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									                     Educational Environment Calculation Form 6 to 21 Year Old
     1. Student's Name:                                                     6. Total Minutes in the
                                                                                                        0
             2. MSIS ID:                                                               School Day
       3. Student's DOB
              4. District:
              5. School:
                                                          8. Location  9. Minutes     10. Minutes
 7. Class/Subject/Course Name (Enter any concurrent
                                                        (Gen Ed, SPED, per day in      per day in
               classes on the same line)
                                                             Both)       Gen Ed          SPED




11. Bell Schedule (Time Between Periods)
12a. Lunch
12b. Recess/Break
                                                        13. Total
                                                                              0             0
                                                        Minutes:
                             15a. Number 15b. Number                  17. Minutes 18. Minutes
                               of times    of times                     for each    for each
                                                      16. Location of                          19. Related
                                Related     Related                       time        time
  14. Name of Related                                 Related Service                         Service Total
                                Service     Service                     Related     Related
        Service                                       (Gen Ed, SPED,                           Minutes per
                              offered per offered per                  Service is  Service is
                                                           Both)                              week in SPED
                             week in Gen    week in                    offered in  offered in
                              Ed Setting SPED Setting                    Gen Ed      SPED
                                                                                                        0
                                                                                                        0
                                                                                                        0
                                                                                                        0
                                                                                                        0
                                                                                                        0
                                                                                                        0
                                                           20. Total
                                                                              0             0           0
                                                           Minutes
                                               21. Percent of time student is in general education:   #DIV/0!

                                              22. Placement:                             #DIV/0!
            23. Signature of Person Completing Form:
                                  24. Date Completed:

                                                                                         Revised 05/09/2007
                            Educational Environment Calculation Form 6 to 21 Year Old
      1. Student's Name:                                                               6. Total Minutes in the
                                                                                                                    390
              2. MSIS ID:                                                                         School Day
                             HS Example in Gen Ed Classes - Note the example of
                             student having Both Gen Ed and SPED as their Location in
         3. Student's DOB the PE and OT below.
                4. District:
                5. School:
                                                                         8. Location  9. Minutes   10. Minutes
 7. Class/Subject/Course Name (Enter any concurrent classes on
                                                                      (Gen Ed, SPED, per day in     per day in
                             the same line)
                                                                            Both)       Gen Ed        SPED
English                                                                     Gen Ed        57             0
History - MS Studies                                                        Gen Ed        57             0
Math - Alg I                                                                Gen Ed        57             0
Tutorial                                                                    SPED           0            57
Science                                                                     SPED           0            57
PE, Adaptive PE                                                              Both         37            20




11. Bell Schedule                                                        Gen Ed          18             0
12a. Lunch                                                               Gen Ed          20             0
12b. Recess/Break                                                        Gen Ed          10             0
                                                                    13. Total
                                                                                         256          134
                                                                    Minutes:
                                                    15b. Number                  17. Minutes 18. Minutes
                                                      of times                     for each    for each
                             15a. Number of times                16. Location of                          19. Related
                                                       Related                       time        time
  14. Name of Related       Related Service offered              Related Service                         Service Total
                                                       Service                     Related     Related
        Service               per week in Gen Ed                 (Gen Ed, SPED,                           Minutes per
                                                     offered per                  Service is  Service is
                                    Setting                           Both)                              week in SPED
                                                    week in SPED                  offered in  offered in
                                                       Setting                      Gen Ed      SPED
OT                                     1                  1            Both            20          30          30
PT                                     1                  0          Gen Ed            57           0           0
                                                                                                                0
                                                                                                                0
                                                                                                                0
                                                                                                                0
                                                                                                                0
                                                                    20. Total
                                                                                       77          30          30
                                                                     Minutes
                                                           21.Percent of time student is in general education:   64.10%

                                                         22. Placement:                                 SB
                        23. Signature of Person Completing Form:
                                              24. Date Completed:

                                                                                               Revised 05/09/2007
                            Educational Environment Calculation Form 6 to 21 Year Old
      1. Student's Name:                                                                   6. Total Minutes in the
                            HS Example in Voc Ed Classes - bus added as related                                       421
              2. MSIS ID:                                                                             School Day
                            service to show that the student travels to the vocational
                            center. LS is during one of the SPED times, do not enter
                            minutes in column 18 when services are offered during
        3. Student's DOB SPED periods.
               4. District:
               5. School:
                                                                        8. Location 9. Minutes       10. Minutes
7. Class/Subject/Course Name (Enter any concurrent classes on
                                                                         (Gen Ed,   per day in        per day in
                        the same line)
                                                                        SPED, Both)   Gen Ed            SPED
SPED English                                                                SPED              0           57
SPED Math                                                                   SPED              0           57
Agricultural Production I                                                  Gen Ed            94            0
Nutrition and Wellness                                                     Gen Ed            57            0
SPED Social Studies                                                         SPED              0           57
SPED Science                                                                SPED              0           57




11. Bell Schedule /Time
between periods                                                              Both            6             6
12a. Lunch                                                                  SPED             0            20
12b. Recess/Break                                                           SPED             0            10
                                                                        13. Total
                                                                                            157          264
                                                                        Minutes:
                                                                                         17. Minutes 18. Minutes
                              15a. Number of      15b. Number of 16. Location              for each    for each
                                                                                                                  19. Related
                               times Related       times Related   of Related                time        time
  14. Name of Related                                                                                            Service Total
                             Service offered per Service offered     Service               Related     Related
        Service                                                                                                   Minutes per
                              week in Gen Ed     per week in SPED   (Gen Ed,              Service is  Service is
                                                                                                                 week in SPED
                                   Setting            Setting     SPED, Both)             offered in  offered in
                                                                                            Gen Ed      SPED
LS                                    0                     1               SPED               0            0          0
Special VocEd Class                   0                     5               SPED               0           21         105
                                                                                                                       0
                                                                                                                       0
                                                                                                                       0
                                                                                                                       0
                                                                           20. Total
                                                                                             0            21          105
                                                                           Minutes
                                                            21.Percent of time student is in general education:      32.30%

                                                         22. Placement:                                    SC
                          23. Signature of Person Completing Form:
                                                24. Date Completed:


                                                                                                    Revised 05/09/2007
                          Educational Environment Calculation Form 6 to 21 Year Old
       1. Student's Name:                                                                 6. Total Minutes in the
                                                                                                                     846
               2. MSIS ID: HS/MS AB Example - since the AB schedule represents 2                     School Day
                             days of classes be sure that all your minutes reflect the
                             two days by doubling the minutes for #6 (Total Min), #11
                             Bell Schedule, 12a (Lunch), 12b (Recess/Break), and
         3. Student's DOB #15a or #15b (Number of Times for RS).
                4. District:
                5. School:
                                                                          8. Location  9. Minutes 10. Minutes
 7. Class/Subject/Course Name (Enter any concurrent classes
                                                                        (Gen Ed, SPED, per day in     per day in
                          on the same line)
                                                                             Both)       Gen Ed         SPED
JROTC                                                                       Gen Ed          96             0
Visual Arts                                                                 Gen Ed          96             0
Nutrition and Wellness                                                      Gen Ed          96             0
Drug Education                                                              Gen Ed          96             0
Driver's Education                                                          Gen Ed          96             0
SPED Emp English                                                             SPED            0            96
SPED Job Skills Math                                                         SPED            0            96
SPED Life Skills Science                                                     SPED            0            96




11. Bell Schedule /Time
between periods                                                          Gen Ed            18            0
12a. Lunch                                                               Gen Ed            60            0
12b. Recess/Break                                                                           0            0
                                                                    13. Total
                                                                                          558           288
                                                                    Minutes:
                                                                                  17. Minutes 18. Minutes
                            15a. Number of        15b. Number of                    for each    for each
                                                                  16. Location of                          19. Related
                             times Related         times Related                      time        time
  14. Name of Related                                             Related Service                         Service Total
                           Service offered per    Service offered                   Related     Related
        Service                                                   (Gen Ed, SPED,                           Minutes per
                            week in Gen Ed           per week in                   Service is  Service is
                                                                       Both)                              week in SPED
                                 Setting           SPED Setting                    offered in  offered in
                                                                                     Gen Ed      SPED
                                                                                                                0
                                                                                                                0
                                                                                                                0
                                                                                                                0
                                                                                                                0
                                                                                                                0
                                                                                                                0
                                                                     20. Total
                                                                                        0           0           0
                                                                      Minutes
                                                           21.Percent of time student is in general education:      65.96%

                                                        22. Placement:                                   SB
                      23. Signature of Person Completing Form:
                                            24. Date Completed:
                                                                                                  Revised 05/09/2007
                          Educational Environment Calculation Form 6 to 21 Year Old
      1. Student's Name: HS Example of 4x4 Block Schedule - example                    6. Total Minutes in the
                                                                                                                  424
               2. MSIS ID: demonstrates splitting one of the block periods to allow               School Day
         3. Student's DOB gen ed placement.
                4. District:
                5. School:
                                                                     8. Location    9. Minutes 10. Minutes
   7a. Class/Subject/Course Name (Enter any concurrent
                                                                   (Gen Ed, SPED, per day in       per day in
                    classes on the same line)
                                                                         Both)        Gen Ed         SPED
Geometry                                                                Gen Ed           96             0
English II                                                              Gen Ed           96             0
US History                                                              Gen Ed           96             0
Study Hall                                                              Gen Ed           48             0
Tutorial                                                                 SPED             0            48




11. Bell Schedule /Time
between periods                                                         Gen Ed           15            0
12a. Lunch                                                              Gen Ed           20            0
12b. Recess/Break                                                       Gen Ed            5            0
                                                                   13. Total
                                                                                        376           48
                                                                   Minutes:
                                                                                    17. Minutes 18. Minutes
                           15a. Number of      15b. Number of                         for each    for each
                                                               16. Location of                               19. Related
                            times Related       times Related                           time        time
  14. Name of Related                                          Related Service                              Service Total
                           Service offered     Service offered                        Related     Related
        Service                                                (Gen Ed, SPED,                                Minutes per
                           per week in Gen        per week in                        Service is  Service is
                                                                    Both)                                   week in SPED
                              Ed Setting        SPED Setting                         offered in  offered in
                                                                                       Gen Ed      SPED
PT                                 0                   3                SPED              0           18          54
Counseling                         0                   2                SPED              0           30          60
                                                                                                                   0
                                                                                                                   0
                                                                                                                   0
                                                                                                                   0
                                                                                                                   0
                                                                       20. Total
                                                                                         0            48          114
                                                                       Minutes
                                                           21.Percent of time student is in general education:   83.30%

                                                     22. Placement:                                    SA
                    23. Signature of Person Completing Form:
                                          24. Date Completed:

                                                                                                Revised 05/09/2007
                          Educational Environment Calculation Form 6 to 21 Year Old
      1. Student's Name:                                                          6. Total Minutes in the
                                                                                                                350
              2. MSIS ID: Elementary Example - note concurrent subjects on the               School Day
        3. Student's DOB same line for activity period.
               4. District:
                5. School:
                                                                 8. Location   9. Minutes 10. Minutes
7. Class/Subject/Course Name (Enter any concurrent classes
                                                               (Gen Ed, SPED, per day in      per day in
                        on the same line)
                                                                    Both)        Gen Ed         SPED
Language Arts                                                        Both           30            20
Reading                                                              Both           25            25
Social Studies                                                     Gen Ed           50             0
Science/Health                                                     Gen Ed           50             0
PE, Music, Art, Comp                                               Gen Ed           50             0
Math                                                               Gen Ed           50             0




11. Bell Schedule /Time
between periods                                                                         0           0
12a. Lunch                                                           Gen Ed            30           0
12b. Recess/Break                                                    Gen Ed            20           0
                                                                13. Total
                                                                                      305          45
                                                                Minutes:
                                                                                   17. Minutes 18. Minutes
                            15a. Number of       15b. Number of                      for each    for each
                                                                 16. Location of                            19. Related
                             times Related        times Related                        time        time
  14. Name of Related                                            Related Service                           Service Total
                           Service offered per   Service offered                     Related     Related
        Service                                                  (Gen Ed, SPED,                             Minutes per
                            week in Gen Ed          per week in                     Service is  Service is
                                                                      Both)                                week in SPED
                                 Setting          SPED Setting                      offered in  offered in
                                                                                      Gen Ed      SPED
LS                                 1                   1             BOTH                30          30          30
PT                                 0                   1             SPED                 0          20          20
                                                                                                                  0
                                                                                                                  0
                                                                                                                  0
                                                                                                                  0
                                                                                                                  0
                                                                    20. Total
                                                                                       30          50           50
                                                                    Minutes
                                                        21.Percent of time student is in general education:   84.29%

                                                      22. Placement:                                SA
                    23. Signature of Person Completing Form:
                                          24. Date Completed:

                                                                                              Revised 05/09/2007
                          Educational Environment Calculation Form 6 to 21 Year Old
      1. Student's Name:
                                                                                       6. Total Minutes in the    350
              2. MSIS ID:   Elementary Example 2 - represents a self-contained                    School Day
                            student who is included for the activity period and PE.
                            Student receives lunch and recess with other students
        3. Student's DOB with disabilities.
               4. District:
               5. School:
                                                                       8. Location  9. Minutes 10. Minutes
7. Class/Subject/Course Name (Enter any concurrent classes
                                                                     (Gen Ed, SPED, per day in     per day in
                       on the same line)
                                                                          Both)       Gen Ed         SPED
SPED Math                                                                 SPED            0            50
SPED LA                                                                   SPED            0            50
SPED Social Studies                                                       SPED            0            50
SPED Science                                                              SPED            0            50
PE                                                                        Gen Ed         50             0
Music, Art, Computer                                                      Gen Ed         50             0




11. Bell Schedule /Time
between periods                                                                         0              0
12a. Lunch                                                            SPED              0             30
12b. Recess/Break                                                     SPED              0             20
                                                                 13. Total
                                                                                       100           250
                                                                 Minutes:
                                                                                   17. Minutes 18. Minutes
                                               15. Number of
                            15a. Number of                                           for each    for each
                                               times Related 16. Location of                                19. Related
                             times Related                                             time        time
  14. Name of Related                              Service   Related Service                               Service Total
                           Service offered per                                       Related     Related
        Service                                  offered per (Gen Ed, SPED,                                 Minutes per
                            week in Gen Ed                                          Service is  Service is
                                               week in SPED       Both)                                    week in SPED
                                 Setting                                            offered in  offered in
                                                   Setting
                                                                                      Gen Ed      SPED
LS                                   0                  3             SPED               0           30          90
PT                                   0                  2             SPED               0           20          40
                                                                                                                  0
                                                                                                                  0
                                                                                                                  0
                                                                                                                  0
                                                                                                                  0
                                                                     20. Total
                                                                                        0             50          130
                                                                     Minutes
                                                        21.Percent of time student is in general education:      21.14%

                                                      22. Placement:                                  SC
                   23. Signature of Person Completing Form:
                                         24. Date Completed:

                                                                                                Revised 05/09/2007
  Instructions for completing the Educational Environment Calculation Form for 6 to 21
                                        year olds
NOTE: Only white cells will allow user to enter data on the Educational Environment Calculation Form for 6 to 21 year olds. White
cells require user entered data for calculations, yellow (shaded) cells will show the calculations. No calculations can be made within
the form if nothing is entered in #6 (Total Minutes in the School Day).

The Educational Environment Calculation Form is to be completed only after the IEP Committee has:

            a. discussed the student's present level of performance and completed that part of the IEP;
            b. used the information completed in the present level of performance to identify the measurable goals and, for students
            with significant cognitive disabilities, determine the measurable short term objectives and complete that part of the IEP;
            and
            c. identified the services needed by the student in order to complete the IEP and recorded them on the IEP.

Below are the instructions for completing the Educational Environment Calculation Form for 6 to 21 year olds. The numbers below
and the text in bold represent the exact numbers and wording on the Educational Environment Form. The words not in bold are the
instructions for completing those cells. Instructions to complete hand calculations of the form are in italics.

1. Student's Name: Enter Student's First Name, Middle Initial, and Last Name.
2. MSIS ID: Enter Student's MSIS ID (9 digits - should contain leading 0's).
3. Student's DOB: Enter Student's Date of Birth.
4. District: Enter District Name or Number.

5. School: Enter School Number and Name.
6. Total Minutes in the School Day: Enter the total minutes in the school day. Minutes should begin at the sounding of the first bell
and end with the sounding of the last bell of the day. NOTE: AB Schedules should double these minutes. Total minutes in line 13 for
columns 9 and 10 should add to the total minutes in the school day.
7. Class/Subject/Course Name: Enter name of the area of study. Enter concurrent periods on same line. If applicable, include level
(i.e. English II, Biology I).
8. Location: Enter the location the student is receiving instruction. This may be the general education class, the special education
class, or both locations in instances when the student receives part of his/her instruction for that course or subject in the general
education class and part of the instruction in the special education class.
9. Minutes per day in Gen Ed: When location (column 8) indicates Gen Ed, enter the number of minutes in the general education
class. When Location (column 8) indicates Both, enter the number of Gen Ed minutes then in column 10 enter the number of SPED
minutes.
10. Minutes per day in SPED: When Location (column 8) indicates SPED, enter the number of minutes in the special education
class. When Location (column 8) indicates Both, after entering the Gen Ed minutes (column 9) enter the number of SPED minutes.
For minutes shown in both general education class and special education class ensure column 9 and 10 sum to the entire class period
time.
11. Bell Schedule/Time Between Periods: Enter the total time for the day of the minutes between classes under columns 9 or 10
(depending if the student is changing classes with gen ed or SPED). Enter 0 in both columns 9 and 10 if the student does not change
classes in the case of some elementary and self-contained classes (keep in mind you may need to enter these minutes for your self-
contained secondary students if these minutes are not captured in the period time). NOTE: Double these minutes for AB Schedules.
12a. Lunch: Enter minutes for lunch each day. NOTE: For AB Schedules, double these minutes.

12b. Recess/Break: Enter minutes for break or recess. This number can be zero. NOTE: For AB Schedules, double these minutes.



                                                                                                          Revised 05/09/2007
  Instructions for completing the Educational Environment Calculation Form for 6 to 21
                                        year olds
13. Total Minutes: Form will sum columns 9 and 10. These two numbers should sum to the toal minutes in the day in #6. Hand
calculations: sum all numbers in column 9 and sum all number in column 10.

14. Name of Related Service: Enter any related services the student may have.

15a. Number of times Related Service offered per week: Enter number of times related service is offered within one week in a Gen
Ed setting. NOTE: AB Schedules should double these service times.
15b. Number of times Related Service offered per week: Enter number of times related service is offered within one week in a
SPED setting. NOTE: AB Schedules should double these service times.
16. Location of Related Service: Enter the location the student receives their related service. This may be the general education
class, the special education class, or both locatioms in instances when the student receives part of his/her related service in the general
education class and part of the related service in the special education class.
17. Minutes for each time Related Service is offered in Gen Ed: When location (column 16) indicates Gen Ed, enter the number of
minutes in the general education class. When Location (column 16) indicates Both, enter the number of Gen Ed minutes then in
column 17 and enter the number of SPED minutes in column 18. If the related services are delivered during a Gen Ed period in #7
above, then enter 0 for the related service minutes.
18. Minutes for each time Related Service is offered in SPED: When Location (column 16) indicates SPED, enter the number of
minutes in the special education class. When Location (column 16) indicates Both, after entering the Gen Ed minutes (column 17)
enter the number of SPED minutes. For minutes shown in both general education and special education ensure column 17 and 18 sum
to the entire related service time. If the related services are delivered during a SPED period in #7 above, then enter 0 for the related
service minutes.
19. Related Service Total Minutes per week in SPED: Form will calculate this value for you. Hand Calculations: Multiply #15b x
#18 across each row.


20. Total Minutes: Form will calculate this value for you. Hand Calculation: Sum all the minutes in column #19 above.

21. Percent of time student is in general education: Form will calculate value for you. Hand Calculation: (#6 Total minutes in the
day minus #13 Total Minutes in SPED minus (#20 Sum of column #19 divided by 5) divided by #6 Total Minutes in the School Day)
multiplied by 100.
22. Placement: Form will calculate for you. Hand Calculation: Enter SA if #21 is equal to 80% or greater, enter SB if #21 is equal
to 79% but less than or equal to 40%, enter SC if #21 is less than 40%. [FORMULA: ((Total Min in Day - Total Min in SPED -
(Total SPED RS Min/5)) / (Total Min in Day)) *100]

23. Signature of Person Completing Form: A signature is required for completion of the form. By signing the Educational
Environment Form, you are verifying that all items on that form are correct and follow the student's IEP.

24. Date Completed: Enter the date the IEP Committee makes decisions and the placement is written on the IEP form.




                                                                                                            Revised 05/09/2007

								
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