Student Services-IEP Forms

Virginia Special Education Procedural Safeguard Requirements

Manual of Directions

Forms All

(Note:  A new, Word 95 version has been placed beside the original, to be used by those people who are unable to print from the XP version)

SECTION 1: Foundation of All IEPs    (Word 95)

Cover Page:   (Word 95)  This page contains general information about the student and documentation of those individuals who participated in the development of the IEP.

Factors for IEP Team Considerations:   (Word 95)  This form is to be used to document the consideration and decisions made around factors that the team must consider during the process of developing the IEP. The documentation of these considerations, while not required, is best practice. However, all members of the IEP team must be aware of the factors that need to be considered by the IEP team during the development of the IEP.

Present Level of Performance   (Word 95)

Present Level of Performance p.2   (Word 95)

Participation in State Accountability/Assessment System, Diploma and Transition Status   (Word 95)

Measurable Annual Goals, Progress Reports   (Word 95)

Objectives/Benchmarks:   (Word 95)  Short-term objectives or benchmarks are required for all students taking alternate assessments aligned with alternate achievement standards (i.e., ASOL’s).

Services, Least Restrictive Environment, Placement   (Word 95)

Services, continued - Accommodations/Modifications   (Word 95)

Services, continued - Participation in State and District-Wide Assessments   (Word 95)

District-wide Assessments:   (Word 95) This page address a student’s participation and accommodations needed when
participating in district-wide assessments.

Services, continued – Placement   (Word 95)

Prior Notice/Consent   (Word 95)

 

 

 

SECTION 2: Additional Pages, as required to meet specific student needs  (Word 95)

IEP Process Checklist/Meeting Agenda   (Word 95)   – This is an example list that can be used by the IEP team as an agenda to facilitate the IEP process.

Cover Page – Medicaid Eligible Students:  (Word 95) This page contains general information about the student and documentation of those individuals who participated in the development of the IEP and assists in meeting the documentation requirements for Medicaid students for which services are billed.

Progress Report Comments:     (Word 95)   This page can be used to provide comments on progress report codes.

Secondary Transition:    (Word 95)   This form includes student’s postsecondary goals and transition services needed to facilitate movement from school to post-school activities beginning not later than the first IEP to be in effect when the child is age 16. This form, when needed, follows the Present Level of Performance and is before the Measurable Annual Goals – Short-Term Objectives and/or Benchmarks – Services.

Secondary Transition Interagency Responsibilities & Needed Linkages:    (Word 95)   This page addresses referrals to other agencies.

Summary of Performance:    (Word 95)   This form may be used to provide the student, prior to graduating or exceeding the age of eligibility, with a summary of his/her academic achievement and functional performance, including recommendations on how to assist the student in meeting postsecondary goals.

Extended School Year Services:    (Word 95)   This page addresses services beyond the normal school year/day, if needed.

Virginia’s Standards of Learning Assessments (SOL), and Virginia Alternate Assessment Program (VAAP):    (Word 95)   This page addresses a student’s participation and accommodations needed when participating in this part of Virginia’s State Assessment System. This should follow the Accommodations/Modifications section of the IEP.

Virginia Grade Level Alternative (VGLA) and Virginia Substitute Evaluation Program (VSEP) Participation Criteria    (Word 95)

Virginia Alternate Assessment Program (VAAP) Participation Criteria:    (Word 95) A student must meet the participation criteria to participate in the VAAP. This page is used to document the IEP team’s consideration and decision.

Prior Notice (including Refusals)   (Word 95)  

IEP Addendum   (Word 95)