Sevier County Special Education
320 Cedar Street, Sevierville, Tennessee
  
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Forms and Templates

These templates are filled in with general Sevier County information, but otherwise blank. They are in Microsoft Word, version 6.0 (except for the blank IEP). If you have this version or later on the computer you are connecting with, you can save the template to your hard drive, then modify it from there. If you are using MS Works instead, you'll need to save to a disk or just download from a computer that does have MS Word.

New Forms for 2008-09

Procedural Safeguards Handbook

Rights of Children with Disabilities and Parent Responsibilities

New FBA

Parent Permission to Assess
FBA Referral
ABC Observation Form
FBA Form
FBA Worksheet
FBA Hypothesis
Teacher Interview
Parent Interview
Student Interview

New ReEval

Parent Input for ReEval
Adaptive Behavior Data
Intellectual/Cognitive Data
Summary Report Sections I & II
Summary Report Section IV
Summary Report Section V
Link to all Section III's

New Problem Solving Team Forms

PS Team Instructions
PS Team Refferal Form
Intervention Documentation
Exclusionary Factors
Team Notes and Decisions

*Assessment Manual by Jeff Moore, Ed.S., L.C.S.W.

*Updated Conference Summary

*Parent Permission for Comprehensive Screening, for the guardians to indicate permission (or not) for the school to screen their child

* Permission for Assessment, to screen for Special Education services; it has a back page that explains each type of assessment listed

* Request for Special Transportation, complete and fax to Rebecca Campbell

* Eligibility Report, to document eligibility for Special Education services and the instructions for completing it. Save it to your own hard drive because depending on your default printer's setup, you may have to reset a few tabs to get the check boxes to line up. Or here is the Eligibility Report as a PDF file.

* Release of Information, the letter guardians sign so Sevier County can either send or get a student's Special Education records

* Special Education Exit Form, for a student reaching 18 years old and choosing to terminate Special Education services
 
 
 
 
 
*Initial Evaluation Timeline Waiver. Also notice that the instructions for completing it require coordination with Nashville.
* Medication Administration Form, for parents to allow their child to be given or take a prescription or over-the-counter medication at school. Please see Use of Medicines by Students, BP 627 for the complete procedure.
 
*Report of Accidents and Injuries (to Students); original to Central Office, copy kept at
school
 
*Prior Written Notice
*Prior Written Notice for Initial Evaluation
 
*Prior Written Notice for Reevaluation
 
 
 
 
 
 
* Package for Requesting Homebound Services
These are in Adobe PDF file format.
* Cover Letter to Parents and Students Requesting Homebound Services, from the Director of Special Education
* Request for Homebound Services, the form to complete
* Homebound Medical Form, the doctor's medical evaluation (for use with other-than pregnancy-related requests)
* Homebound for Pregnancy Form, the physician's verification
* Homebound for Pregnancy Information, two pages of questions, answers, and advice
* Release of Information, permission for the school system to get information to and from the physician
* Parent Acknowledgement, consent for the teacher to come to the home
* SCS Anecdotal Record, for documenting day-to-day incidental reports to students' records. You may want to print this one on green paper to match what is currently in the files.
 
 
 
 
*Manifestation Determination Review includes a step-by-step worksheet.
*Manifestation Determination Questionnaire in MS Word, a 2-page version, similar to the FBA worksheets and checklists.
* Manifestation of Handicapping Condition Decision behavior or attendance record's correlation to the handicapping condition (a checklist form).
* Flexible Inservice Credits, for professional staff to document the 6 (or more) hours of inservice time required each year.
2008 Special Education Manual (Draft)
 
 
                                                                                                                                                                                                Last Updated 11/17/09
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