1. Manifestation Determination Review
1.1. Nature of the Child's Disability
1.2. Nature of the Behavior Subject to Disciplinary Action
1.3. Determination of the Relationship of the Behavior of the Concern to the Student's Disability
1.3.1. Did the IEP team review relevant information in the student’s file and the student’s IEP?
1.3.2. Did the IEP team review relevant information presented by the parents and teacher observations?
1.3.3. Did the IEP team determine that the conduct in question was caused by/or had a direct and substantial relationship to the child’s disability?
1.3.4. Was the child’s conduct a direct result of the district’s failure to implement the IEP?
1.4. Conclusion
2. Referral for Evaluation
2.1. Child's Information
2.2. Parents'/Guardian Information
2.3. Reason for Referral
2.4. Educational History
2.4.1. Provide data about the child's progress in the general curriculum or, for the preschool-age child, data pertaining to the child's growth and development
2.4.2. Provide data from previous interventions, including Interventions required by rule 3301-35-06 or; for the preschool child, data from early intervention, community or preschool providers:
2.4.3. Provide any relevant trend data beyond the past twelve months, including the review of current and previous IEPs:
2.4.4. Number of school districts attended:
2.4.5. Years at present school building
2.4.6. List schools/early childhood programs and dates:
2.5. Attendance
2.6. Background Info
2.6.1. Do you suspect problems with
2.6.1.1. Vision
2.6.1.2. Hearing
2.6.2. Does the student
2.6.2.1. Wear Glasses
2.6.2.2. Use Hearing Aids
2.6.3. Does the student take medication
2.6.4. Environmental Factors
2.7. Signatures
3. Parent Consent Evaluation
3.1. Permission/Grant Consent
3.2. Refuse Consent
4. Individualized Education Program
4.1. Child's Information
4.2. Parent/Guardian Information
4.3. Meeting Information
4.4. IEP Time Lines
4.5. IEP Form Status
4.6. Amendments
4.7. Future Planning
4.8. Special Instructional Factors
4.8.1. Does the child have behavior which impedes his/her learning or the learning of others?
4.8.2. Does the child have limited English proficiency?
4.8.3. Is the child blind or visually impaired?
4.8.4. Does the child have communication needs (required for deaf or hearing impaired )?
4.8.5. Does the child need assistive technology devices and/or services?
4.8.6. Does the child require specially designed physical education?
4.9. Profile
4.10. Extended School Year Services
4.11. Postsecondary Training and Education
4.11.1. Measurable Postsecondary Goal
4.11.2. Age Appropriate Transition Assessment regarding Post Secondary Training and Education
4.11.3. Courses of Student
4.11.4. Number of Annual Goals Related to Transitional Needs
4.11.5. Transition Service/Activity
4.12. Competitive Integrated Employment
4.12.1. ^
4.13. Independent Living
4.13.1. ^^
4.14. Measurable Annual Goals
4.14.1. Objectives
4.15. Descriptions of Specially Designed Services
4.15.1. Specially Designed Instruction
4.15.2. Related Services
4.15.3. Assistive Technology
4.15.4. Accommodations
4.15.5. Modifications
4.15.6. Support for School Personnel
4.15.7. Services to Support Medical Needs
4.16. Transportation as a Related Service
4.17. Nonacademic and Extracurricular Activities
4.18. General Factors
4.18.1. Has the IEP Team Considered
4.18.1.1. The strengths of the child?
4.18.1.2. The concerns of the parents for the education of the child?
4.18.1.3. The results of the initial or most recent evaluations of the child?
4.18.1.4. As appropriate, the results of performance on any state or district-wide assessments?
4.18.1.5. The academic, developmental and functional needs of the child?
4.18.1.6. Regarding the Third Grade Reading Guarantee, is the child on-track for reading?
4.19. Least Restrictive Environment
4.20. Statewide and District Wide Testing
4.21. Exemptions
4.22. Meeting Participants
4.23. Signatures
5. Prior Written Notice To Parents
5.1. Begins with the type of action that will be taken
5.1.1. Proposes to initiate an initial evaluation
5.1.2. Refusal to initiate an evaluation
5.1.3. Expedited evaluation
5.1.4. Change of placement
5.1.5. Change of placement for disciplinary reasons
5.1.6. Proposes to change the identification, evaluation or educational placement of the child or provision of FAPE
5.1.7. Refusal to change the identification, evaluation or educational placement of the child or provision of FAPE
5.1.8. Reevaluation
5.1.9. IEP issues/meetings where the parent(s) disagree with the district
5.1.10. Revocation of Consent
5.1.11. Due process hearing, or an expedited due process hearing, initiated by the district
5.1.12. Graduation from high school
5.1.13. Exiting high school due to exceeding the age eligibility for FAPE
5.2. Next requires descriptions of the actions being taken
5.3. Provision of Procedural Safeguards
6. Parent Invitation
6.1. Invite to attend a meeting to discuss the educational needs of the child
6.2. Purpose for Meeting
6.2.1. To determine if a child has a suspected disability
6.2.2. To develop an evaluation plan
6.2.3. To determine eligibility for services as a child with a disability
6.2.4. To develop, review, and/or revise the student’s IEP
6.2.5. To determine reevaluation needs
6.2.6. To discuss transition from early childhood to school-age programs
6.2.7. To discuss transition from school-age to secondary programs/activities
6.2.8. To discuss disciplinary matters
6.2.9. Request to discuss
6.3. Meeting is Scheduled as:
6.3.1. face to face
6.3.2. telephone conference/conference call
6.3.3. video conference
6.4. Date
6.5. Time
6.6. Location
6.7. Other People Invited
6.7.1. General Education Teacher
6.7.2. Intervention Specialist
6.7.3. Speech and Language Pathologist
6.7.4. Student
6.7.5. School Psychologist
6.7.6. District Representative
6.8. Response to Parent Invitation
7. Evaluation Team Report
7.1. Individual Evaluator's Assessment
7.1.1. Areas of Assessment
7.1.2. Evaluation Methods and Strategies
7.1.2.1. Observations
7.1.2.2. Interviews
7.1.2.3. Review of Records and Relevant Trend Data (School Records, Work Samples, Educational History)
7.1.2.4. Scientific, Research-Based Interventions
7.1.2.5. Curriculum-Based Assessments
7.1.2.6. Norm-Referenced Assessments
7.1.2.7. Classroom-Based Assessments
7.1.3. Assessment Information
7.1.3.1. Summary of Assessment Results
7.1.3.2. Description of Educational Needs
7.1.3.3. Implications for Instruction and Progress Monitoring
7.2. Team Summary
7.2.1. Interventions Summary
7.2.1.1. Initial Evaluation
7.2.1.2. Reevaluation
7.2.2. Reasons for Evaluation
7.2.3. Summary of Information Provided by Parents of the Child
7.2.4. Summary of Observations
7.2.5. Medical Info
7.2.6. Summary of Assessment Results
7.2.7. Description of Educational Needs
7.2.8. Implications for Instruction and Progress Monitoring
7.3. Specific Learning Disability Documentation for Determination
7.3.1. Required Notification
7.3.1.1. The state's policies regarding the amount and nature of student performance data that would be collected and the general services that would be provided
7.3.1.2. Strategies for increasing the child's rate of learning
7.3.1.3. The parents' right to request an evaluation
7.3.2. Identified Areas
7.3.2.1. Oral Expression
7.3.2.2. Listening Comprehension
7.3.2.3. Reading Fluency Skills
7.3.2.4. Reading Comprehension
7.3.2.5. Written Expression
7.3.2.6. Basic Reading Skill
7.3.2.7. Mathematics Calculation
7.3.2.8. Mathematics Problem solving
7.3.3. Response to Scientific, Research Based Intervention
7.3.4. Patterns of Strengths and Weaknesses
7.3.5. Exclusionary Factors
7.3.5.1. A Visual, Hearing, or Motor Disability
7.3.5.2. Intellectual Disability
7.3.5.3. Emotional Disturbance
7.3.5.4. Limited English Proficiency
7.3.5.5. Environmental or Economic Disadvantage
7.3.5.6. Cultural Factors
7.3.6. Documentation - Underachievement not due to a lack of appropriate instruction
7.3.7. Observation
7.3.8. Medical Findings
7.4. Eligibility Determination
7.4.1. The determining factor for the child's poor performance is not due to a lack of appropriate instruction in reading or math or the child's limited English proficiency. For the preschool-age child, the determining factor for the child's poor performance is not due to a lack of preschool pre-academics.
7.4.2. The child meets the state criteria for having a disability (or continuing to have a disability) based on the data in this document.
7.4.3. The child demonstrates an educational need that requires specially designed instruction.
7.4.4. Basis for Eligibility Determination
7.5. Signatures
7.5.1. Evaluation Team
7.5.2. Statement of Disagreement