Worksheet C - Self-Review Checklist
Please confirm completeness of your application using this checklist.

A brief narrative identifying the student by CSRS number is attached to the front of each high-need application.

The redacted IEP is current on the deadline date for the round in which it is submitted. The
IEP is included with the application and the evaluation/reevaluation dates are stated.
Evaluations/reevaluations are conducted at least once every 3 years, unless the parent and the district document that a reevaluation is unnecessary.

P-223H enrollment is recorded correctly in accordance with instructions on Line 17.

The IEP includes present levels of academic achievement and functional performance with measurable annual goals for both academic and functional performance.

The IEP includes a description of how the student’s progress toward meeting the annual goals will be measured and when periodic reports on the progress the child is making toward meeting the annual goals will be provided.

The IEP includes a statement of the special education and related services and supplementary aids and services to be provided to the child or on behalf of the child, and a statement of the program modifications or supports for school personnel that will be provided for the child.

The IEP includes an explanation of the extent to which the child will not participate with nondisabled children in the regular class.

The IEP includes a statement of any individual appropriate accommodations that are necessary to measure the academic achievement and functional performance of the child on State and district-wide assessments.

All costs included on Worksheet C are supported in the summary of service of the IEP including the projected date for the beginning of the services and modifications, the anticipated frequency, location, duration, and provider of those services and modifications.

Beginning not later than the first IEP in effect when the child is 16, and updated annually thereafter, appropriate measurable postsecondary goals based upon age-appropriate transition assessments, and transition services (included courses of study) needed to assist the child in reaching these goals are evident in the IEP.

Beginning not later than one year before the child reaches the age of majority under state law, a statement that the child has been informed of the child’s rights under this title, if any, that will transfer to him or her on reaching the age of majority.

The IEP documents participation of the IEP team including general education and parents.

One original and three copies of the high-need application packet are included.

All supporting materials (invoices, contracts, etc.) are attached.
W ORKSHEET C - SELF REVIEW CHECKLIST (12/05)