RED – State Mandated Forms
Green- Forms on KDE Website
Pink – Forms on Resource CD
Forms for Compliance
1.
FAPE
(Lead) _____________________, _______________________,
_____________________, _______________________
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Assignment of Personnel to Check Functioning of Hearing Aids
Other Forms Needed – Please List:
2.
Child Find
(Lead) _____________________, _______________________,
_____________________, _______________________
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Referral for Multi-Disciplinary Evaluation – KDE Website
FERPA requirements - Resource PD
Child Find Notice to be Published in Newspaper - Resource CD
Child Find Intake Form – Resource CD
Other Forms Needed – Please List:
3.
Procedural Safeguards
(Lead) _____________________, _______________________,
_____________________, _______________________
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Conference Summary Report – KDE Website
Invitation to an Admissions and Release Committee (ARC) Meeting
[Meeting Notice] – KDE Website
ARC Procedural Checklist - Resource CD
Determination of Student Representative - Resource CD
Authorization for Appointment of a Representative for Educational Decisions
- Resource CD
Student Representative Forms
Statement of Authorization for Representative - Resource CD
Free/low cost Legal Service Providers - Resource CD
Parent contacts
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“So Sorry Letters”
Other Forms Needed – Please List:
4.
Discipline
(Lead) _____________________, _______________________,
_____________________, _______________________
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Manifestation Determination Form – KDE Website
Interim Alternative Education Settings
Record reviews for students considered for alternative schools
Mediation statement/information when due process hearing is requested
Notice of ARC Meeting Regarding Safety Issue or Code of Conduct
Other Forms Needed – Please List:
5.
Evaluation
(Lead) _____________________, _______________________,
_____________________, _______________________
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Evaluation Planning Form – KDE Website
Consent to Evaluate – KDE Website
Social/Developmental History
Physician Statements
Behavior Observations
Reevaluation Forms
Independent Evaluation Information
Screening Forms
Health Plans
Summary of academic achievement upon graduation
Other Forms Needed – Please List:
6.
Eligibility
(Lead) _____________________, _______________________,
_____________________, _______________________
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Eligibility Categories (ALL) – KDE Website
Other Forms Needed – Please List:
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7.
IEP
(Lead) _____________________, _______________________,
_____________________, _______________________
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Individual Education Program (IEP) – KDE Website
Parental and District Consent to Excuse an ARC Member for Attending an
ARC Meeting – Resource CD
IEP Implementation Assurance Form - Resource CD
Accommodations Determination – KDE Website
Other Forms Needed – Please List:
8.
Placement in LRE
(Lead) _____________________, _______________________,
_____________________, _______________________
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Transfer Checklist - Resource CD
FAPE Letter to Withdrawal prior to Completion - Resource CD
Worksheet for Placement in LRE - Resource CD
Other Forms Needed – Please List:
9.
Implementation and Service Delivery
(Lead) _____________________, _______________________,
_____________________, _______________________
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Related Services Forms for OT and PT (see Resource Manual for
Educationally Related Occupational Therapy and Physical Therapy in
Kentucky Public Schools on KDE Website)
Related Services Forms for Speech
Application for Home/Hospital Instruction – KDE Website
Other Forms Needed – Please List:
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10. Confidentiality
(Lead _____________________, _______________________,
_____________________, _______________________
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Record of access (Form of all people having access)
Consent for Special Education and Related Services – KDE Website
Consent for Release or Exchange of Information – Resource CD
Consent for release of Student Records - Resource CD (Laurel)
Consent to Release Medical Information – Resource CD (Laurel)
Request to Inspect, Review, Amend, or Destruction of Special Education
Records – Resource CD (Laurel)
Request for Release of Student Records to Third Party – Resource CD
(Laurel)
Letter to Amend Educational Records – Resource CD
Notice of Transfer of Right at Age 18 – Resource CD
Age of majority letters-for parent and student
Parental Request for Hearing to Amend Educational Records
Request for Consent for Invitation to an ARC Meeting – Resource CD
(Laurel)
Outside Agency Involvement Consent Form
Other Forms Needed – Please List:
11. Children Placed in Private School
(Lead) _____________________, _______________________,
_____________________, _______________________
 Service Plan for Private School Students with Disabilities – KDE Website
 Letter of Invitation for Consultation with Parents of Students Placed by Their
Parents in Private and Home Schools – Resource CD
 Affirmation of Consultation - Resource CD
 Form Letter for Consultation - Resource CD
 Other Forms Needed – Please List:
Preschool
(Lead)_____________________, _______________________,
_____________________, _______________________
 Various preschool forms
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Guidance for Forms Committees
Members of UCSEC will form committees to develop/refine forms for compliance.
It is understood that mandated state forms was addressed in an email sent from
Larry Taylor to the DoSE Listserv (2/16/09) (Referral, Conference Summary, IEP,
and Eligibility Categories). Sub-committees will be formed and will meet via
technology or on-site to review and develop/refine assigned forms. Completion of
the final products should occur prior to June 5 in order have forms ready for the
2009-2010 school year. Please note the following requests and timelines.
 Our first task should be to review all state forms listed on the KDE website to
see if revisions are needed.
 Form development/revisions suggested as a result of our discussion will be
assigned to groups. There will be a Lead assigned to each group.
 The Committee Leads will contact other committee members to arrange
times for review and work.
 Provide samples of any district forms that you use to the appropriate
Committee Lead by March 2 so they can incorporate any needed part of
your information into the form.
 Final products from the committee leads should be sent to
debbie.lawson@kedc.org by June 5 as she will burn the final forms to CD for
distribution at our June 19 UCSEC meeting.
 You will be able to make additions, deletions, changes to the forms for your
district from the CD.
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