Forms Related to Special Education

Forms related to the eligibility process, the reevaluation process, and the Individualized Education Program (IEP). Additional forms related to the special education process are also included here.

Multi-Purpose Referral Forms

  • Multi-Purpose Referral Form (SS/SE-5)
    When there is reason to suspect that a student has a disability and is in need of special education and related services, a referral can be made to the local screening committee through the use of the Multi-Purpose Referral form. 
  • Multi-Purpose Referral Form (page 2) (SS/SE-5A)
    Page two of the Multi-Purpose Referral form must be completed by the student's classroom teacher or other appropriate school staff members, prior to the local screening committee meeting. This fillable form may create problems in Google Chrome.  Please open using another web browser, such as Internet Explorer, or download from the web to your device, then open in a PDF reader, such as Adobe Reader.

Procedural Safeguards

  • Virginia Special Education Procedural Safeguard Requirements
    Key parts of the Individuals with Disabilities Education Improvement Act of 2004 (IDEA), a federal law governing the education of students with disabilities. 

    Further explanation of the procedural safeguards is available by contacting:
    Due Process and Eligibility, 571-423-4470
    Special Education Procedural Support, 571-423-4290
    Parent Resource Center, 703-204-3941

Eligibility Related Forms

The following forms are used throughout the initial eligibility and reevaluation processes, including the basis for committee decision (BCD) forms for each area of disability.

Basis for Committee Decision (BCD) Forms List (Ordered Alphabetically by Title)

Individualized Education Program (IEP) Forms

The following forms may be used throughout the IEP process.

IEP 100s

IEP 200s

IEP 300s

Individual Services Plan (ISP) Forms

An individual services plan (ISP) documents the service(s) a student may receive when the student is receiving homeschooling or attends a parentally placed private school.

Additional Forms

These forms are related to the special education process and may be used as needed.