Anticipated Services

ADVERTISEMENT

SOUTH BEND COMMUNITY SCHOOL CORPORATION
Special Education Services
215 South St. Joseph Street, South Bend, Indiana, 46601
Phone: 574-283-8130 Fax: 574-283-8105
Anticipated Services
Please complete for students 14 years of age and older who have withdrawn or exited special education
programs in the South Bend Community School Corporation.
Student:__________________________________ Date of Exit: ________________ Grade: _________
SBCSC ID#: ______________ STN #: _____________________ School: ________________________
Termination Code: ______________________ Special Education Teacher: _______________________
(see description below)
Please check Yes or No for each anticipated service:
Anticipated Service
Yes
No
Anticipated Service
Yes
No
Mobility Services
Special Transportation
Technological Aids/Adaptive
Communication Services
Equipment
Medical/Medically Related
Independent Living Services
Services
Residential Services
Social Skills Training
Mental Health Services
Vocational Training/Job Placement
Ongoing Employment Related
Alternative Education Services
Services
Services to support Post-
Recreation and Leisure Services
Secondary Education
Family Services
Case Management Services
Check here if no special services anticipated: ______
Termination Reason Codes:
A
No longer eligible for Special Education Services
F
Moved out of SBCSC, continuing in school
B
Graduated with diploma
G
Moved out of SBCSC, not known if in school
C
Graduated with a Certificate (check one)
H
Dropped Out
___Fulfilled IEP
____Received GED
D
Reached maximum age (22 yrs old)
I
Expelled
E
Deceased
J
Incarcerated
Please return to the Special Education Office upon student’s withdrawal or exit from all South Bend
Community Schools.
8/10/10

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go