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

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.

Age of Majority Information

Information and forms for parents and students as students reach the age of 18.

  • Age of Majority
    Under most circumstances, when a student reaches the age of majority on his or her eighteenth (18) birthday, the rights related to special education provided by the school system transfer from the parents or guardians to the student.
  • Educational Representation for Adult Students
    Information for parents and guardians who, due to the nature or severity of their student’s disability, desire to continue to serve as their students’ educational representative.

Additional Forms

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

Special Education Instructional Programs and Services

Special Education Procedural Support Services