2007 MONTH DAY YEAR U.S. DEPARTMENT OF EDUCATION TABLE 1 PAGE 1 OF 8 OFFICE OF SPECIAL EDUCATION OFFICE OF SPECIAL EDUCATION PROGRAMS

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1 U.S. DEPARTMENT OF EDUCATION TABLE 1 PAGE 1 OF 8 AND REHABILITATIVE SERVICES REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION OMB NO: SECTION A. DATA COLLECTION DATE COUNT DATE: 12 3 MONTH DAY YEAR

2 U.S. DEPARTMENT OF EDUCATION TABLE 1 PAGE 2 OF 8 AND REHABILITATIVE SERVICES REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION OMB NO: SECTION B. DISCRETE AGE BY FOR CHILDREN AGES 3-5 RECEIVING SPECIAL EDUCATION SPEECH OR LANGUAGE IMPAIRMENTS VISUAL IMPAIRMENTS DEVELOPMENTAL DELAY 2 TOTAL: (Sum of all of the above) AGE AS OF DATA COLLECTION DATE (PERCENT) % % % % % % % % % % % % % % 1 STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED. 2 States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting. ED FORM:869-5

3 U.S. DEPARTMENT OF EDUCATION TABLE 1 PAGE 3 OF 8 AND REHABILITATIVE SERVICES REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION OMB NO: SECTION C. RACE/ETHNICITY BY OF CHILDREN AGES 3-5 RECEIVING SPECIAL EDUCATION RACE/ETHNICITY AMERICAN INDIAN OR ALASKA NATIVE ASIAN OR OTHER PACIFIC ISLANDER BLACK (NOT HISPANIC) HISPANIC WHITE (NOT HISPANIC) TOTAL SPEECH OR LANGUAGE IMPAIRMENTS VISUAL IMPAIRMENTS DEVELOPMENTAL DELAY 1 TOTAL: (Sum of all of the above) TOTAL (PERCENT) % 2% 14% 7% 77% 100% 1 States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting. 2 STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

4 U.S. DEPARTMENT OF EDUCATION AND REHABILITATIVE SERVICES TABLE 1 REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION PAGE 4 OF 8 OMB NO.: SECTION D. DISCRETE AGE BY OF CHILDREN AGE 6-21 RECEIVING SPECIAL EDUCATION AGE AS OF DATA COLLECTION DATE SPEECH OR LANGUAGE IMPAIRMENTS VISUAL IMPAIRMENTS DEVELOPMENTAL DELAY TOTAL: (Sum of all the above) States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting. ED FORM:869-5

5 U.S. DEPARTMENT OF EDUCATION PAGE 5 OF 8 TABLE 1 AND REHABILITATIVE SERVICES OMB NO.: REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION SECTION D (CONTINUED) SPEECH OR LANGUAGE IMPAIRMENTS VISUAL IMPAIRMENTS DEVELOPMENTAL DELAY TOTAL: (Sum of all the above) AGE AS OF DATA COLLECTION DATE

6 U.S. DEPARTMENT OF EDUCATION PAGE 6 OF 8 TABLE 1 AND REHABILITATIVE SERVICES OMB NO.: REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION SECTION D (COUNTINUED) SPEECH OR LANGUAGE IMPAIRMENT VISUAL IMPAIRMENT DEVELOPMENTAL DELAY 2 TOTAL (Sum of all the above) AGE AS OF COLLECTION DATE (Actual Data) (Optional) (Optional) (PERCENT) % % % % % % % % % % % % % % 1 STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED. 2 States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting.

7 U.S. DEPARTMENT OF EDUCATION TABLE 1 PAGE 7 OF 8 AND REHABILITATIVE SERVICES REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION OMB NO: SECTION E. RACE/ETHNICITY BY OF CHILDREN AGES 6-21 RECEIVING SPECIAL EDUCATION RACE/ETHNICITY AMERICAN INDIAN ASIAN OR OTHER BLACK WHITE OR ALASKA NATIVE PACIFIC ISLANDER (NOT HISPANIC) HISPANIC (NOT HISPANIC) TOTAL SPEECH OR LANGUAGE IMPAIRMENTS VISUAL IMPAIRMENTS DEVELOPMENTAL DELAY TOTAL (Sum of all the above) TOTAL (PERCENT) 2 0% 1% 18% 7% 74% 100% 1 States must have defined and established eligibility criteria for developmental delay in order to use this category for reporting. 2 STATES SHOULD NOT PROVIDE PERCENTAGES IN THIS SECTION, AS THEY WILL BE CALCULATED AFTER THE COUNTS ARE SUBMITTED.

8 U.S. DEPARTMENT OF EDUCATION TABLE 1 PAGE 8 OF 8 AND REHABILITATIVE SERVICES REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION OMB NO: REPORT DUE NO LATER THAN FEBRUARY 1, SECTION F. - CERTIFICATION I CERTIFY that these data represent an accurate and unduplicated count of children with disabilities receiving special education and related services according to an Individualized Education Program on my State's designated child count date, which falls between October 1 and December 1 of. AUTHORIZING OFFICIAL NAME AND TITLE (TYPE OR PRINT) SIGNATURE DATE OF SIGNATURE

9 U.S. DEPARTMENT OF EDUCATION TABLE 1 COMMENTS AND REHABILITATIVE SERVICES REPORT OF CHILDREN WITH DISABILITIES RECEIVING SPECIAL EDUCATION COMMENTS