Special Education - Forms

This page contains an alphabetical list of various forms created to assist educators, administrators and families in providing special education services.

   
DISPUTE RESOLUTION INFORMATION & FORMS
   
 

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:

   
RESPONSIVENESS TO INSTRUCTION (RTI) FORMS
   
 

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.

   
SPECIAL EDUCATION FORMS
   
 

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 ZIP archive. Forms may be downloaded to a computer hard drive and completed using a word processing application.

   
 
    Instructions to Special Education Forms

   

  Form 1: Notice of Meeting

       

  Form 2: Evaluation Plan and Report

       

  Form 3: Notice of a Special Education Evaluation

       

 

       

  Form 4: Notice of Evaluation Delay

       

  Form 5: Individualized Education Program (IEP)

       
   
       
   

       
   

       
   

       

  Form 6: Consent for Initial Provision of Special Education Services  

       
   

       
   
  • Form 6(b): Part C to Part B Transition--Determining Eligibility for Early Childhood Special Education Services at age 3.This new special education form is to be used by the local education agency (LEA) representative (s) during the 90 day transition conference for children who are approaching their 3rd birthday, have received Part C Early Intervention Services, and who may be 'potentially eligible' to receive Part B Early Childhood Special Education services at age 3. The form informs parents and team members of eligibility criteria as well as necessary evidence needed for the LEA representative (s) to determine the child's eligibility to receive Part B Early Childhood Special Education service at age 3. Questions or comments about the new form or process please contact Kate Rogers at (802) 479-1454 or email kate.rogers@state.vt.us.
 
       

  Form 7: Notice of Local Educational Agency Refusal

       
   

       

  Form 8: Written Agreement between Parents and District - Re-evaluations

       
    Form 9: Completion of an Evaluation of a Transfer Student

       
    Form 10: Written Affirmation of Consultation for Parentally Placed Private School School Students

Page Last Updated on December 16, 2014