Iep Revision Form - South Bend Community School Corporation Special Education Department Page 10

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South Bend Community School Corporation
Special Education Department
IEP Revision
Student: ______________________________ STN: ______________________ Revise IEP of ____________________
Effective Dates:
Begin date: _____________________________ End date: __________________________________
Least Restrictive Environment
School of Legal Settlement
School of Service
Additional information regarding school of service:
LRE Placement Category based Federal Program Types:
School Age (6-21) - Student will be Age 6+ as of next December 1st
50
Regular class 80% or more (In a regular classroom for 80% or more of the day)
51
Resource Room (In a regular class for 40% to 79% of the day)
52
Separate Class (In a regular class for less than 40% of the day)
53
Separate day school facility
54
Residential Facility
55
Correctional Facility
56
Parentally placed in private school
57
Homebound/hospital
If student’s primary disability is ED:
EDFT
EDPT
Additional Descriptors
Harmful Effects
This form is only to be used when an IEP has been finalized for future dates, and a revision is required for the currently
valid IEP. It is not to be used when there are questions of eligibility or state assessment.

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