SPE-20R
11/13
Special Education / RTI Monitoring Checklist
Student Name_______________________________________
Date______________________
Disability/Model______________________________
School/Grade___________________________
Case Manager_______________________________
Peer Monitor_________________________________
1. Select all appropriate sections that apply to the attached file.
2. Attach a copy of the procedure page(s) used as a guide.
**Send All Originals to Special Ed Services**
Select All That Apply:
Initial Referral Due Process
Procedures:
Directions for Sending
Paperwork to Special Ed
Services:
___Initial Referral (see Middle Column)
RTI Referrals:
___Initial Eligibility / Placement
(Include Re-eval paperwork if student is in Speech and
referred for psych testing)
 Send Originals within two (2) weeks
of meeting
___ SPE 15 Sped Referral Packet
 Notify Testing Coordinator of
Accommodation/Modifications
___Transfer-In
___Annual review
___Re-evaluation
___ Observations
_____ 3 Year
___ SPE 9 Consent to Use Other
Evaluations
_____ FBA
___ SPE-56 Surrogate Parent
_____ OT/PT
___ SPE-8 Biographical, Environmental
and Socio-Cultural Data
___Change in LRE:
(Disability; Class / Model; School)
___ SPE-67 Consent to Share Information
___Dismissal/Termination
___Special Review:
___ IEP Amendments
___ Procedural Changes
___ BIP
___ Change IEP w/out mtg.
___ Manifestation Determination
Hearing
___ DNQ
___ SPE-19 Vision/Hearing Screening
SPED Services provides copies for
Psychologist and/or SLP._____________
If a Parent Requests to Revoke Consent
for Sped Services:
 No Meeting is Required
 Contact Director of Special Services
for Procedures
 Status Sheet (SPE 26a) send only
if CHANGES in:

LRE
 Disability
 RE-EVAL
 Add / Change / Drop a
Disability / Dismiss from All
Sped
 Provide a copy of SPE 26 A to
school clerk when changes affect
EFA disability code.
EX:
 Dropping or Adding
Speech

Disability change TO:
 Emotional Disability
 Traumatic Brain Injury
 Autism
 Moderate Intellectual
Disability
 Orthopedic Impaired
 Hearing Impaired
 Visually Impaired