Special Education Forms and Procedures 2016-12-07T09:01:49+00:00

Section 1: Child Find

1.1         Child Find

 

Section 2: Confidentiality and Teacher of Record (TOR)

2.1         Confidentiality

2.2         Authorization for Release and Exchange of Information-Form

2.2S       Authorization for Release and Exchange of Information-Spanish-Form

2.3         Special Education Teacher Responsibilities

2.4         Special Education Student Information Distribution

 

Section 3: Enrollment

3.1         Enrollment Form

3.1S       Enrollment Form-Spanish

3.2         Move-In Procedure

3.2a       Suspected Special Education Student Enrollment Form

3.3         Transfer Procedure Flowchart

 

Section 5: Procedural Safeguards and Surrogate Parent

5.1         Distribution of Procedural Safeguards/Parent Rights

5.2         Summary of Parent Rights

5.3         Indiana Department of Education Notice of Procedural Safeguards

5.3S       Indiana Department of Education Notice of Procedural Safeguards-Spanish

5.4         Educational Surrogate Parent Procedures and Guidelines

5.5         Surrogate Parent Appointment Form

 

Section 7: Reevaluation

7.1         Reevaluation Procedure Flowchart

7.2         Reevaluation Plan

7.3         Social History Reevaluation-Form

7.3         Social History Reevaluation-Online Template

7.4         Parent Notification Reevaluation of Scheduled Case Conference

 

Section 8: Multidisciplinary Responsibilities and Evaluations

8.1         Multidisciplinary Team Process

8.2         Multidisciplinary Evaluation Plan

8.3         Autism Spectrum Disorders (ASD) Multidisciplinary Team Members and Responsibilities

8.4         Eligibility Criteria for Autism Spectrum Disorder (ASD) Multidisciplinary Team Summary

8.5         Blind Low Vision (BLV) Multidisciplinary Team Members and Responsibilities

8.6         Eligibility Criteria for Blind Low Vision (BLV) Multidisciplinary Team Summary

8.7         Cognitive Disabilities Multidisciplinary Team Members and Responsibilities

8.8         Eligibility Criteria for Cognitive Disability Multidisciplinary Team Summary

8.9         Deaf-Blind (DB) Multidisciplinary Team Members and Responsibilities

8.10       Developmental Delay (DD) Multidisciplinary Team Members and Responsibilities

8.11        Eligibility Criteria for Developmental Delay (DD)Multidisciplinary Team Summary

8.12       Emotional Disability (ED) Multidisciplinary Team Members and Responsibilities

8.13       Eligibility Criteria for Emotional Disability (ED) Multidisciplinary Team Summary

8.14       Language or Speech Impairment (LSI) Multidisciplinary Team Members and Responsibilities

8.15       Eligibility Criteria for Language or Speech Impairment (LSI) Multidisciplinary Team Summary

8.16       Multiple Disabilities Multidisciplinary Team Members and Responsibilities

8.17       Eligibility Criteria for Multiple Disabilities Multidisciplinary Team Summary

8.18       Orthopedic Impairment (OI) Multidisciplinary Team Members and Responsibilities

8.19       Eligibility Criteria for Orthopedic Impairment (OI) Multidisciplinary Team Summary

8.20      Other Health Impairment (OHI) Multidisciplinary Team Members and Responsibilities

8.21       Eligibility Criteria for Other Health Impairment (OHI) Multidisciplinary Team Summary

8.22      Specific Learning Disability (SLD) Multidisciplinary Team Members and Responsibilities

8.23      Eligibility Criteria for Specific Learning Disability (SLD) Multidisciplinary Team Summary

8.24      Traumatic Brain Injury (TBI) Multidisciplinary Team Members and Responsibilities

8.25      Eligibility Criteria for Traumatic Brain Injury (TBI) Multidisciplinary Team Summary

8.26      Determining Eligibility for a Reading Disability Resulting from Organic Dysfunction Flowchart

1          ICAM/NIMAS Form 1: Special Consideration Factor

2          ICAM/NIMAS Form 2: Determination of Specialized Formats

3A       ICAM/NIMAS Form 3A: Add Update Student

3B       ICAM/NIMAS Form 3B: Add Update Student

3C       ICAM/NIMAS Form 3C: Add Update Student

4          ICAM/NIMAS Form 4: Eligibility and Certification for Specialized Formats of Print Instructional Materials

5          ICAM/NIMAS Form 5: Student/Parent Accessible Materials Use Agreement

8.27      Print Disability Eligibility Form

8.28      Preschool Teacher Information Form Parent Referral for Individual Evaluation

8.29      Preschool Special Education Teacher Summary Report

8.30      Physician Questionnaire for Medical Concerns

 

Section 10: Case Conference Process

10.1         Reevaluation Procedure Flowchart

10.2         Annual Case Conference Due Dates

10.3         Parent Notification of Scheduled Case Conference Eligible/Ineligible

10.4         Parent Notification: Completed Annual Case Conference

 

Section 13: Extended School Year

13.1         Extended School Year (ESY) Services Guidelines

13.2         Extended School Year (ESY) Services Decision Making Form

 

Section 16: Functional Behavioral Assessment and Positive Behavior Intervention Plan

16.1                    Functional Behavioral Assessment (FBA) & Positive Behavior Intervention Plan (PBIP) Guidelines

16.2                   Steps to Conducting a Functional Behavioral Assessment (FBA) and Positive Behavior Intervention

16.3                   FBA and PBIP Flowchart

16.4                   Record Review Notes

16.5                   FBA Teacher/Staff Interview

16.5(temp)       FBA Teacher/Staff Interview – Online Template

16.6                   FBA Behavior of Concern Questionnaire

16.6(temp)       FBA Behavior of Concern Questionnaire –  Online Template

16.7                    FBA Functional Assessment Checklist for Teachers and Staff (FACTS A and B)

16.7(ex)            FBA Functional Assessment Checklist for Teachers and Staff (FACTS A and B) Example (not available)

16.7(temp)       FBA Functional Assessment Checklist for Teachers and Staff (FACTS A and B) Template

16.8                   FBA Student Interview

16.8(temp)       FBA Student Interview-Online Template

16.9a                  FBA Reinforcement Survey

16.9a(temp)     FBA Reinforcement Survey – Online Template

16.9b                 FBA Dunn Rankin Reward Preference Inventory

16.9b(temp)     FBA Dunn Rankin Reward Preference Inventory Template

16.10                 FBA Functional Assessment Checklist for Students (FACTS A and B)

16.10(ex)          FBA Functional Assessment Checklist for Students (FACTS A and B) Example (Not available at this time)

16.10(temp)     FBA Functional Assessment Checklist for Students (FACTS A and B) Template

16.11                  FBA Parent Interview Form

16.11(temp)      FBA Parent Interview Form – Online Template

16.12                  FBA Possible Data Collection Methods

16.12a                ABC Recording Form

16.12a(ex)        ABC Recording Form Example

16.12b               Event Recording (Frequency) Form

16.12b(ex)        Event Recording (Frequency) Form Example

16.12c                Scatterplot

1612c(ex)          Scatterplot Example

16.12d               Duration Recording Form

16.12d(ex)        Duration Recording Form Example

16.12e                Intensity Recording Form

16.12e(temp)    Intensity Recording Form Example (Not available at this time)

16.12f                 Latency (Time to Respond) Recording Form

16.12f(ex)          Latency (Time to Respond) Recording Form Example

16.12g                Behavior Data Graphing Form

16.12g(ex)         Behavior Data Graphing Form Example

16.12g(temp)    Behavior Data Graphing Form Template

16.13                   Functional Assessment (FBA) Data Triangulation

16.13(ex)            Functional Assessment (FBA) Data Triangulation Example (Not available at this time)

16.13(temp)       Functional Assessment (FBA) Data Triangulation – Online Template

16.14                   FBA Function of Behavior Checklist

16.15                   FBA Competing Behavior Pathway

16.15(inst)         FBA Competing Behavior Pathway Instructions

16.15(ex)            FBA Competing Behavior Pathway Example

16.15(temp)       FBA Competing Behavior Pathway – Online Template

16.16                   Positive Behavior Intervention Plan (PBIP)

16.16(ex)            Positive Behavior Intervention Plan (PBIP) Example (Not available at this time)

16.16(temp)      Positive Behavior Intervention Plan (PBIP) – Online Template

16.17                   Individual Crisis Management Plan

16.17(ex)            Individual Crisis Management Plan Example

16.17(temp)       Individual Crisis Management Plan – Online Template

16.18                   FBA & PBIP Additional Resources

16.18a                 Environmental Inventory

16.18b                 Classroom Environment Checklist

16.18c                 Possible ABC Strategies by Function

16.18d                Classroom Interventions

16.18e                ABC Intervention Ideas

16.19                  FBA & PBIP Behavior Support Resources

 

Section 17 Physical Restraint and Time-Out

17.1         Physical Restraint Guidelines

17.2         Physical Restraint Reporting Form

17.3         Seclusion Timeout Procedures

17.4         Seclusion Timeout Reporting Form

17.5         Procedures for Students with Wandering Running Behavior

 

Section 18: Transition

18.1         Transition Individualized Education Plan (IEP) (not available)

18.2         Student Transition Assessment Planning Interview

18.3         IEP Transition Examples

18.4         Community Resources Information Sheet

18.5         Transition from Early Intervention Services to Early Childhood Special Education

 

Section 19: Medicaid

19.1         Procedures for Medicaid

19.2         Speech/Language/Audiology/Occupational Therapy Referral

19.3         Physical Therapy Referral

19.4         Approval for Behavioral Services

 

Section 20: Testing Accommodations

20.1         District Assessments

20.2         Guidelines for ISTEP/GQE/ECA Accommodations

20.3         Determining Participation in the State Assessment System

 

Section 21: Homebound

21.1         Homebound Education Guidelines

 

Section 22: Nonpublic and Home School Services

22.1         Procedures for Nonpublic School and Home School Students

22.2         Evaluation of Nonpublic School and Home School Students Flowchart

 

Section 23: Codes and Categories

23.1         Special Education Codes and Categories