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Individualized Education Program (IEP)
New Re-Eval
New Problem Solving Team Forms
Assessment Manual
Assessment Guide: developed by Jeff Moore, Ed.S., L.C.S.W.
Easy IEP
IEP Process
 IEP Meeting Before and After Evaluation, especially useful for teachers new to IEP meetings - Invitation to a Meeting, a locally
revised form with a suggested list of invitees given
as a PDF
- Conference Summary, the IEP Team Meeting Minutes, summary of concerns/recommendations addressed at the IEP or Re-eval meeting (December 2006 version replaces the April 2002 version). Here it is as a PDF file. You may want to print this one on pink paper to match what is currently in the IEP files.
- Placement of IEP Folder Documentation, what goes where in Sevier County's IEP records
- Record of File Review, the page that goes on top of the left side of the IEP record, for reviewers to sign
- Documentation of Medical Diagnosis Form, for
doctors to indicate a diagnosis/prognosis for students with health/orthopedic
impairments, attention deficits, or traumatic brain injury (in MS Word, and as a PDF file.)
- Certification Forms enumerating the handicapping condition and giving the date of either the Psychological Evaluation, Medical Evaluation, Audiological Evaluation, Psychological Evaluation or Speech/Language Assessment, or Psychological/Medical Evaluation. These certification forms aren't required, but are used locally by Sevier County's School Psychologists. Case managers may leave them on top of the eligibility report, or just put the eligibility report (which is required) on the left side of the IEP folder atop all of its supporting documentation.
- Specific Learning
Disabilities Eligibility Documentation, notice boxes 4a and 4b especially.
Sevier County's interpretation of an appropriate time period for an intervention
is 6 to 12 weeks.
- Individual Education Plan (IEP) - just in case
- Blank IEP Template (in MS Word) this one uses text boxes, making it a little easier to complete
- Notice of Provision of Free, Appropriate Public Education, the summary page that parents/guardians receive with the IEP
 PWN Initial Evaluation Template, a Prior Written Notice template for an initial referral meeting
- PWN for a 3-Year Re-evaluation Template, a Prior Written Notice template for use during a re-evaluation meeting
- Data Collection Form for Determining Extended School Year Eligibility, to be kept all year long for IEP documentation tracking
- Extended School Year Eligibility 5 Question Worksheet, for the case manager to write up prior to the annual IEP meeting
- Extended School Year Service Plan for use before and during the ESY placement to document goal progress
- Prevocational Checklist, as an Excel 4.0 file, and as a PDF
- Preschool Prevocational Skills Checklist, a slightly different version for the 3 to 5 year olds
- Data Collection and Behavior Documentation Forms, a growing assortment of PDF-file forms from PolyXO.com
- Behavior Plan
- Consent to Invite Outside Agency for Transition Planning
State and County Forms
 Tennessee Special Education Forms
- Parent Survey, for guardians to rate the evaluation and Special Education planning process
- Parent Permission for Comprehensive Screening, for the guardians to indicate permission (or not) for the school to screen their child
- Assessment Report, a cover sheet for the test administrator to indicate results, recommendations, and comments from the assessment testing sessions
- 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. Eligibility Report a an e-form.
- Release of Information, the letter guardians sign so Sevier County can either send or get a student's Special Education records
- Continuation of Educational Services so guardians can indicate previous Special Education enrollment when their child moves around or out of Sevier County
- 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 instruction for completing it (in MS Word) 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.
- 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.
- Request for Special Transportation, complete and fax to Rebecca Campbell
- Tracking Calls Home one way, or a second way to record talks with parents
- Assessment Summary, 1-page tracking of a single student's assessment progress over her or his school career
- Four Year Educational Plan, a worksheet to plan credits for grades 9 through 12
- CDC Transition Planning Worksheet for 17 - 21 year olds, to track by name or total number your students' transition to work progress
- CDC Program Tracking for High School, a checklist to help CDC teachers keep up with the paper work and other to-dos month-to-month
- CDC Program Tracking for Primary, Elementary, Middle, and Intermediate School, a checklist to help CDC teachers keep up with the paper work and other to-dos month-to-month
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Last Updated 03/31/10
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