WVEIS Data Worksheet
Basic Information
Name: ___________________
Date: ____________________
Student Name: _______________________________
School: _______________________________
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WVEIS #: _______________
Sex:  Male  Female
Race: ______
Age: ______
Class: ______
Student Special Education Services Detail
Birth date: _______________
E/R Code
D/U Flag
Entry Date
Exit Date
MPW
LRE Code
Status Code
Teacher ID
Active?  Yes  No
SS #: _______________
Medicaid #: _______________
Diagnosis Code: ____________
Diploma:  R
Initial
Re-Eval
Annual Review
Transfer
Amendment
M
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Comment(s): ______________________________
______________________________
Referral/Re-evaluation Detail
Request Date: _________ Method: ____ Response: ____
Date last Eligibility determined: ____________________
Eligibility Status:  (1) Eligible  (2) Not Eligible
E/R Code:  LD
 MP (Profound MI)
 OH
 CD
 MM (Mild/Mod MI)
 MS (Severe MI)
 MD (Moderate MI)
 BD
Re-evaluation Due Date: _______________________
Status Codes Index
Reminder:
Code
Description
030 IN PROGRAM (OPTIONAL)
040 GRADUATED WITH REGULAR DIPLOMA
050 GRADUATED WITH MODIFIED DIPLOMA
070 REACHED MAXIMUM AGE
080 MOVED, KNOWN TO BE CONTINUING
090 DROPPED OUT
While we
commonly report minutes/month
on IEPs, WVEIS asks for
minutes/week… so be careful to
convert
LRE Codes Index
Code
Description
0 GENERAL EDUCATION - FULL-TIME
1 GENERAL EDUCATION - PART-TIME
2 SPECIAL EDUCATION - SEPARATE CLASS
6 SPECIAL ED: RESIDENTIAL FACILITY (PC ONLY)
9 6-21 YR OLD PLCD IN CORRECTIONAL FACILIT
IEP Detail
IEP Completed: __________________ Request Date: ________________ Method: ____
Next IEP Due: __________________
Response: ___
Testing Information
Regular Testing:
 Yes
Assessment with Accommodations:
 Yes
Alternate Assessment:
 Yes
Alternate Assessment w/Accommodations:  Yes
 No
 No
 No
 No
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