County Forms
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.
Enrollment Card with boxes for emergency information, last school attended, who can sign out the student, and the textbook agreement
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
Sevier County Schools Student Referral for Special Education, the first steps in getting a general education student Special Education services
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.)
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. Or here is the
Eligibility Report as a PDF file.
TLC Release of Information, the letter guardians sign so
the Center can either send or get a student's Special Education records; the
same as a PDF file
Continuation of Educational Services
in MSWord and as a
PDF File, so guardians can indicate previous Special Education enrollment when their child moves around or out of Sevier County
Initial Evaluation Timeline Waiver. Also notice that the instruction for completing it (in MS Word or as a
PDF file) 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
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.
Information for SPED Census, the form (in MS Word) for faxing to Rebecca Campbell after programming changes involving any Special Education student
Special Education Staffing Report, for building-level IEP Monitors to update the Trula Lawson Center records monthly (by faxing to Rebecca Campbell after each month's updates)
Request for Special Transportation, complete and fax to Rebecca Campbell
Field Trip Permission to Parents one fill-in-the-blanks model to send home. Also see
Field Trips and Excursions, Sevier County School Board Policy 515.
Tracking Calls Home one way, or
a second way to record talks with parents
Note to Home, a progress update to send home with the student each day
CDC/SDC Meeting Record, a table-structured conference form, for keeping all staff working with the same students informed of the same highlights or actions needed
Special Education Class Roster, single page access to students' contact information, goals, modifications, related services, etc.
Caseload Management Chart, another single-look at dates, background of the students on your caseload
Group Goal/Objective Matrix, for setting up group instruction by motor, adaptive, communication, social, and cognitive goals
Assessment Summary, 1-page tracking of a single student's assessment progress over her or his school career-
Inclusion Schedule, for weekly tracking of rooms students are to be in for certain periods
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
Review of Progress Toward IEP Goals, for use in drafting six week progress reports
Lesson Plan Form,
an MS Word template covering what is required in lesson plans for
nontenured teachers
Student's Skill Summary, another way of reporting progress on IEP goals
IEP Progress Report Cover Sheet, for the parent and teacher to send and receive comments each grading period
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Behavior Plan in Word, as commonly used in Sevier County when necessary; also
as a PDF file
FBA Behavior Support Plan in Word,
as a PDF, and
in MS Works. Similar to the one directly above.
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Manifestation Determination Form, the documentation of review needed for
determining if a student's behavior was or was not a manifestation of the
disability (in MS Word, and as a PDF file.)
Report of
Suspension Form to be used for all Sevier County student suspensions.
(Here is the same file as a PDF.)-
You'll need Adobe Acrobat Reader for the following three files. If you don't have Acrobat Reader already loaded, you can download it from here. Printer definition files [PDFs] will print out with exactly the same look and pagination as the original, paper forms.
Application for Employment with the Sevier County School System, for teaching assistants or others requesting work that does not require certification
Application for Teaching Employment with the Sevier County School System, for those requesting teaching or other certified positions
Certified, Noncertified, and Substitute Teacher Applications are available in MS Word under the "Documents" link at this Sevier County page
County Contract Supplement Form, for employees to be paid from Sliver Grant funds
Flexible Inservice Credits, for professional staff to document the 6 (or more) hours of inservice time required each year. The
same form as an Acrobat PDF file.
Request
for Professional Leave, must be signed by the principal and director of
curriculum and instruction before the date(s) requested-
Claim for Traveling Expenses, for covered employees to be reimbursed for driving their own vehicles on official business (new form for 03-04 school year)
Dental or Vision Direct Reimbursement Claim Form, for covered employees to receive back part of their payments for covered dental work
or eye exams, glasses, contacts, etc. (form was revised to add vision in January 2004)
Bus Conduct Report, the driver's form for reporting student behavior and corrective action taken
Bus Maintenance/Completion Reporting Form, Sevier County Schools Form 620, for the driver to indicate a problem and the garage staff to report how they fixed the vehicle
Application for Tennessee Teaching License or Amendment to Licensure, the form for adding education credits, additional endorsements, or Praxis scores
Table of Endorsement Titles and Corresponding Codes, includes most (but not all) Tennessee Teaching License add-on endorsement codes. Link to the full list. This also lists disability codes.
- Individualized Education Program (IEP). Also see
the IEPs links on the Sevier County Information Page for IEP documents that aren't forms.
Checklist for Multidisciplinary Team Meeting/IEP Creation, steps to keep in mind and their IDEA '97 and 34 CFR 300 regulatory references
IEP Meeting Before and After Evaluation, especially useful for teachers new to IEP meetings
Invitation to a Meeting, the former "Notice of Multidisciplinary Team Meeting" to parents/guardians
Invitation to a Meeting, the former "Notice of Multidisciplinary Team Meeting" to parents/guardians (in MS Works 4)
IEP or Re-evaluation Tracking, year-at-a-glance format for tracking when students' IEPs or evaluations need to be ready
Conference Summary, the summary of concerns/recommendations addressed at the IEP or Re-eval meeting (April 2002 version). You may want to print this one on pink paper to match what is currently in the IEP files.
IEP Summary, a table for matching the students with their common IEP goals
Placement of IEP Folder Documentation, what goes where in Sevier County's IEP records
Placement of IEP Folder Documentation, what goes where in Sevier County's IEP records (MS Works 4 file)
Record of File Review, the page that goes on top of the left side of the IEP record, for reviewers to sign
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.
Individual Education Plan (IEP), for use in planning IEP meetings. This has on it the changes added in September 2003, to the accommodations/standardized testing planning page. You'll need MS Word 97 or later to open this one; the rest of the Word files on this site are Winword 6.0 accessible.. The
blank IEP as a PDF file, for those handwriting the IEP.
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
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
Parent/Professional Vision Observations Checklist, a 3-page PDF used as part of the functional vision assessment
Behavior Plan in Word, as commonly used in Sevier County when necessary; also
as a PDF file
FBA Behavior Support Plan in Word,
as a PDF, and
in MS Works. Similar to the one directly above.
Accommodations
Checklist, a 2-page expanded listing for modifications to make for students,
especially in general education settings-
Home/Community Activities
Inventory for Primary and Elementary Students, a product of Tennessee's
LRE for LIFE Project. It helps parents give input prior to IEP development.
Data Collection and Behavior Documentation Forms, a growing assortment of PDF-file forms from PolyXO.com
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