1. Extended School Year
Teacher To Do
2017

2. Purpose of ESY
ESY services are designed to maintain skills and behaviors, not to introduce new skills
ESY services are not intended to be as intensive as school year services

3. Extended School Year Forms
Forms required for ESY Eligibility:
ESY Checklist
ESY Summary Profile Data (for eligible students only)
Other Pertinent Data, including Related Services (OT, PT, Speech etc.)
A copy of these forms should be shared with your Supervisor and District LEA. These forms should be kept with you (the teacher) in a student file if needed for future reference.

4. Determining Eligibility
Eligibility is driven by the following two forms:
ESY Checklist
ESY Summary Profile Data (alternative data forms are also acceptable, check with IU supervisor)
Behavioral concerns can determine eligibility for ESY, contact your supervisor for assistance with this determination.

5. ESY Checklist
Completed for ALL students (only eligible students should be referred to ESY)
Items checked with an asterisk indicate possible eligibility for ESY
Checklist is available on Sharepoint:

8. Summary Profile Data Form
Include data for goals on which the student demonstrated regression; two to three goals are sufficient (please keep in mind there are only 20 ESY instructional days to maintain goals)
Attach progress monitoring graphs or other data collection sheets as necessary
Summary Profile Data Form is available on Sharepoint

10. Deadline for Determination & other important dates
February 28, 2017: eligibility must determined by the IEP team and submitted to LEA for approval by this date.
Include Profile Summary Data Form and Checklist
Related service providers MUST be afforded the opportunity to participate in determining the eligibility, type, frequency and duration of services needed
March 17, 2017: Once approved by LEA, send LEA approval to IU supervisor (or as soon as LEA makes approval)
Revise IEP and ESY Section of IEP to reflect the services to be provided
Complete ESY Referral by April 1, 2017

11. ESY referral form The ESY referral is a web based document
(referral official release date will be in mid to late January, 2017)
Link to ESY Referral:
Step by step instructions available at ESY page and on Sharepoint ESY page

12. Required for Eligible Students Summary
Extended School Year Checklist
ESY Summary Profile Data
Approval from District LEA
All Philadelphia students are required to have a signed NOREP for ESY services
Update IEP: Goals to be worked on must be listed in Section VI-D of the IEP
IU Referral for ESY services

13. Required for Non-eligible Students
Extended School Year Checklist, for teacher records only
If student NOT ELIGIBLE for ESY please update IEP (there is no need to fill out an ESY referral for students who do NOT qualify)

14. Student Materials
District and IU School Year Teachers should provide the following to the ESY teacher:
IEP
ESY Goals to be maintained
Data Collection Sheet
Curriculum for number of days of instruction
20 for center based instruction
Min of 5 lessons for home based instruction
Behavior Plan
Health Plan .

15. ESY move form
An ESY Move Form should be completed for student materials and equipment to be moved from current school to ESY location
If only one small item is to be moved, please arrange to have items delivered to ESY office by June 9, 2017
Please look for to be sent in late May, regarding completing the ESY Move Form

16. Center-Based ESY: ESY Dates: 2017 ESY
4 days a week: Monday through Thursday
Student Hours: 9am to 2:30pm
Social Skills Classes: Tues, Wed, Thurs
9am-11:30am: Elementary School (K-6th)
12noon-2:30pm: Middle/High School (7th-12th)
*Social Skills Classes will be held at Makefield Elementary and Strayer Middle School only
ESY Dates:
Wednesday, July 5 to Tuesday, August 8, 2017
June 29, 2017 ESY OPEN HOUSE 11am to 1pm

17. 2017 ESY Locations (Locations may vary depending on programming)
Cornwells Elementary and Snyder Middle School serves:
Bensalem, Bristol Township, Bristol Borough, Centennial
Makefield Elementary School serves:
Neshaminy, Pennsbury, Morrisville
Strayer Middle School serves:
Quakertown, Pennridge, Palisades
MBIT- (Transition and Brainsteps only)
All districts
Everitt Elementary
BCIU Student specific programming

18. ESY Contact information
Regina Carpenter, ESY Supervisor
For Questions Please Contact:
Kelly Housman, ESY Specialist
ext. 1307
Michelle Connor, ESY Program Assistant
ext. 1311

19. Teacher Cheat Sheet Fill out ESY checklist and ESY data sheet.
By Feb 28, 2017, send to district LEA with checklist, data and goals to be maintained during ESY (uploaded and attached). Ask for written approval for LEA. If no response contact LEA again in one week Include any requests for RELATED SERVICES. Teacher must contact all related service providers for ESY input. Must collect related service data and recommended service level for ESY.
Once LEA approves, forward written approval and revised IEP to IU supervisor by March 17, 2017.
Complete ESY Referral Form Be sure to upload revised IEP with ESY goals, behavior plan, transportation plan, feeding plan, health care plan to ESY Referral Form.
Submit Referral by April 1, 2017.
Organize student curriculum, Revised IEP and data sheets to be completed by ESY teacher by June 9, 2017
Fill out move form (available mid May)