Exceptional Student Education
The School Board of St. Lucie County, Florida
Manifestation Determination for Students with Disabilities
772-429-4570
Date of Meeting:
Student Name:
Identification Number:
School:
Grade:
IDEA Eligible: (List all Exceptionalities)
Number of Cumulative Suspension Days to Date for this School Year:
Description of the infraction or misconduct:
Date of Birth:
/
/
/
/
Proposed Disciplinary action which constitutes a change of placement:
Is this consistent with the disciplinary action proposed for students without disabilities?
(√) ____Y____N
The following sources of information have been reviewed:
___Infraction for which suspension is
recommended
___Witness account of incident
___Discipline history
___Functional Behavioral Assessment(If not on
file, date ordered) ___/___/___
___Parental Information
___Student account of incident
___Cumulative Folder
___Current IEP
___Behavior Intervention Plan
___Evaluation and diagnostic results
___Observations (s)
___Other Relevant Information
The IEP Team must determine the following:
1.
In relationship to the behavior subject to disciplinary action, was the conduct in question, caused by, or have a direct and
substantial relationship to, the student’s disability?
Consensus of the IEP Team (√) ____Yes ____No
2. Was the conduct in question the direct result of the school district’s failure to implement the IEP?
Consensus of the IEP Team (√) ____Yes ____No
If the school district, the parent, and relevant members of the IEP Team answered yes to either question one or two above, the
conduct must be determined to be a manifestation of the student’s disability and the school district must take immediate step s to
remedy those deficiencies.
If the school district, the parent, and relevant members of the IEP Team determine that the conduct was a manifestation of the
student’s disability, the IEP Team must either:
1.
2.
Conduct a functional behavioral assessment , unless the school district had conducted a functional behavioral assessment before the behavior that resulted
in the change of placement occurred, and implement a behavioral intervention plan for the student; or
If a behavior intervention plan already has been developed, review it and modify it, as necessary, to address the behavior; and
3. Except as a recommendation for an IAES Placement, return the student to the placement from which the student was removed, unless the parent and the
school district agree to a change in placement as part of the modification of the behavior intervention plan.
If the behavior that gave rise to the violation of the code of student conduct is determined not to be a manifestation of the
student’s disability, the relevant disciplinary procedures applicable to students without disabilities may be applied to the student
in the same manner and for the same duration in which they would be applied to students without disabilities, except that
services consistent with the provision of FAPE must be made available in order to allow the child to participate in the gener al
curriculum and progress toward the goals of the IEP.
Recommendation of the Team
_____Forty –Five Day Interim Alternative Educational Setting (Possession of a weapon, possession or use of illegal drugs, or sells or
solicits the sale of a controlled substance while at school, on school premises, or at a school function under the jurisdiction
of a state education agency or a school district; or has inflicted serious bodily injury upon another person while at school, on
school premises, or at a school function under the jurisdiction of a state education agency or a school district.)
_____Return to the same placement from which the student was removed, the team considers this placement appropriate
_____Convene an IEP meeting to discuss change of placement at current school assignment
_____Convene an IEP meeting to discuss placement at an Alternative Educational Facility with a Therapeutic Emphasis
_____Convene an IEP meeting to discuss placement at an Alternative Educational Facility with a Behavioral Emphasis
Manifestation Determination Committee Members
ESE Director/Designee/LEA:
ESE Teacher:
Dean:
Principal:
Other:
XED 0095
General Education Teacher:
Evaluation Specialist:
Parent:
Student:
Other:
Revised 11/09