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PROGRAMS
& SERVICES:
SPECIAL EDUCATION:
FORMS
(Updated 1/10/12)
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This page contains an
alphabetical list of various forms created to assist educators, administrators and
families in providing special education services.
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DISPUTE RESOLUTION INFORMATION & FORMS
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Dispute Resolution Information & Forms
Parents of a student receiving special education services who disagree with decisions made by the school regarding a student’s identification, eligibility, evaluation, Individualized Education Program (IEP) or placement have three options available for resolving disputes with the school. These options include mediation, due process hearing and administrative complaint:
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RESPONSIVENESS TO INSTRUCTION (RTI) FORMS
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Responsiveness to Instruction (RtI) Readiness Tool
This updated self-assessment tool will help schools to determine their current readiness status for RtI implementation with a greater focus on fidelity and integrity of their model.
- Identification of Specific Learning Disabilities
Field Memo #08-07 clarifies the conditions to be met regarding the identification of a specific learning disability as discussed in department Special Education Regulations adopted September 17, 2007. The memo articulates federal regulations and identifies conditions that must be met whether using a discrepancy model or a responsiveness to instruction model for the identification of specific learning disabilities. The field memo further clarifies documentation that must be included as part of a comprehensive evaluation within a responsiveness to instruction model of student support.
- Responsiveness to Instruction (RtI) Readiness Memo
View Field Memo #06-01 dated February 6, 2006
- Responsiveness to Instruction (RtI) Topic Group Report
The final report of the responsiveness to instruction (RtI) topic group, in response to the changes in the IDEIA 2004, identifies possible next steps for using RtI in lieu of the discrepancy model for identification of students with specific learning disabilities. The report includes implications for change within general education in order for this to occur.
- A Student Support Method to Attain School Quality Standards Using RtI as a Decision-Making Tool
An RtI decision-making model is consistent with elements identified in the School Quality Standards and Act 117. This document has been developed to help teams make decisions about how already existing practices support a decision-making RtI model. It can help to provide a framework for teams to develop a plan that identifies next steps. NOTE: This document is also available in the following formats:
- Documentation of RtI Implementation Plan Guidance
In order to comply with Vermont Department of Education Special Education Regulation 2362.1(b)(1)(iii), the local educational agency (LEA) must submit documentation of intent to implement a problem solving, responsiveness to instruction model prior to the identification of students under the disability category of Specific Learning Disabilities (2362.1). Documentation must be submitted to Karin Edwards, Director of Student Support, Vermont Department of Education, 120 State Street, Montpelier, VT, 05620-2501 or e-mailed to karin.edwards@state.vt.us. View the key elements of RtI documentation.
- An Inventory of Educator Practice to Meet the Needs of All Learners
The purpose of this inventory is to provide guidance in order to identify the effectiveness of your system in meeting the needs of ALL learners. This download includes:
- General Education Core Instructional Practices: An Inventory of Classroom Practice
- Supplemental Instruction/Intervention Within General Education
- Special Education Evaluation for Specific Leaning Disabilities
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SPECIAL EDUCATION FORMS
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The following links contain special education forms with required notification letters. Users of these forms will be evaluating children age three through 21 years of age to determine their eligibility for special education services. Users will also use the individualized education program (IEP) form to develop a document of appropriate services, if the child is eligible. NOTE: The Special Education forms 1-10 are available individually as Word files or as Rich Format Text (RTF) documents; a complete packet of forms is available in PDF format. Forms may be downloaded to a computer hard drive and completed using a word processing application.
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Instructions to Special
Education Forms |
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Form 1: Notice of
Meeting
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Word |
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Form 2: Evaluation
Plan and Report |
Word |
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Form 3: Notice of
a Special Education Evaluation |
Word |
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- Form 3(a): Consent
for a Special Education Evaluation
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Word |
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Form 4: Notice of
Evaluation Delay |
Word |
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Form 5: Individualized
Education Program (IEP) |
Word |
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- Form 5(a): Written Agreement for Not Attending an IEP Meeting
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Word |
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- Form 5(b)/5(c): Agreement to Revise the IEP Between Annual Review Meetings
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Word |
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Form 6: Consent for
Initial Provision of Special Education Services |
Word |
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- Form 6(a): Revocation of Consent for Provision of Special Education Services
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Word |
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Form 7: Notice of
Local Educational Agency Refusal |
Word |
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- Form 7(a): Notice of Local Educational Agency Decision
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Word |
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Form 8: Written Agreement between Parents and District - Re-evaluations |
Word |
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Form 9: Completion of an Evaluation of a Transfer Student |
Word |
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Form 10: Written Affirmation of Consultation for Parentally Placed Private School School Students |
Word |
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