Exit this survey SB1327 2015-2016 Instructions: Complete this form for each student served by IDEA or Section 504, upon severing attendance or denial of admission. Please note that the CALPADS code appears to the right of many of the reasons for severance as applicable.DEADLINE: July 1, 2016 for the 2015-2016 School Year Question Title * 1. District Information Name of School District, Private School, or Charter School Name of School: Contact Person: Email Address: Phone Number: Question Title * 2. Student Information Name of Student: Last known Address: Address 2: City/Town: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: Question Title * 3. Student's Grade K 1 2 3 4 5 6 7 8 9 10 11 12 Question Title * 4. Date of severance or denial Question Title * 5. School Referred to: School Name District City Question Title * 6. Check all that apply: Individual with exceptional needs under IDEA Qualified handicapped person under Section 504 Question Title * 7. Action taken/reason for action (check all that apply): Severance of attendance from the district of residence, county school or program, or private school (explain in question #8) Expelled, under Education Code 48915, from the district of residence, county school or program, or private school (explain in question #9) Excluded from the district of residence, county school or program, or private school (explain in question #10) Exemption from the district of residence, county school or program, or private school (explain in question #11) Transfer from the district of residence, county school or program, or private school (explain in question #12) Suspension beyond ten school days Denial of Admission to district of residency, other district, county school or program, or private school (explain in question #13) Question Title * 8. Severance of attendance from the district of residence, county school or program, or private school (Explanation of response to #7) Withdrew, did not pass CAHSEE (E230-104) Withdrew, no known enrollment (E140) Enrolled in adult education, dropped - no longer in district Special Ed (E230-360) Completed 12th grade, non graduate, dropped- no longer in district Special Ed (E230-360) Dropout or reason unknown (E140) Incarcerated (T160) No Show (N420) Reached maximum age/age exceeded above 22 (E400) Other, please specify Question Title * 9. Expelled, under Education Code 48915, from the district of residence, county school or program, private school or charter school (Explanation of response to #7) 48195 (a) 48195 (c) 48915 (e) Other, please specify Question Title * 10. Excluded from the district of residence, county school or program, or private school (Explanation of response to #7) Ages 18-21, disruptive Ages 18-21, no graduation progress For medical or health reasons (E410) Other, please specify Question Title * 11. Exemption from the district of residence, county school or program, or private school (Explanation of response to #7). Graduated - earned high school diploma (E230-100) Exceptional needs student with certificate of completion (E230-120) Deceased (E130) Entered college (T280) Completed GED (E230-320) Passed CHSPE (E230-330) Entered health care facility (T310) Left, medical reasons (E410) Private School (T180-T200) Question Title * 12. Transfer from the district of residence, county school or program, private school, or charter school (Explanation of response to #7) Intradistrict transfer (T167) Continuation High School(T167) District Community Day School(T167) County Community Day School(T167) Interdistrict transfer (T160) County program (T167) Opportunity class or program (T167) Independent Study (T167) Home & Hospital Program (T460) Adult Education (T260) Attending College (T280) Private school (T180) Charter School (T160) Other, please specify Question Title * 13. Denial of Admission (to district of residency, other district, county school or program, private school, or charter school. (Explanation of response to #7): District of Residence Other district County School or program Private School Other, please specify Question Title * 14. Status RSP SDC 504 Other, please specify Question Title * 15. Identified Disability: Question Title * 16. Reason for Action Taken: Submit