PASSAIC PUBLIC SCHOOLS - DEPARTMENT OF SPECIAL SERVICES
2013 - 2014 STUDENT SERVICE NEEDS
THIS WILL ALSO SERVE AS YOUR END OF 2012-2013 CASE MANAGEMENT LIST
Case Manager
First Name
Last Name
Case Manager Email
Student Name
First Name
Last Name
DSS #
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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17
18
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24
25
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28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
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1963
1962
1961
1960
1959
1958
1957
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1952
1951
1950
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1948
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1945
1944
1943
1942
1941
1940
1939
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1936
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1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Street Address
2012-2013 School
Please Select
01
02
03
04
05
06
07
08
09
10
11
12
15
16
17
19
20
OOD School
Please Select
American School for the Deaf
Banyon School
Banyon Upper School
Benway
Bergen County Technical Schools (shared time)
Bergen Center for Child Development
Bleshman Regional Day
Bonnie Brae
Brownstone Reg
Calais
Cerebral Palsy Center - Full time Program
CP Center of North Jersey- Horizon Lower School
Chancellor Academy I
Chapel Hill Academy
Celebrate the Children
Children's Home- Mary A. Dobbins School
Children's Therapy Center- Fairlawn
Children's Therapy Center-Upper School- Midland Park
Concordia Learning Ctr- @ St. Josephs School for the Blind
David Gregory
Daytop Prep School
Department of Children & Families- Totowa Campus
Department of Children & Families- Wanaque Campus
Deron 1 (Union)
Deron 11 (Montclair)
Early Childhood Learning Center
East Mountain School (Carrier Clinic)
Elmwood Park Public School
Ernest May Academy
Essex Campus Academy
Essex High School
Essex Junior Academy
Essex Valley School
Evergreen Acdemy
Felician School for Exceptional Children
Fort Lee Educational School
Forum School
Garden Academy
Gateway School
George Washington
Glenview Academy
Godwin School
Gramon School
Grove School
Ha'or Beacon School
High Point School
Lakeland/Andover School
JFK Johnson Rehabilitation
Lake Drive School
Lakeview Learning Center
Learning Center for Exceptional Children
HIP/Midland Park School
SHIP/Midland Park School
Millburn Regional Day
Mt. Carmel Guild Academy
Mt. Carmel Guild High School
Mt. Saint Joseph Children's Center
Montclair St. Univ. Demo. Pgm- Childrens Ctr
National Deaf Academy
New Alliance Academy-Paramus- (Naples Approved)
New Beginnings
New Bridges
North Hudson Academy
Northwest Essex Community
NOVA North- Emerson High Sch Program
Palisades Regional Academy
Passaic County Tech Institute- Special Ed
Paterson Public Schools- Great Falls- Special Ed
Paterson Public Schools- Stars Academy
Phoenix Center
Pinter School
Ridgefield Memorial High School
Rockland Institute for Special Education
Sage Day (Naples Approved)
Salem County Special Services School
Sawtelle Annex- Kearny
Sawtelle Learning Center-Montclair
Shaler Academy
Shepard Academy
Shepard High School
Sinai Special Needs Institute- River Edge
Sinai Special Needs Institute- Livingston
Slocum Skews
Somerset Hills
South Bergen Jointure- Lodi
Springboard Program
Transition Center WoodRidge
HIP/Union Street School
Venture Program
Visions
Washington Academy
Washington North
Washington South -Paramus
Washington South -Ridgewood
Westbridge Academy
Willowglen Academy
Windsor Academy
Windsor Learning Center
Windsor Prep High School
Woods Services
Millville Board of Education
NJ Commission for the Blind
Passaic County Tech Institute- Regular Ed
Paterson Public Schools- Great Falls-Reg Ed
Hope Academy -Regular Ed (1)
Clifton Board of Education- Regular Ed
Franklin Township Board of Education- Regular Ed
Ridgewood Board of Education-Regular Ed
Ranch Hope
Atlantic City Board of Education- Regular Ed
Flemington-Raritan Regional School District -Reg Ed
Classification
Please Select
SLD
AUT
AUD IMP
ED
COG IMP
COM IMP
MD
PSD
OHI
DEAF/BLIND
ORTH IMP
TBI
IF MD, SELECT DISABLING CONDITION
Please Select
N/A
SLD
AUD IMP
ED
COG IMP
COM IMP
MD
PSD
OHI
DEAF/BLIND
ORTH IMP
TBI
AUT
IF MD, SELECT A SECOND DISABLING CONDITION
Please Select
N/A
SLD
AUD IMP
ED
COG IMP
COM IMP
MD
PSD
OHI
DEAF/BLIND
ORTH IMP
TBI
AUT
Grade
Please Select
PK
K
1
2
3
4
5
6
7
8
9
10
11
12
12+
MONOLINGUAL, BILINGUAL, OR TRANSITIONAL?
Please Select
MONO
BIL
TRANS
Current Teacher/HR
WAS STUDENT DECLASSIFIED DURING 2011-2012?
Please Select
NO
YES
DATE OF MOST RECENT IEP
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
PRE-K INSTRUCTIONAL PROGRAM INFO
*
N/A
RED ED
CaaS
ICS
PSD SC
Planning Time
Work Time
Recall Time
Small Group
Large Group
Outside Time
K -6 Language Arts
Please Select
CaaS
ICS
ICR
PO
LLDMM
LLDSEV
COM-IMP
MD
COG-IMP
AUT
MDBD
N/A
K -6 Writing
Please Select
CaaS
ICS
ICR
PO
LLDMM
LLDSEV
COM-IMP
MD
COG-IMP
AUT
MDBD
N/A
K -6 Math
Please Select
CaaS
ICS
ICR
PO
LLDMM
LLDSEV
COM-IMP
MD
COG-IMP
AUT
MDBD
N/A
K -6 Science
Please Select
CaaS
ICS
ICR
PO
LLDMM
LLDSEV
COM-IMP
MD
COG-IMP
AUT
MDBD
N/A
7-8 Math
Please Select
CaaS
ICS
PO
DEPT
LLDMM
LLDSEV
MD
MDBD
COG-IMP
N/A
7-8 Language Arts
Please Select
CaaS
ICS
PO
DEPT
LLDMM
LLDSEV
MD
MDBD
COG-IMP
N/A
7-8 Social Studies
Please Select
CaaS
ICS
PO
DEPT
LLDMM
LLDSEV
MD
MDBD
COG-IMP
N/A
7-8 Science
Please Select
CaaS
ICS
PO
DEPT
LLDMM
LLDSEV
MD
MDBD
COG-IMP
N/A
9-12 Math
Please Select
CaaS
ICS
PO
DEPT
LLDMM
LLDSEV
MD
MDBD
COG-IMP
N/A
9-12 Math Course Title
9-12 English
Please Select
CaaS
ICS
PO
DEPT
LLDMM
LLDSEV
MD
MDBD
COG-IMP
N/A
9-12 English Course Title
9-12 History
Please Select
CaaS
ICS
PO
DEPT
LLDMM
LLDSEV
MD
MDBD
COG-IMP
N/A
9-12 History Course Title
9-12 Science
Please Select
CaaS
ICS
PO
DEPT
LLDMM
LLDSEV
MD
MDBD
COG-IMP
N/A
9-12 Science Course Title
Speech
Please Select
N/A
1x/wk
2x/wk
3x/wk
Speech Ratio
Please Select
individual
group
OT
Please Select
N/A
1x/wk
2x/wk
3x/wk
PT
Please Select
N/A
1x/wk
2x/wk
3x/wk
Counseling
Please Select
N/A
1x/wk
2x/wk
3x/wk
Counseling Ratio
Please Select
individual
group
PARAPROFESSIONAL
Please Select
Yes
No
PARA Ratio
Please Select
N/A
1 to 1
2 to 1
3 to 1
4 to 1
CURRENT PARAPROFESSIONAL
TRANSPORTATION FOR 2013-2014?
Please Select
NO
YES
ESY IN CURRENT IEP?
Please Select
NO
YES
Submit
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