Fillable REPORT TO THE CPSE/CSE JUSTIFICATION FOR SUMMER PROGRAMMING (Monroe-Woodbury Central School District)

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REPORT TO THE CPSE/CSE JUSTIFICATION FOR SUMMER PROGRAMMING (Monroe-Woodbury Central School District)

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REPORT TO THE CPSE/CSE
JUSTIFICATION FOR SUMMER PROGRAMMING
Student: District:
Last
First
Recommended Service: Days/Week Minutes/Sessions
Location:
Service Provider (s):
RATIONALE FOR SUMMER PROGRAMING
1. Describe the specific skill areas in which substantial regression would occur without summer services.
Substantial regression means a student’s inability to maintain developmental levels due to loss of skill or
knowledge during the months of July and August of such severity as to require them to take an inordinate period
of review at the beginning of the school year (8 weeks or more) to reestablish and maintain IEP goals and
objectives mastered at the end of the previous school year.
2. Please provide quantitative and qualitative information to support evidence of previous regression or that would
predict regression in the future.
Do not alter Essex County Forms they have been designed to meet State and Federal requirements.
3. Please provide student attendance data for the school year thus far as well as the previous summer (if
applicable).
4. Please review the above recommendation with the student’s parents and have them sign below.
I agree with recommendation for summer services described above and verify that my child is available to
attend during the six (6) week program. I understand that this recommendation will need to be reviewed
and approved by the CPSE/CSE prior to the start.
Parent’s Signature Date
Service Provider’s Signature Date
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REPORT TO THE CPSECSE JUSTIFICATION FOR SUMMER PROGRAMMING (Monroe-Woodbury Central School District)

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Completed 15 April 2021

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