Special Education Required Forms Procedural Manual Updated 10/1/18 Table of Contents Page Advance Written Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Determination of Adverse Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Documentation of Agreement of Non-Attendance for IEP/IFSP Team member whose Curriculum Area IS NOT being Discussed . . . . . . . . . 12 Documentation of Agreement of Non-Attendance for IEP/IFSP Team member whose Curriculum Area IS being Discussed . . . . . . . . . . . . . 13 Individualized Education Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Parental Consent for Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Parental Consent to Invite Other Agencies to IEP Meetings – Postsecondary Goals & Transition Services . . . . . . . . . . . . . . . . . . . . 46 Referral for Special Education Services. . . . . . . . . . . . . . . . . . . . . . . .. 48
If yes, provide explanation of why the child cannot participate in the regular district-wide or State-wide assessment and why the alternate assessment selected is appropriate. The Maine’s Alternate Assessment Participation Guidelines can be found at the following website: The Participation Decision Flowchart can be found at the following website: Section 8: SPECIAL EDUCATION AND RELATED SERVICES This section is used to: Document any special education and related services including ESY services. Special Education Services Directions: Indicate the specialized instruction services the child requires. Each identified instructional area should be listed separately. Indicate the position of the properly certified or licensed personnel who will be responsible for the identified specialized instruction area. Only the role of the person should be identified, not specific individuals by name. This allows for continuation of services when there are changes in staff or when the child changes schools. Indicate the location where the service will be provided. Be reasonably specific, e.g., specific general education setting, specific special education setting, related service room, etc. Indicate frequency of services. Identify how many minutes the provider will work with the child on a daily, weekly or monthly basis. Totals should be tallied for ease of data collection. Frequency should be written so as to facilitate calculation of LRE. The frequency of direct and related services should be documented in a way that does not exceed the school day or school week. Indicate the start date. Services indicated should ordinarily begin on the Effective Date of the IEP with the exception of ESY Services. Indicate the end date. The date indicates the anticipated duration of the service. Speech/Language services are a direct special education service when:
If so, check “YES” and describe the basis for this conclusion in the “Verification” box. If you have checked “YES”, go on to Question 8. If not, check “NO” and describe the basis for this conclusion in the “Verification” box. Then go on to the next factor. Consider whether the child’s failure to achieve adequately is primarily the result of an emotional disturbance. Sources of data include: rating scales, disciplinary records, teacher/parent reports, medical records, observations. Emotional Disability – areas that are not part of the referral If so, check “YES” and describe the basis for this conclusion in the “Verification” box. If you have checked “YES”, go on to Question 8. If not, check “NO” and describe the basis for this conclusion in the “Verification” box. Then go on to the next factor. Consider whether the child’s failure to achieve adequately is primarily the result of an environmental, cultural or economic disadvantage and/or limited English proficiency. Sources of data include: WIDA scores, ACCESS scores, parent/guardian report; documentation of chronic life disruptions. If so, check “YES” and describe the basis for this conclusion in the “Verification” box. If you have checked “YES”, go on to Question 8. If not, check “NO” and describe the basis for this conclusion in the “Verification” box. Then go on to the next question. This section is used to: Identify whether the child’s strengths and weaknesses demonstrate a pattern of strengths and weaknesses. “Performance” refers to how the child performs in the classroom; “achievement” refers to how the child performs on academic assessments. Directions: This decision should be based on the profile of the child using all Sections a-d. A child whose performance and achievement scores are uniformly depressed and are consistent with the child’s intellectual development does not demonstrate a pattern of strengths and weaknesses consistent with a specific learning disability, in contrast to a child whose performance and
The disability is of such a nature AND degree that it can be adequately addressed through general education interventions and/or accommodations; therefore, special education and related services are not needed to address it. This section is used to: Determine the level of articulation impairment. Directions: Check “No articulation assessment needed” when a standardized assessment was not administered because articulation impairment was not part of the referral, and was not raised as an area of suspected disability during referral or as part of a re-evaluation. Unless “No articulation assessment needed” is checked, one of the four boxes in each of the three categories must be checked. When completing the “Informal Assessments” category for a child aged 5, use the “Ages 3-5” grid if the child is receiving services through CDS, and the “Ages 5-20” grid if the child is receiving services through the SAU. If either the “Moderate” or “Severe” box is checked in each of the three categories, then the child exhibits an articulation impairment and the “Yes” box for question 1 on page 1 should be checked. If “No apparent problem” or “Mild” is checked for any of the three categories, the child does not exhibit an articulation impairment and the “No” box for question 1 on page 1 should be checked. This section is used to: Determine the level of language impairment. Directions: Check “No language assessment needed” when a standardized assessment was not administered because language impairment was not part of the referral, and was not raised as an area of suspected disability during referral or as part of a re-evaluation. Unless “No language assessment needed” is checked, one of the four boxes in each of the two categories must be checked. If either the “Moderate” or “Severe” box is checked in both of the two categories, then the child exhibits a language impairment and the “Yes” box for question 2 on page 1 should be checked. If “No apparent problem” or “Mild” is checked for either of the two categories, the child does not exhibit a language impairment and the “No” box for question 2 on page 1 should be checked.
This section is used to: Determine the level of fluency impairment. Directions: Check “No fluency assessment needed” when a standardized assessment was not administered because fluency impairment was not part of the referral, and was not raised as an area of suspected disability during referral or as part of a re-evaluation. For children in CDS, a standardized assessment is not required; alternative assessment procedures such as clinical observations can be utilized to score the description of fluency. Unless “No fluency assessment needed” is checked, one of the four boxes in each of the two categories must be checked. If either the “Moderate” or “Severe” box is checked in each of the two categories, then the child exhibits a fluency impairment and the “Yes” box for question 3 on page 1 should be checked. If “No apparent problem” or “Mild” is checked for either of the two categories, the child does not exhibit a fluency impairment and the “No” box for question 3 on page 1 should be checked. This section is used to: Determine the level of voice impairment. Directions: Voice impairment is a medical condition, and the diagnosis from a physician is required. Check “No voice assessment needed” when a physician’s assessment was not obtained because voice impairment was not part of the referral, and was not raised as an area of suspected disability during referral or as part of a re-evaluation. Unless “No voice assessment needed” is checked, one of the four boxes in each of the two categories must be checked. If either the “Moderate” or “Severe” box is checked in each of the two categories, then the child exhibits a voice impairment and the “Yes” box for question 4 on page 1 should be checked. If “No apparent problem” or “Mild” is checked for either of the two categories, the child does not exhibit a voice impairment and the “No” box for question 4 on page 1 should be checked.
Continue to improve budget skills Seek support for banking and budget management Pay bills with parental assistance Work on driving skills Monitor regular car maintenance such as oil changes, tire pressure, and tune-up schedule Practice laundry skills and cooking at home Preplan meals and make shopping lists before entering grocery store Review home safety plan Access community agencies and resources as needed for services Review emergency contacts and phone numbers for support Seek support for medical appointments Written Notice The form is used to: Meet the requirement to notify parents at least 7 days prior to the date upon which the SAU takes any proposed action or refuses to act with regard to: referral evaluation identification programming placement informed consent for initial placement of services provision of early intervention services or a free appropriate public education to a child. Provide documentation of specific changes to be made to the IEP/IFSP and the timing for those changes. A Written Notice must be generated and sent to a parent after every IEP/IFSP Team meeting, agreement with parent to amend the IEP/IFSP without a meeting, or any other time that the SAU makes a decision affecting FAPE or Early Intervention Services. This includes an SAU decision to not convene an IEP meeting. Document parents’ informed consent to the initial provision of special education services. This section is used to: Document the pertinent child-related information.