Date of IEP Meeting: ___/___/___
Date received IEP ___/___/___
Date returned for checks ___/___/___
IEP Forms Checklist: Re-evaluation
RE-4 or RE-5, part one
Student: _____________________Teacher:________________ IEP Due Date: __/__/__
R-1 Referral
1. Must do file review prior to decision to use RE-4 or RE-5. See example.
Mandatory
2. Do this at least 90 days before date due. Because, if team decides to do
RE-5 Notice and Consent to Assess, 90 day timeline applies and this takes
time.
Mandatory
RE-1 Notice of Re-evaluation
EW-1 Worksheet. (To determine if need assessment. Must be
Mandatory
completed. Need LEA, regular education teacher, special education teacher,
dates and what was discussed on worksheet. See example)
For OHI, Other Health Impairment, need consent for disclosure of
Contingent
information and for school records signed by parent. This should be done 3060 days before testing. This form is in the school office. Should be faxed to
School Health Services.
Must Choose
Mandatory
Mandatory
Mandatory
RE-4 Notice No Additional Assessments or
RE-5 Notice and Consent to Assess
Fill out above form, see example.
Make a copy, of all above forms; send to Student Services at Ad. Bldg.,
Belinda Kirschbaum asap. Keep copy for yourself.
ALERT Team and give them the timeline. Follow next sheet for meeting.
RE-4
Notice of No Additional Assessments

Must do current assessments, MAPS

Must do complete record review

Must do student interview

Must do classroom observation
RE-5
Notice and Consent to Assess

Parent must sign

See example on how to fill out form

Must also complete record review, student interview,
classroom observation, and such. This is to be documented.
Cannot do any standardized tests such as Woodcock-Johnson.
Spot √ ⃞
Read Completely ⃞
Lead Teacher Initials___________________ Archive ⃞
Date sent to be archived: ___/___/___
IEP Forms Checklist: Re-evaluation: MEETING
RE-4 or RE-5, part two
Date of IEP Meeting: ___/___/___
Date received IEP ___/___/___
Date returned for checks ___/___/___
Student: _____________________Teacher:________________ IEP Due Date: __/__/__
Check
Status
Mandatory
Forms
Make agenda for Re-evaluation and Annual IEP.
Do not attach or send in with IEP. Make copies for all members.
Mandatory
Green Sheet: Child with Disabilities Data Base Record Card
Mandatory
1-3 Evaluation Cover Sheet. Only check evaluation Box.
Mandatory
ER-1 Evaluation and Determination of Eligibility
Mandatory
ER-1A
Contingent
ER-2 Evaluation and SLD Documentation
Contingent
ER-3 Evaluation and Braille Determination
*Attach all Team Member’s reports here*
ER-4 Notice that Child is NOT a child with a disability. If this is
Contingent
the determination of team, process is complete. No additional
forms are needed.
This completes Re-evaluation Paperwork. Follow Annual IEP Procedures
Mandatory
using checklist if child continues to qualify. Case manager is responsible for
making 3 copies and sending 2 copies to Student Services at Ad. Bldg. and 1
copy to Student Service Secretary in your building to file in confidential file.
Spot √ ⃞
Read Completely ⃞
Lead Teacher Initials___________________ Archive ⃞
Date sent to be archived: ___/___/___