHOOD       |        |       |        |       |       |       |
| SETTING         |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(B\) EARLY     |        |       |        |       |       |       |
| CHILDHOOD       |        |       |        |       |       |       |
| SPECIAL         |        |       |        |       |       |       |
| EDUCATION       |        |       |        |       |       |       |
| SETTING         |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(C\) HOME      |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(D\) PART-TIME |        |       |        |       |       |       |
| EARLY           |        |       |        |       |       |       |
| CHILDHOOD/      |        |       |        |       |       |       |
|                 |        |       |        |       |       |       |
| > PART-TIME     |        |       |        |       |       |       |
| > EARLY         |        |       |        |       |       |       |
| > CHILDHOOD     |        |       |        |       |       |       |
| > SPECIAL       |        |       |        |       |       |       |
| > EDUCATION     |        |       |        |       |       |       |
| > SETTING       |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(E\)           |        |       |        |       |       |       |
| RESIDENTIAL     |        |       |        |       |       |       |
| FACILITY        |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(F\) SEPARATE  |        |       |        |       |       |       |
| SCHOOL          |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(G\) ITINERANT |        |       |        |       |       |       |
| SERVICE OUTSIDE |        |       |        |       |       |       |
| THE HOME        |        |       |        |       |       |       |
| (OPTIONAL)      |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(H\) REVERSE   |        |       |        |       |       |       |
| MAINSTREAM      |        |       |        |       |       |       |
| SETTING         |        |       |        |       |       |       |
| (OPTIONAL)      |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(I\) TOTAL (OF |        |       |        |       |       |       |
| COLUMNS):       |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+

ED FORM: 869-4

The order of the categories does not reflect a continuum from least to
most restrictive. The categories are alphabetized, with the exception of
the two optional categories, which are listed at the end.

U.S. DEPARTMENT OF EDUCATION PAGE 10 OF 10

OFFICE OF SPECIAL EDUCATION TABLE 3 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0517

OFFICE OF SPECIAL EDUCATION PART B, INDIVIDUALS WITH DISABILITIES
EDUCATION ACT

PROGRAMS IMPLEMENTATION OF FAPE REQUIREMENTS FORM EXPIRES:

2000-2001 SCHOOL YEAR

STATE: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SECTION G: RACE/ETHNICITY OF CHILDREN WITH DISABILITIES AGES 6-21 BY
EDUCATIONAL ENVIRONMENT

+-----------------+--------+-------+--------+-------+-------+-------+
| EDUCATIONAL     | RA     |       |        |       |       |       |
| ENVIRONMENT     | CE/ETH |       |        |       |       |       |
|                 | NICITY |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
|                 | AM     | ASIAN | BLACK  | HIS   | WHITE | TOTAL |
|                 | ERICAN | OR    |        | PANIC | (Not  |       |
|                 | INDIAN | PA    | (Not   |       | Hisp  |       |
|                 | OR     | CIFIC | His    |       | anic) |       |
|                 | ALASKA | ISL   | panic) |       |       |       |
|                 | NATIVE | ANDER |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(A\) SPECIAL   |        |       |        |       |       |       |
| EDUCATION       |        |       |        |       |       |       |
| OUTSIDE REGULAR |        |       |        |       |       |       |
| CLASS LESS THAN |        |       |        |       |       |       |
| 21% OF DAY      |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(B\) SPECIAL   |        |       |        |       |       |       |
| EDUCATION       |        |       |        |       |       |       |
| OUTSIDE REGULAR |        |       |        |       |       |       |
| CLASS AT LEAST  |        |       |        |       |       |       |
| 21% OF DAY AND  |        |       |        |       |       |       |
| NO MORE THAN    |        |       |        |       |       |       |
| 60% OF DAY      |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(C\) SPECIAL   |        |       |        |       |       |       |
| EDUCATION       |        |       |        |       |       |       |
| OUTSIDE REGULAR |        |       |        |       |       |       |
| CLASS MORE LESS |        |       |        |       |       |       |
| THAN 60% OF DAY |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(D\) PUBLIC    |        |       |        |       |       |       |
| SEPARATE SCHOOL |        |       |        |       |       |       |
| FACILITY        |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(E\) PRIVATE   |        |       |        |       |       |       |
| SEPARATE SCHOOL |        |       |        |       |       |       |
| FACILITY        |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(F\) PUBLIC    |        |       |        |       |       |       |
| RESIDENTIAL     |        |       |        |       |       |       |
| FACILITY        |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(G\) PRIVATE   |        |       |        |       |       |       |
| RESIDENTIAL     |        |       |        |       |       |       |
| FACILITY        |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(H\)           |        |       |        |       |       |       |
| HOM             |        |       |        |       |       |       |
| EBOUND/HOSPITAL |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| \(I\) TOTAL (OF |        |       |        |       |       |       |
| ROWS A-H):      |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| SECTION H:      |        |       |        |       |       |       |
| RACE/ETHNICITY  |        |       |        |       |       |       |
| OF CHILDREN     |        |       |        |       |       |       |
| WITH            |        |       |        |       |       |       |
| DISABILITIES    |        |       |        |       |       |       |
| REPORTED IN     |        |       |        |       |       |       |
| SECTIONS D & E  |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| CORRECTIONAL    |        |       |        |       |       |       |
| FACILITIES      |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+
| CHILDREN WITH   |        |       |        |       |       |       |
| DISABILITIES    |        |       |        |       |       |       |
| ENROLLED IN     |        |       |        |       |       |       |
| PRIVATE SCHOOLS |        |       |        |       |       |       |
| NOT PLACED OR   |        |       |        |       |       |       |
| REFERRED BY     |        |       |        |       |       |       |
| PUBLIC AGENCIES |        |       |        |       |       |       |
+-----------------+--------+-------+--------+-------+-------+-------+

ED FORM: 869-4

[^1]: Children ages 3 through 9 may be reported under the category
    developmental delay in those States in which diagnostic instruments
    and procedures have been put in place to measure delays in one or
    more of the following areas: physical development, cognitive
    development, communication development, social or emotional
    development, or adaptive development. States must have defined and
    established eligibility criteria for developmental delay in order to
    use this category for reporting.

    The reporting of data on developmental delay is optional. Neither
    States nor LEAs are required to use this category. States and LEAs
    having diagnostic instruments and procedures in place to measure
    delays in one or more of the specified areas may report the number
    of students having developmental delays at their discretion.

[^2]: ^2^ A private institution or school is a school NOT under Federal
    or public supervision or control and may be non-profit or
    proprietary.