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20. |
Individualized Education Program,
the IEP |
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When to use this form:
This form is the Department of Education’s IEP document.
The special education staff in conjunction with the IEP
team completes the IEP form. The IEP identifies the
special education services and related and supplementary
services that the student will be provided. The IEP form
reflects the student’s annual (1 year) educational plan
as agreed to by the student’s parents/guardian and the
school district. The School district/cooperative staff
should refer to the Department of Education’s IEP
Technical Assistance Guide during the development of an
IEP and in any subsequent modifications. |
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Printable Version
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20a. |
Addendum to the IEP |
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When to use this form:
This form is part of the Department of Education’s IEP document
and is completed when there is a change in any portion
of a current active IEP.
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Printable Version
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21. |
IEP Technical
Assistance Guide |
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When to use this form:
This form is the Department of Education’s Technical
Assistance Guide for writing an appropriate IEP. Special
education personnel should refer to the IEP Technical
Assistance Guide during the development of a student’s
IEP. |
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Printable Version
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22. |
Therapy Session
Statement |
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When to use this form:
When writing an IEP that requires related services,
be sure to include the statement that related services
will be provided when school is in session, except
when extended school year services are needed.
An example statement
may look like this:
Johnny will receive
speech therapy services two times a week for 20 minutes
each when school is in session. |
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Question and Answer |
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23. |
Sample
Justification Statements for Alternative Placements |
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When to use this form:
This form is used by special education personnel when
developing a justification statement(s) for removing a
student from the general education classroom setting.
The form contains sample justification statements for
various placement settings. |
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Printable Version
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24. |
IEP Team
Placement Committee Over-Ride |
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When to use this form:
This form is used by the student’s IEP team to justify
the student’s eligibility for special education services
when evaluation data reflects that the student did not
meet the Department of Education’s eligibility criteria.
This form allows the district/cooperative IEP Committee
Team to provide for an exception (over-ride), by citing
other relevant evaluation data that would justify the
student’s eligibility for special education services.
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Printable Version
Computer Version
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25. |
Parents/Guardian
Placement Refusal |
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When to use this form:
This form may be used by the student’s IEP Team to
document that the parents/guardian were given the
opportunity to place their child in the
district/cooperative special education program but
refused. |
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Printable Version
Computer Version
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26. |
Transition
Course of Study Worksheet |
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When to use this form:
This form is used by the high school special education
staff to keep a record of a high school student’s course
of study toward meeting the district’s graduation
requirements. The school district’s general education
course requirements are listed and the district’s
special education substitute courses are listed with
course completion dates. |
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Printable Version
Computer Version
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27. |
Parent/Guardian
Not in Attendance at an IEP Meeting |
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When to use this form:
This form is used by the special education staff as a
cover letter to parents/guardian who did not attend an
IEP meeting after a series of attempts was made by the
district/cooperative special education staff to ensure
their attendance. The form is sent with their student’s
IEP asking the parents/guardian to sign and return the
IEP signature page with their consent to implement the
IEP. |
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Printable Version
Computer Version
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28. |
Notices of
Changes to an IEP without an IEP Meeting |
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When to use this form:
This form is used by the special education staff to
allow for changes to a student’s IEP without a meeting.
The special education staff may use communication
devices such as parent- teacher meetings, phone
conversations, e-mails, etc. to communicate with
parents/guardian for agreed changes to a student’s IEP.
The form states the reason for the change, other options
considered and provides parents/guardian procedural
safeguards. |
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Printable Version
Computer Version
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29. |
Changes to IEP |
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When to use this form:
This form is given to the student’s parents/guardian
after the parents/guardian has agreed to change the
student’s IEP without an IEP Team meeting. The form
describes the changes to the student’s IEP and the date
changes to the IEP will begin. |
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Printable Version
Computer
Version
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30. |
Parent/Guardian
Notice that Graduation Requirements will be Met |
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When to use this form:
This form is used by special education staff to notify
parents/guardian that the student’s IEP Team has met and
determined that their child’s graduation requirements
will be met at the end of the current school term and
will proceed to graduation upon successful completion of
the current curriculum and IEP. |
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Printable Version
Computer Version
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32. |
IEP Student
Progress Report |
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When to use this form:
This form is completed by special education personnel to
report to parents/guardians the student’s progress
toward meeting annual IEP goals. The form identifies the
student’s annual goals, rating scale toward progress,
evaluation procedures and a recommendation if the
progress is sufficient for the student to achieve the
goal by the end of the school term, and staff comments
to parents/guardians. At a minimum, the form should be
completed and discussed with the student’s
parents/guardians at the same frequency as general
education teachers communicate student progress with
parents/guardians. For struggling students, the form
should be completed and discussed with the student’s
parents more frequently than students who are making
adequate progress toward their IEP goals. |
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Printable Version
Computer Version
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33. |
Revocation of Special Education Consent
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When to use this form:
This form enables the parent or adult student to
revoke their consent for special education services in
writing. Special education and related services
can be discontinued only after the school district's
receipt of the parent's/guardian's signature to revoke
consent for special education services for the student
and provision of Prior Written Notice to
the parents/guardian. |
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Printable Version
Computer Version
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