april 2009 copyright © 2006 mississippi department of education 1 extended school year

April 2009 Copyright © 2006 Mississippi Department of Education 1

Extended School Year


Overview

• Extended School Year (ESY) is the provision of special education and related services to students with disabilities in accordance with their Individualized Education Program (IEP) beyond the normal school year of the local school district and at no cost to the parents of the students.

• The IEP Committee may begin making ESY decisions no earlier than January 15th of each year. The deadline for all reviews are to be completed by April 15th of each year.


Required Forms

• O-1:Cover Page• Q-1: Nonparticipation• R-1: Projected Budget Summary• R-2A-E: Projected Budget Narrative

R-2A: Salaries/Fringes R-2B: Travel/Transportation R-2C: Contractual Services R-2D: Materials/Supplies/Commodities R-2E: Other

• R-3: ESY Private Placement• R-4: ESY Roll• R-5: ESY Service Provider Listing• R-6: Reimbursement Form


ESY Application Directions

Q-1: Nonparticipation Assurance Form

• If no student within the district is eligible for ESY services based on the decisions of the IEP committee:

Fill in the name of the school district, the district code, an original superintendent’s signature, and the date; and

Submit the completed form to the Office of Special Education by May 1, 2009


O1: Cover Page

• When submitting the ESY Application to the MDE, this form should be First Page of the ESY Application. Complete this form as follows:

Section A: Provide the district’s name and district’s code.

Section B: Provide the total number of students served in the ESY program by disability.

Section C: Provide the beginning date and ending date of ESY.

– If there is a child in private placement and the placement begins and ends before the regular session, then that will be the beginning and ending dates

Section D: Certify by superintendent’s original signature the assurances described in this section

Section E: Provide the estimated overall costs for the ESY program.

COVER PAGE

EXTENDED SCHOOL YEAR APPLICATION SUMMER 2009

B. STUDENT INFORMATION

Disability Category

Number Served

Disability Category

Number Served

MR (EMR) EmD MR (TMR) HI MR (S/PR) D/B SLD VI L/S DD OHI AU OI TBI MD TOTAL

C. Beginning Date for ESY ________________ Ending Date for ESY ________________ D. ASSURANCES

As Superintendent of this district, I certify by my signature that: 1. This estimated budget for the ESY has been computed in accordance with Mississippi Department of

Education regulations and guidelines. 2. All students with disabilities receiving an ESY meet criteria established in accordance with regulations

and documentation is on file to support the decisions by the IEP Committee(s). 3. The specific skills to be maintained are clearly identified on the student's IEP, as requiring the

provision of an ESY. 4. No expenditure(s) which would have been incurred if there were no ESY is (are) included in this

budget. Documentation to support expenditures will be maintained on file for audit inspection.

Superintendent’s Signature Date E. ESTIMATED OVERALL COSTS:

MDE USE ONLY: APPROVAL:

Salaries $

Travel $ MDE Staff Consultant Date

Contractual services $

Director, Division of Program Management Date

Materials/Supplies/ Commodities

$ Bureau Director, Data & Fiscal Management Date

Private Placement

$

Other

$ PROJECTED APPROVAL AMOUNT:

Total

$ $_____________________________

A. SCHOOL DISTRICT: DISTRICT CODE:


R-1: Projected Budget Summary

List the total projected budget for each budget category. Totals for each category should match the totals on budget narrative forms R-2A thru R-2E.

Note: There is no budget category for equipment because equipment may not be purchased from ESY funds.


R-2A: Salaries/Fringes

• Provide a narrative description of the use of funds for the people that will be employed during ESY.

• The rate formula for teachers must be based on the MAEP salary, excluding the local supplement, for the 2008-2009 school year and the number of hours of instruction provided. The master teacher pay can be included in the rate

formula. The maximum number of hours is 8 hours per day.

• The rate formula for administrative salaries must be based on the 2008-2009 school year and the salary paid during the previous regular school year. If the administrative personnel is on a 12-month contract, then they cannot be employed during ESY.

• Teacher aides, janitors, bus drivers, and bus aides must be reimbursed at no more than the hourly rate paid during the regular school year.

ESY PROJECTED BUDGET NARRATIVE

2009

Describe the budget items for each category. Documentation should be on file in the district to justify the necessity and reasonableness of each item. These pages may be reproduced as needed.

Salaries/Fringes

Use the section below to provide a description of the planned use of funds for salaries, wages, and/or fringe benefits. Salaries, Wages, Fees and/or Fringes: Example: Sarah Johnson, SpEd Teacher Betty Lyle, Teacher Assistant John Smith, Bus Driver

Amount Requested: $ 3,046.63 1,001.53 683.00

Total for Salaries, Wages, Fees and/or Fringes:

$ 4,731.16


R-2B: Travel/Transportation

• Provide a detailed description of the planned use of funds for travel/transportation.

Travel section: used to pay for mileage for the personnel providing homebound services

Transportation section: used to pay for usage of the district school bus and private carriers to transport the student(s) to ESY services

– The mileage rate to be reimbursed is determined by the school district.

R-2B


2009

TRAVEL/TRANSPORTATION

Use the section below to provide a detailed description of the planned use of funds for travel/transportation. Travel: Example: Mileage for Marla May to provide homebound services to Steve Jackson. Transportation: Example: District School Bus Private Carrier

# Students Served: Amount Requested: 1 $ 32.75 10 $ 3,794.00 2 346.00

Total for Travel:

$ 4,172.75


R-2C: Contractual Services

• Provide a detailed description for the planned use of funds for contractual services (physical therapists, occupational therapists, speech therapists, etc.) Salaries should be

computed at no more than the hourly rate paid during the regular school year.

R-2C

ESY

PROJECTED BUDGET NARRATIVE 2009

CONTRACTUAL SERVICES

Use the section below to provide a detailed description for the planned use of funds for contractual services. Contractual Services: Example: Mary Allen- Speech Therapy for 15 hours

Amount Requested:

$ 375.00

Example: Central Hospital – OT/PT Services

1,200.00

Total for Contractual Services:

$ 1,575.00


R-2D: Materials/Supplies/Commodities

• Provide a detailed description of the planned use of funds for the purchase of materials, supplies, and commodities.

R-2D


2009

Materials/Supplies/Commodities

Use the section below to provide a detailed description of the planned use of funds for the purchase of materials/supplies/commodities. Materials/Supplies/Commodities: Example: Snacks for 14 children for 15 days Disposable diapers for 4 students

Amount Requested:

$ 343.00 160.00

Total for Materials/Supplies/Commodities:

$ 503.00


R-2E: Other

• Provide a description of the planned use of funds for other expenses incurred for ESY (such as utilities).

R-2E


2009

Other

Use the section below to provide a description of the planned use of funds for other expenses incurred for Extended School Year. Other: Example: Electricity for 3 classrooms at Central Elementary for 15 days

Amount Requested:

$ 1,308.00


R-3: Private Placement

• List the name of each student receiving educational services in a private facility and the student’s MSIS ID number.

• List the IEP approval date.

• Be sure that a current IEP for each student is on file under the Educable Child Program and that it addresses ESY services for the summer session.

• State the name of the facility in which the student is placed.

• List the beginning and ending dates of services and the number of calendar days services will be provided.

• The daily rate in which the facility will be reimbursed is $153.00 for educational services.

• Any student in private placement should also be included on the R-4 (student roll).

ESY PRIVATE PLACEMENT 2009

EDUCATIONAL Student Name/Disability MSIS

# IEP

Approval Date

Name of

Facility

Beginning Date

of Services

Ending Date

of Services

# Days Served

Daily Rate

Amount MDE USE

1

2

3

4

5

6

7

8

RESIDENTIAL Student Name/Disability MSIS

# IEP

Approval Date

Name of

Facility

Beginning Date

of Services

Ending Date

of Services

# Days Served

Daily Rate

Amount MDE USE

1

2

3

4

5

6

7

8


R-4: ESY Roll

• For each student receiving ESY services report the following:

Name MSIS ID number Age Disability Total number of days the student will receive

ESY instruction Total number of hours for ESY services per

student Place an “X” to indicate whether ESY services

was based on the need to maintain critical skills (C/S); to maintain skills due to regression w/o recoupment (R/R); or extenuating circumstances (E/C)

Location of services Name of teacher(s) providing instruction Place an “X” to indicate whether an aide is to

be utilized Related services to be provided (OT, PT, etc.) Name of person providing related services Place an “X” to indicate whether transportation

is necessary by bus or private carriers Compute the total number of students in ESY

ESY STUDENT ROLL

2009

List all students served in ESY (including those students in private placement - R-3).

JUSTIFI- CATION

TRANSPOR- TATION

BUS PRIVATE

NAME OF STUDENT

MSIS ID NUMBER A

GE

DIS

AB

ILIT

Y

TO

TA

L D

AY

S S

ER

VE

D

TO

TA

L H

RS

SE

RV

ED

C/S R/R E/S

LOCATION OF

SERVICES

TEACHER

AIDE Y N

RELATED SERVICES

PROVIDER BUS P/C

1 Mary Jane Doe

0000001 9 MR 15

45 X ABC Elem.

Jo Easter

X OT Mark Case

X

South Hosp.

PT South Hosp

Mom

L/S Ann Hope X 2 3 4 5

TOTAL NUMBER OF STUDENTS SERVED


R-5: ESY Service Provider Listing

• List all service providers (including private service providers) who will be providing ESY instruction/services.

• Indicate the position of each person listed (i.e., teacher, teacher aide, bus driver, custodian, OT, PT, etc.).

• Provide the license number for each teacher, PT, and OT.

• List the number of students served by each provider and the total number of hours each provider will work during ESY.

R-5

ESY PROJECTED SERVICE PROVIDER LISTING

2009

SERVICE PROVIDER NAME

Ex: Jane Jones

POSITION

Speech Path.

LICENSE #

0001234

# STUDENTS

6

TOTAL HRS

25


R6: Request for Reimbursement

• Provide the actual costs and the actual number of children served for ESY services.

• The complete application form is due in the Office of Special Education on September 28, 2009.

• The application form must be signed and dated by the superintendent.

FOR MDE USE ONLY Approved for Payment:

$__________________________ ESY Consultant: _____________ Division Director: ___________________

REQUEST FOR REIMBURSEMENT

EXTENDED SCHOOL YEAR 2009

DISTRICT NAME: ______________________________ DISTRICT CODE:_____________________ ACTUAL ESY EXPENDITURES Salaries $ Travel $ Contractual services $ Materials/Supplies/Commodities $ Private Placement $ Private Placement Costs $ Total $

STUDENT INFORMATION

Disability Category

Number Served

Disability Category

Number Served

MR (EMR) EmD MR (TMR) HI MR (S/PR) D/B SLD VI L/S DD OHI AU OI TBI MD TOTAL

As superintendent of this district, I certify by my signature below and that to the best of my knowledge: 1. This application for reimbursement represents the actual cost of operating ESY for the 2009 summer session.

Sufficient documentation is available for audit inspection. 2. The students with disabilities served met the ESY criteria established in accordance with the Mississippi

Department of Education regulations and the educational services provided are specified in each student’s Individualized Education Program.

3. No expenditure which would have been incurred if there had not been ESY is included for reimbursement. SUPERINTENDENT’S SIGNATURE DATE

Mail to: Mississippi Department of Education

Office of Special Education Post Office Box 771

Jackson, MS 39205-0771

DUE DATE: September 30, 2009

R-6


Request for Reimbursement

• Reimbursement requests received by 9/30/09

– Immediately processed for 50% disbursement

• Reimbursement request received 10/01/09 and after

– Processed for payment no later than 05/10

april 2009 copyright © 2006 mississippi department of education 1 extended school year

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