Sanilac Intermediate School District
Special Education Forms
Audiologial
AUD Form 1 Audiological Referral Procedure AUD Form 2 Audiological Request AUD Form 3 HI Cert Form AUD Form 4 Middle Ear Screening Results AUD Form 5 Hearing Screening Results June06-MI Sp Ed Due Process Model Form_163287_7
Behavioral
BEH 10 FBA Worksheet BEH 11 ABC Form Basic BEH 12 ABC Checklist BEH 5 Behavior Intervention Plan Form BEH 7 FBA Parent Report BEH 8 FBA Student Interview BEH 9 FBA Teacher Report Emergency Seclusion Restraint FAQ Thrun Emergency Seclusion and Restraint Flow Chart Seclusion and Restraint Debriefing Form Seclusion and Restraint Documentation Form Seclusion and Restraint Lime Green Envelope Cover Sheet Seclusion and Restratint Debriefing Meeting Guidelines
Build Up Michigan
Development Case History Form Hearing/Vision Development Screening Checking Permission for Early Childhood Baseline Data Collection Early Childhood Progress Notes Registration Form Referral Form
Child Study/Early On
Inquiry Form Developmental Case History Consent to Share Information Form Screening Summary Report Child Study Team Form Child Study - Early On Checklist COSF Entry Form COSF Exit Form Early On Request for Protected Information (Health) Authorization to Release Early On Record Early On Request for Information (Non-Health) Early On Authorization to Share Information Hearing/Vision Development Screening Checking Early On Prior Written Notice Hearing/Vision Screening Results Early On Consent to Evaluate Early On Parental Consent
Discipline
DISC 1 Discipline Procedures Manual Notice of Change in Placement as a Result of a Disciplinary Removal Written-Notice of a Change in Placement as a Result of a Disciplinary Removal DISC 2 Interim Alternative Educational Setting Form Directions for Completing DISC 3 Interim Alternative Educational Setting Form DISC 4 Manifestation Form Directions DISC 4a Manifestation Determination Review (MDR) Instructions and Information DISC 5 Manifestation Form DISC 6 Worksheet for Determining Pattern Behavior Form Directions DISC 7 Worksheet for Determining Pattern Behavior Form DISC 8 Interim Alternative Educational Setting (11th Day of FAPE) DISC 9 Notice of FAPE Discipline Red Envelope Cover Sheet DISC 10 MDR Invite Notice of Disciplinary Removal Written-Notice of Disciplinary Removal
Early ChildHood Developmentally Delayed
ECDD 1 ECDD Exit Plan ECDD 2 ECDD Exit Process
Employment
EMP 1- 30 Day Evaluation Notice EMP 2- Program Specification Form EMP 3 -Training Plan Agreement EMP 4 - Employer's Work Evaluation Report EMP 5 - Information Sheet EMP 6 -School Rep 30 Day Eval EMP 7 - Grade Averaging Sheet EMP 8 Referral for Michigan Jobs Commission EMP 8 Referral for Michigan Jobs Commission EMP 9 EI Referral MRS EMP 10 Teacher Input Vocational EMP 11 Job Shadow Information EMP 12 Permission to attend Job Shadow Permission Slip
Evaluation
ER 5 Parental Input Form For Initial or 3 Year ER 6 Support Staff Input Form ER 7 Explanation of Evaluation Services ER 8 Evaluation Extension Form
Extended School Year
Extended School Year Consideration of Need and Definition Extended School Year Document ESY Guidance ESY Standards
IEE
IEE1 IEE Process and Resouce Handbook jan08IEE
IEP
IEP 1 Special Education Referal Form IEP Signature Page Change IEP Explanation of No-Signature IEP 8 Notice of Responsibility to Implement IEP IEP 10 Age of Majority Notice to Parents IEP 12 Excusal Form IEP 13 Withdrawal of Consent for Special Ed IEP 13 Withdrawal of Consent for Special Ed Notice Letter of Assurance No Consent Letter (Fill In)
IEP Quick Reference Guides
Section 1: Demographic Information Section 2: Present Level of Academic Achievement and Function Performance (Present Level) Section 3: Secondary Transition Considerations Section 4: Goals and Objectives/Benchmarks Section 5: Supplementary Aids and Services Section 6: Assessment Participation and Provisions Section 7: Special Education Services and Programs Michigan Special Education One Pager: Consent Michigan Special Education One Pager: Timelines for Initials Michigan Special Education One Pager: Notice Michigan Special Education One Pager: Child Find
LRE
LRE04_110622_7 Sanilac ISD Referral Packet for MoCi Programs fill in Sanilac ISD Referral Packet for MoCi Programs pdf Sanilac ISD Referral Packet for MoCi Programs word document
Medicaid
CRS 2 Medicaid Students Currently Eligible CRS 3 Medicaid Students Who Become Eligible CCC Supervisory Form Consent for Medicaid School-Based Services Medicaid Manual 7/1/12 Medicaid Parental Consent Annual Notification Parent/Guardian Release of Medical Information Personal Care Service Authorization Personal Health Care Monthly Service Log SBS Letter to Parents SBS Overview Transportation Log Written Notification Regarding Use of Public Benefits and Insurance
Medical
MEDS 1 Medication Control Information MEDS 2 Medication Parent Letter MEDS 3 Record of Medication Administration in School MEDS 4 Physician's Order for Medical Procedure MEDS 5 Homebound Hospitalized MEDS 6 Seizure Record
METS
MET 12 Medical Report For Special Education Evaluation MET 13 Medical Report 36 month Re-evaluation MET 14 Explanation of Evaluation Services MET 15 Parent Notification of Evaluation Results
OTPT
OTPT 1 OTPT PreReferral Referral Process OTPT 2 Concerns Checklist OTPT 4 Criteria for OT Service OTPT 5 Criteria for Service Termination OTPT 6 OT PT Guidelines - May 2009
Para Educator
PAP 1 Determination of Paraeducator
Parent Handbook
Cover Page ISD Parent Handbook names and numbers ISD Parent Handbook
Personal Curriculum
Personal Curriculum Plan IEP Course of Study Flowchart Nov_2017 Sanilac ISD Personal Curriculum Process Flow Chart Personal Curriculum Process Checklist MDE Parents Guide to Personal Curriculum (without House Bills 4465 and 4466) MDE What's New? House Bills 4465 and 4466 MDE Personal Curriculum Additional Resources MDE Personal Curriculum Frequently Asked Questions Michigan Merit Curriculum High School Graduation Requirements Updated September 2017
Procedural Safeguards
Release of Information
ROI 1a Physicians Prescription ROI 2 Consent to Share Information Form ROI 2 HIPAA Compliant Interagency Release of Information Authorization 2019checklist ROI 4 Tranfer of Student Record Form ROI 5 Request for Educational Records ROI 6 Permission to Examine Student Files ROI 7 Notification of Destruction of Records
SLD Guidelines
SLD 1 Determination Process SLD 3 Worksheet for Charting a Pattern of Strengths and Weaknesses SLD 4 Eligibility Documents Worksheet SLD 5 CA-6- Review SLD 6 Parent/Guardian Form SLD 7 Teacher Observation Record SLD 8 Criteria for Classroom Observation SLD 9 Classroom Observation Record SLD 10 Norm-Referenced Assessment Data Reports SLD 11 Exclusionary Factors Worksheet SLD 12 SLD MET Summary Report SLD 14 Intervention Meeting Log SLD 15 Teacher Assessment of Student Needs SLD 16 What is a Specific Learning Disability? SLD 17 Assessment Examples SLD 18 Sample Intervention Log - Reading SLD 19 Sample Intervention Documents
Special Education Process
SPE 1 Steps to Receiving Special Education Services SPE 2 Steps to 3 Year Redeterminiation of Eligibility SPE 3 MET Timelines SPE 4 Transition IEP Process
Speech
SP 1 Pre-Referral Speech Form SP 2 Speech and Language Pre-Referral SP 3 Referral for Speech and Language Evaluation SP 4 Teacher Input-language Impairments SP 5 Speech Letter to Parent SP 6 Speech and Language Services Parent Input SP 7 Speech and Language Case History
State Complaint
DueProcess_Complaint_Procedures_340126_7 Withdrawal of State Complaint Form State Complaint Resolution Form
Summary of Performance
SOP 1 ADAPTIONS MODIFICATIONS SOP 2 SUMMARY OF ACADEMIC ACHIEVEMENT AND FUNCTIONAL PERFORMANCE SOP 3 Student Post School Contact Form
Transition
EDP 1 (.doc) EDP 1 (.PDF) Sanilac CountyTransition Brochure Student/Parent Transition Handbook Michigan Rehabilitation Referral Form
Transition Reports by Grade
5th
Cover Page Not Everyone Knows That Self Determination Steps-Skills Transition Planning Worksheet Exit-Process Steps
6th
Cover Page Interest Survey Personal Planning Sheet The Top Ten Things
7th
Cover Page Alternate Educational Development Plan Plan of Action Transition Assessment
8th
Cover Page Transition Planning-Parent Questionaire Transition Planning- Student Questionaire
8th-12th
Exit Year
Student Post School Contact Form Summary of Academic Achievement Summary of Performance
Others
Age of Majority in Michigan Student Information Age of Majority (for Parent) Notice Form Age of Majority Notice FormEligibility Area Checklists Eligibility Area ChecklistsOHR 1 Request for SISD Services Michigan Administrative Rules for Special Education (MARSE) Sanilac County ISD - 504 Manual
Record
hal_mhc_rms_local_gs2_171482_7 Records retention and disposal website