Special Education Association of Peoria County
SPECIAL EDUCATION ASSOCIATION OF PEORIA COUNTY
4812 W Pfeiffer Rd., Bartonville, IL. 61607
Ph: 309-697-0880 Fax: 309-697-0884
ESY DATA FORM
School Year: 2021
| | |
|CURRENT YEAR INFORMATION |ESY SPEECH ONLY AND RELATED SERVICES ONLY |
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| |MINUTES |
| | |
| | |
| |Service Provider |
| |Start |
| |Date |
| |Stop |
| |Date |
| | |
| | |
| |SEAPCO |
| |LEA |
| | |
| | |
| | |
| |13 |
| | |
| |Occupational Therapy |
| | |
| | |
| | |
| | |
| | |
| |19 |
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| |Physical Therapy |
| | |
| | |
| | |
| | |
| | |
| |23 |
| | |
| |Speech/Language |
| | |
| | |
| | |
| | |
| | |
| |25 |
| | |
| |Transportation (Special) |
| | |
| | |
| | |
| | |
| | |
| | |
| |Other |
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|Legal Name: Last |First |Middle | |
| | | | |
|Birth Date: |Sex: |Disability Code: | |
|Resident District: |Serving District: | |
|Current Grade: |Current Program: |Current Teacher: | |
|Annual Review Date: |Eligibility Determination Date: | |
|ESY AND RELATED SERVICES |
| |
|MINUTES |
| |
| |
|Service Provider |
| |
| |
|SEAPCO |
| |
|LEA |
|Start |
|Date |
|Stop |
|Date |
| |
|02 |
|Aide: Classroom |
| |
| |
| |
| |
| |
|03 |
|Aide: Individual |
| |
| |
| |
| |
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|08 |
|Consultant |
| |
| |
| |
| |
| |
|13 |
|Occupational Therapy |
| |
| |
| |
| |
| |
|18 |
|Psychological Services |
| |
| |
| |
| |
| |
|19 |
|Physical Therapy |
| |
| |
| |
| |
| |
|23 |
|Speech/Language |
| |
| |
| |
| |
| |
|24 |
|Social Work Services |
| |
| |
| |
| |
| |
|25 |
|Transportation (Special) |
| |
| |
| |
| |
| |
|28 |
|Behavior Intervention Plan |
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| |
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|Other |
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|ESY PROGRAM OPTIONS/MIN |
|Program |
|Mins/Week |
|Start |
|Date |
|Stop |
|Date |
| |
|Public Day: SEAPCO ESY |
|Location: PVMS/3780 |
|720 |
|6/14/2021 |
|7/15/2021 |
| |
|Senior ESY/3600-SEAPCO Offices |
|1440 |
|6/28/2021 |
|7/13/2021 |
| |
| |
|Public Day: SEAPCO Academy/3780 |
|720 |
|6/14/2021 |
|7/15/2021 |
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|HISRA |
| |
| |
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|Tutoring |
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|Remote: |
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Administrator’s Signature: Date: / /
-----------------------
RETURN To: Rosemary Skinner @ SEAPCO
Email: rskinner@
Fax: 309-697-0884
Ph: 309-697-0880 Ext.201
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