Requested Review/less restrictive/i.e. Self-cont.Resource
Please note: Any meeting held after January 1st can be considered the
student’s Annual Review if annual goals are included and parent has been
notified that meeting will be an annual.
Requested Review/more restrictive/i.e.
Resource – Self Cont
Date _____________
Requested Review Related Service only
Screened by ________________________________
Reevaluation
School _________________________________________
Transfer Student
Name __________________________________________
Initial Eligibility Determination
Screening Checklist
CSE Referral Form
IDSF
Consent for Evaluation
Consent for Evaluation (for re-evaluation – if not, documentation of 3 attempts)
Psychological or Rationale determined by Psychologist
Behavioral Assessment – needed for E.D.
Adaptive Behavior Indicator (Vineland) – needed for MR
Social History
PST statement regarding Social History
Health History/Physical Exam
New/Revised/PLEPS & New IEP Goals in IEP Direct Draft Document
Quarterly Reports are current in IEP Direct
IEP Direct Validation Sheet
Classroom Observation – by someone other than child’s teacher
Level I Behavior Plan
Transition Section completed in IEP (for year child turns 15)
Level I Voc Assessment (for year child turns 12)
Level II Behavior Plan – (FBA & BIP) requested for all students with behaviors that
interfere with instruction
Writing Sample
Adapted Physical Education
OT/PT Evaluation
these reports
VI/HI Evaluation
only needed
Speech/Language Evaluation
when services/changes
Request for TA 1:1/2:1 Packet
are recommended
CSE Form of COP
Consent for Administrative Placement
Copy of Parent Invitation (cc: student if 14 years old) – if school does Local Meeting
Revised 10/25/07