Kentucky Department of Education

 

Special Education Forms - Due Process

Last Updated on Wednesday, May 23, 2012 at 8:22 PM

This page contains downloads to special education forms commonly used by local school districts to document due process and implementation of appropriate programs.  Included are state approved forms for the Referral, Consents, Individual Education Program (IEP), Conference Summary and other state approved special education forms.

Revisions to the forms in the SIS occur based on feedback the Division of Learning Services receives from Director’s of Special Education, State Stakeholder Groups, KDE Interpretation of Law, and Legal Decisions.  In addition, the Division of Learning Services, Diverse Learners Branch make revisions to the state mandated forms based on on-site and desk audit monitoring. 

State approved forms used for  evaluation and eligibility determination can be found by clicking on this link:

Special Education Forms - Eligibility Determination

These forms will be included in the state's student information system (SIS).  The forms below exist in two formats; a Microsoft Word file and an Adobe Acrobat or PDF file.  The Word version is an electronic form that can be downloaded and completed directly from the Word program electronically.  The Adobe Acrobat version is intended to be printed out and completed manually.

The advantage to the Word version is that once completed it can be saved as a file and uploaded to the SIS at the child level.  This option is not available in the Adobe Acrobat version unless the manually completed form is scanned and an electronic file created by that scan.

If you have questions about the content of these forms and the process for uploading files to the SIS, please contact either Windy Newton or Chris Thacker at (502) 564-4970.

To download the forms below, right click on the icons and select Save Target or Save File As.

 

 

Referral for Multi-Disciplinary Evaluation
2011-2012

Referral for Multi Disciplnary Evaluation.doc Referral for Multi Disciplnary Evaluation.pdf

Consent for Special Education and Related Services 2011-2012

ConsentforSpecialEducationandRelatedServices.doc Consent for Special Education and Related Services.pdf

Conference Summary/Action Form 2011-2012

Revised 6/21/11

Conference Summary.doc Conference Summary.pdf

Individual Education Program (IEP) 2011-2012

Guidance Document for Individualized Education Program (IEP)  Development 2011-2012, Revised August 26, 2011.

(Word Version Updated to allow text fields to expand with data input - 09/27/2011)

(Updated both word and pdf versions to reflect Kentucky Administrative Regulations pursuant to Accommodations of Assessment - 03/20/2012)

KY IEP 2012.doc KYIEP 2012.pdf 2011_2012 IEP Guidance Document.pdf
Service Plan for Private School Students with Disabilities 2011-2012 KY Private School Services Plan 2011.doc KY Private School Services Plan.pdf

Notice of Admissions and Release Committee (ARC) Meeting [Meeting Notice] 2011-2012

REVISED September 16, 2011

Meeting Notice.doc Meeting Notice.pdf
Manifestation Determination Form Manifestation Determination.doc Manifestation Determination.pdf

Record of Access Form (Posted July 12, 2011)

Record of Access Form.doc Record of Access Form.pdf

Accommodation Determination Form
(Updated 03/27/2009)

Accommodation Determination Form Accommodations Determination

Alternate Assessment Participation Eligibility Form
(Posted 10/22/2009)

Alternate Assessment Participation Eligibility Form Alternate Assessment Participation Eligibility Form

Consent for Outside Agency Invitation (Posted 10/11/10)

Consent for Outside Agency Invitation Form July 2010.doc Consent for Special Education and Related Services

Nonprogrammatic IEP Change Form (Posted 10/11/10)

Nonprogrammatic IEP Change Form Revised.doc Nonprogrammatic IEP Change Form Revised.pdf

Behavior Intervention Plan (BIP) 2011-2012

Revised 9/1/11

Behavior Intervention Plan 2011.doc Behavior Intervention Plan 2011.pdf

Functional Behavior Assessment (FBA) 2012

Revised February 2012

Functional Behavior Assessment 2012.doc Functional Behavior Assessment 2012.pdf

Review of Records/Reevaluation Summary Form

Revised February 2012

Review of Records Reevaluation Summary 2012.doc Review of Records Reevaluation Summary 2012.pdf
Determination of Educational Representative Determination of Educational Representative.doc Determination of Educational Representative.pdf
For more information contact:

Windy Newton
500 Mero Street, 19th Floor CPT
Frankfort, KY 40601
Phone: 502-564-4772
windy.newton@education.ky.gov