Exiting Special Education During the School Year Table 4

Page 6 of 6

TABLE 4 - RE7 (for reporting race/ethnicity according to New 10/2007 Guidance)

(DRAFT 09-24-08)

REPORT OF CHILDREN WITH DISABILITIES EXITING

SPECIAL EDUCATION

JULY 1, 2008 – JUNE 30, 2009

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 1820-0521. The time required to complete this information collection is estimated to average 11 hours per SEA and 6 hours per LEA 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. 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, 400 Maryland Avenue, SW, Washington, D.C. 20202.

Authorization: P.L. 108-446, Section 618(a)(1)(A)(iv) and Section 618(a)(3); 34 CFR §§300.640, 300.641(b) through 300.641(d), 300.642(b), 300.644, 300.645

Due Date: November 1, 2009

Sampling Allowed: Yes

Send Form to: William Knudsen, Acting Director

Office of Special Education Programs

Part B Data Reports

Program Support Services Group

Mail stop 2600

550 12th Street, S.W.

Washington, D.C. 20202

Attn: Cheryl Broady

General Instructions

Provide a count of the number of children with disabilities reported under IDEA, Part B who exited special education between July 1, 2008 and June 30, 2009. Data are to be provided by age, disability category, basis of exit, race/ethnicity, gender, and limited English proficiency (LEP) status. Include only children who were in special education at the start of the reporting period, but were not in special education at the end of the reporting period. All data provided must sum, as an unduplicated count, to Section B of the table where you report the total for all disabilities. The age of the student should reflect his/her age in years on the date of the most recent child count prior to the child’s exiting, not at time of exit.

In providing data for this collection, the State is to submit complete and unsuppressed data.

STATES SHOULD NOT PROVIDE PERCENTAGES IN SECTIONS A THROUGH E, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

Sampling Guidelines

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 that 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 1 of the reporting school year (that is, the September prior to the start of the data collection period).

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 (ADM) of over 50,000 must be included in the sample. States with fewer than 25 districts with ADMs over 25,000 must include all districts with over 25,000 ADMs. The total number of districts sampled must equal or exceed 100. If the total number of 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 in each disability category 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

Sections A-E

In these tables, enter an unduplicated count of all children with disabilities, by age, disability category, race/ethnicity, gender, and limited English proficiency (LEP) status, who were in special education at the start of the reporting period, but were not in special education at the end of the reporting period. States must use a 12-month interval for reporting exiting data, from July 1, 2008 to June 30, 2009. Place zeros (0) in categories where no children have exited the program. Enter (-9) for categories not used by the State.

Row A. Transferred to regular education. Total who were served in special education at the start of the reporting period, but at some point during that 12-month period, returned to regular education. These are students who no longer have an IEP and are receiving all of their educational services from a regular education program.

Row B. Graduated with regular high school diploma. Total who exited an educational program through receipt of a high school diploma identical to that for which students without disabilities are eligible. These are students who met the same standards for graduation as those for students without disabilities. As defined in 34 CFR §300.102(a)(3)(iv), “the term regular high school diploma does not include an alternative degree that is not fully aligned with the State’s academic standards, such as a certificate or a general educational development credential (GED).”

Row C. Received a certificate. Total who exited an educational program and received a certificate of completion, modified diploma, or some similar document. This includes students who received a high school diploma, but did not meet the same standards for graduation as those for students without disabilities. This category also includes students receiving any alternative degree that is not fully aligned with the State’s academic standards, such as a certificate or a general educational development credential (GED), so long as the student remained continuously enrolled in the secondary educational program. If your State does not use certificates, enter -9 in the appropriate cells.

Row D. Reached maximum age. Total who exited special education because of reaching the maximum age for receipt of special education services, including students with disabilities who reached the maximum age and did not receive a diploma.

Row E. Died. Total who died.

Row F. Moved, known to be continuing. Total who moved out of the catchment area or otherwise transferred to another district and are KNOWN to be continuing in an educational program. There need not be evidence that the student is continuing in special education, only that he/she is continuing in an education program. This row includes students in residential drug/alcohol rehabilitation centers, correctional facilities, or charter schools if those facilities operate as separate districts, excluding normal matriculation.

Row G. Dropped out. Total who were enrolled at the start of the reporting period, were not enrolled at the end of the reporting period, and did not exit special education through any of the other bases described. This row includes dropouts, runaways, GED recipients (in cases where students are required to drop out of the secondary educational program in order to pursue the GED certificiate),¹ expulsions, status unknown, students who moved and are not known to be continuing in another educational program, and other exiters from special education.

Row H. Total of rows (A) through (G).

Section A. Disability and Discrete Age by Basis of Exit

Report the number of students ages 14-21 who exited special education by age-year, disability category, and basis of exit.

Section B. Discrete Age by Basis of Exit

Report the total number of students ages 14-21 who exited special education by age-year and basis of exit. These figures must equal the sum of the data reported in Section A.

Section C. Race/ethnicity by Basis of Exit

In October 2007, the Department of Education published its Final Guidance on Maintaining, Collecting and Reporting Racial and Ethnic Data to the U.S. Department of Education in the Federal Register (Vol. 72, No. 202, available at http://www.gpoaccess.gov/nara/index.html ), referred to in these instructions as the new guidance. The procedures for collecting, aggregating, and reporting race and ethnicity, as described in the new guidance, must be implemented by no later than the report of the SY 2010-11 Exiting data. Although not required to do so prior to the 2010-11 report, SEAs may, as early as for reports referencing SY 2008-09, collect and aggregate their data as specified in the new guidance, to report aggregate race/ethnicity data in the seven (7) categories listed in this form. When implementing the new reporting guidance, SEAs must do so at the beginning of the relevant reporting period and must apply the guidance consistently to ALL data reported within that period.

DO NOT USE THIS form to report race/ethnicity within the five categories as applied in previous years.² To report Exiting under the five race/ethnicity categories, you must use Table 4 – RE5 (5 race/ethnicity reporting categories as used prior to 2007 guidance).

SEAs who have fully implemented the Department of Education’s new guidance (10/07) should report all children with disabilities according to the seven categories listed below. The following definitions of the seven categories for aggregate report of race/ethnicity have been adapted from definitions appearing in the new guidance.

Report the total number of students ages 14-21 who exited special education by race/ethnicity and basis of exit. These figures must equal the total data for ages 14-21 reported in Section B.

Hispanic/Latino	A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Refers to Hispanic and/or Latino.
American Indian or Alaska Native	A person having origins in any of the original peoples of North and South America (including Central America) and who maintains tribal affiliation or community attachment. (Does not include persons of Hispanic/Latino ethnicity.)
Asian	A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent. This includes, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. (Does not include persons of Hispanic/Latino ethnicity.)
Black or African American	A person having origins in any of the Black racial groups of Africa. (Does not include persons of Hispanic/Latino ethnicity.)
Native Hawaiian or Other Pacific Islander	A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or the Pacific Islands. (Does not include persons of Hispanic/Latino ethnicity.)
White	A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. (Does not include persons of Hispanic/Latino ethnicity.)
Two or more races	A person having origins in two or more of the five race categories listed immediately above. (Does not include persons of Hispanic/Latino ethnicity.)
Total	The unduplicated total across the seven (7) race/ethnicity designations.

Note that children can only be reported in one race/ethnicity category.

Section D. Gender by Basis of Exit

Report the total number of students ages 14-21 who exited special education by gender and basis of exit. These figures must equal the total data reported in Section B.

Section E. Limited English Proficiency Status by Basis of Exit

Report the total number of students ages 14-21 who exited special education by LEP status. These figures must equal the total data reported in Section B.

Limited English Proficient. A child who meets the definition of a limited English proficient child under the Elementary and Secondary Education Act, 20 U.S.C. Section 7801(A)(25):

“The term ‘limited English proficient,’ when used with respect to an individual, means an individual -

(A) who is aged 3 through 21;

(B) who is enrolled or preparing to enroll in an elementary school or secondary school;

(C)

(i) who was not born in the United States or whose native language is a language other than English;

(ii)

(I) who is a Native American or Alaska Native, or a native resident of the outlying areas; and

(II) who comes from an environment where a language other than English has had a significant impact on the individual's level of English language proficiency; or

(iii) who is migratory, whose native language is a language other than English, and who comes from an environment where a language other than English is dominant; and

(D) whose difficulties in speaking, reading, writing, or understanding the English language may be sufficient to deny the individual -

(i) the ability to meet the State's proficient level of achievement on State assessments described in section 6311(b)(3) of this title;

(ii) the ability to successfully achieve in classrooms

where the language of instruction is English; or

(iii) the opportunity to participate fully in society.”

LEP status should reflect the child’s status as of the date of exit.

U.S. DEPARTMENT OF EDUCATION PAGE 1 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION A. DISCRETE AGE AND DISABILITY BY BASIS OF EXIT

BASIS OF EXIT:	MENTAL RETARDATION										HEARING IMPAIRMENTS
	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)
(A) TRANSFERED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
(C) RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 2 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION A (CONTINUED)

BASIS OF EXIT:	SPEECH OR LANGUAGE IMPAIRMENTS										VISUAL IMPAIRMENTS
	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)
(A) TRANSFERED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
(C) RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 3 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION A (CONTINUED)

BASIS OF EXIT:	EMOTIONAL DISTURBANCE										ORTHOPEDIC IMPAIRMENTS
	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)
(A) TRANSFERED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
(C) RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 4 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION A (CONTINUED)

BASIS OF EXIT:	OTHER HEALTH IMPAIRMENTS										SPECIFIC LEARNING DISABILITIES
	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)
(A) TRANSFERED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
(C) RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 5 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION A (CONTINUED)

BASIS OF EXIT:	DEAF-BLINDNESS										MULTIPLE DISABILITIES
	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)
(A) TRANSFERED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
(C) RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 6 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION A (CONTINUED)

BASIS OF EXIT:	AUTISM										TRAUMATIC BRAIN INJURY
	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)
(A) TRANSFERED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
(C) RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 7 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION B. DISCRETE AGE BY BASIS OF EXIT

BASIS OF EXIT:	ALL DISABILITIES
	14	15	16	17	18	19	20	21	14-21 TOTAL	22+ (Optional)
(A) TRANSFERRED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
© RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 8 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION B (CONTINUED)

BASIS OF EXIT:	ALL DISABILITIES (PERCENT)1
	14 (PERCENT)	15 (PERCENT)	16 (PERCENT)	17 (PERCENT)	18 (PERCENT)	19 (PERCENT)	20 (PERCENT)	21 (PERCENT)	14-21 TOTAL (PERCENT)
(A) TRANSFERED TO REGULAR EDUCATION									100%
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA									100%
(C) RECEIVED A CERTIFICATE									100%
(D) REACHED MAXIMUM AGE									100%
(E) DIED									100%
(F) MOVED, KNOWN TO BE CONTINUING									100%
(G) DROPPED OUT									100%
(H) TOTAL (OF ROWS A-G):									100%

¹ STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 9 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION C. RACE/ETHNICITY BY BASIS OF EXIT

BASIS OF EXIT	RACE/ETHNICITY
	HISPANIC/ LATINO	AMERICAN INDIAN OR ALASKA NATIVE	ASIAN	BLACK OR AFRICAN AMERICAN	NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER	WHITE	TWO OR MORE RACES	TOTAL
(A) TRANSFERED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
(C) RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 10 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION C (CONTINUED)

BASIS OF EXIT	RACE/ETHNICITY (PERCENT)1
	HISPANIC/ LATINO (PERCENT)	AMERICAN INDIAN OR ALASKA NATIVE (PERCENT)	ASIAN (PERCENT)	BLACK OR AFRICAN AMERICAN (PERCENT)	NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER (PERCENT)	WHITE (PERCENT)	TWO OR MORE RACES (PERCENT)	TOTAL (PERCENT)
(A) TRANSFERED TO REGULAR EDUCATION								100%
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA								100%
(C) RECEIVED A CERTIFICATE								100%
(D) REACHED MAXIMUM AGE								100%
(E) DIED								100%
(F) MOVED, KNOWN TO BE CONTINUING								100%
(G) DROPPED OUT								100%
(H) TOTAL (OF ROWS A-G):								100%

¹ STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 11 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION D. GENDER BY BASIS OF EXIT

BASIS OF EXIT:	GENDER
	MALE	FEMALE	TOTAL
(A) TRANSFERED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
(C) RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 12 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION D (CONTINUED)

BASIS OF EXIT:	GENDER (PERCENT)1
	MALE (PERCENT)	FEMALE (PERCENT)	TOTAL (PERCENT)
(A) TRANSFERED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
(C) RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):	100%	100%	100%

¹ STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 13 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION E. LIMITED ENGLISH PROFICIENCY BY BASIS OF EXIT

BASIS OF EXIT:	LIMITED ENGLISH PROFICIENCY STATUS
	YES	NO	TOTAL
(A) TRANSFERED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
(C) RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):

ED FORM: 869-3

U.S. DEPARTMENT OF EDUCATION PAGE 14 OF 14

OFFICE OF SPECIAL EDUCATION TABLE 4 (continued)

AND REHABILITATIVE SERVICES OMB NO.: 1820-0521

OFFICE OF SPECIAL EDUCATION REPORT OF CHILDREN WITH DISABILITIES EXITING

PROGRAMS SPECIAL EDUCATION FROM JULY 1, 2008 THROUGH JUNE 30, 2009 FORM EXPIRES: 08/31/2009

STATE: ____________________

SECTION E. LIMITED ENGLISH PROFICIENCY BY BASIS OF EXIT

BASIS OF EXIT:	LIMITED ENGLISH PROFICIENCY STATUS (PERCENT)1
	YES (PERCENT)	NO (PERCENT)	TOTAL (PERCENT)
(A) TRANSFERED TO REGULAR EDUCATION
(B) GRADUATED WITH REGULAR HIGH SCHOOL DIPLOMA
(C) RECEIVED A CERTIFICATE
(D) REACHED MAXIMUM AGE
(E) DIED
(F) MOVED, KNOWN TO BE CONTINUING
(G) DROPPED OUT
(H) TOTAL (OF ROWS A-G):	100%	100%	100%

¹ STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

ED FORM: 869-3

1In States where students may receive a GED without dropping out of school, these students may be reported as receiving a certificate (Row C). These are students who were jointly enrolled in secondary education and a GED program. In all other cases, GED recipients should be reported in Row G.

2 If your State is collecting race/ethnicity information in a manner that is NOT in full accordance with the new guidance (including the two-part question format for ascertaining and reporting Hispanic ethnicity), you should report aggregate data through the 5-category format ( the ‘…-RE5’ version of the form for this collection) until your State is prepared to fully implement the new guidance, and then to do so for all of the IDEA Part B collections associated with the given reporting reference year (e.g., 2009-10 year). Until you make that full transition, you should use the –RE5 version of this form, and apply either of two options to account for students who are identified as multiracial or two or more races, as described in the document entitled, “Handling Missing Data When Reporting Race/Ethnicity” (https://www.ideadata.org/docs/PartBRaceEthnicity.doc).