Comprehensive Colorado Student Record Review Form

Student Information: / Student Name
DoB
IEP date
Eligibility Category
School
Race/ethnicity
ELL status/language
IEP Type
Use the sections of the Student Review Form as detailed below:
·  If an eligibility (initial or reevaluation), complete the section for Initial Evaluations or Reevaluations and then complete the rest of the Record Review form
·  If an annual review, skip the Initial Evaluations or Reevaluations section and go to: IEP DEVELOPMENT (page 12) and then complete the rest of the Student Record Review
USE THIS SECTION FOR INITIAL EVALUATIONS or REEVALUATIONS
PWN was provided to parents, describing evaluation procedures proposed
300.503(b)(3)
300.304(a)
4.02(3)(b) / Y N / Y N / Y N / Y N
PWN contains the required elements:
300.503; 6.02(3) / Prior Notice & Consent for Evaluation
Note: look for separate PWN if AU doesn’t use PWN and Consent for Eval form
·  Description of the action proposed or refused / Y N / Y N / Y N / Y N
·  An explanation of why the AU proposed or refused that action / Y N / Y N / Y N / Y N
·  Procedural safeguards were provided / Y N / Y N / Y N / Y N
·  Sources for the parent to contact / Y N / Y N / Y N / Y N
·  Description of the information used as a basis for the proposed or refused action / Y N / Y N / Y N / Y N
·  Description of other relevant factors / Y N / Y N / Y N / Y N
·  Provided in the parent’s native language or other mode of communication / Y N / Y N / Y N / Y N
Note any exemplars
Describe any element for which you answer NO
Parental consent for initial evaluation was obtained prior to evaluation
300.300(a)(1)(i)
2.10
4.01
4.02(4)(a) / Prior Notice & Consent for Evaluation
·  Note date consent received-if this isn’t recorded, note date signed / Y N
Date consent received: / Y N
Date consent received: / Y N
Date consent received: / Y N
ssDate consent received:
Parental consent for reevaluation was obtained prior to evaluation
300.300(c)(1)(i)
2.10
4.02(4)(a)
4.02(5) / Prior Notice & Consent for Evaluation
·  Note date consent received-if this isn’t recorded, note date signed / Y N NA
Date consent received: / Y N NA
Date consent received: / Y N NA
Date consent received: / Y N NA
Date consent received:
If parental consent was not obtained, reasonable efforts were made and documented to obtain consent (re-eval only)
300.330(c)(2)(i)(ii)
4.02(4)(a)
4.02(5) / Y N NA / Y N NA / Y N NA / Y N NA
If no additional assessments were determined to be necessary
·  Parent was informed of the decision and the reason for it
300.305(d)(1)(i)
4.02(4) / PWN / Y N NA / Y N NA / Y N NA / Y N NA
·  Parent was informed of their right to request an assessment
300.305(d)(1)(ii)
4.02(4) / PWN / Y N NA / Y N NA / Y N NA / Y N NA
Parents were provided procedural safeguards at request for initial consent for evaluation
300.504(a)(1) through (4)
4.02(3)(b) / Prior Notice & Consent for Evaluation
IEP Section 4: Procedural Safeguards / Y N / Y N / Y N / Y N
Parental consent for initial provision of services was obtained prior to onset of services
300.503
4.01 / Prior Written Notice and Consent for Initial Provision of Special Education and Related Services
·  Note Date
·  Not necessary to go back beyond current year / Y N NA
Date consent received: / Y N NA
Date consent received: / Y N NA
Date consent received: / Y N NA
Date consent received:
PWN and Consent for Provision of Services contains the required elements:
300.503
6.02(3)
·  Description of the action proposed or refused / Y N / Y N / Y N / Y N
·  An explanation of why the AU proposed or refused the action / Y N / Y N / Y N / Y N
·  Procedural safeguards were provided / Y N / Y N / Y N / Y N
·  Sources for parents to contact / Y N / Y N / Y N / Y N
·  Description of the information used as a basis for the proposed or refused action / Y N / Y N / Y N / Y N
·  Description of other options considered and why they were rejected / Y N / Y N / Y N / Y N
·  Description of other relevant factors / Y N / Y N / Y N / Y N
·  Provided in the parent’s native language or other mode of communication / Please note the native language even if English / Y N
Native language: / Y N
Native language: / Y N
Native language: / Y N
Native language:
·  Note any exemplars
·  Describe any element for which you answered NO
Follow up to vision and hearing screening (preschool, kindergarten, grades 1,2, 3,5, 7 and 9 yearly)
·  Appropriate educational referrals were made if the child was suspected of having an educationally significant vision or hearing loss and
·  Parents were informed of any need for further medical evaluation
4.02(2)(c)(iii) / Evaluation Report
OR
IEP Section 6:
Present Levels of Academic Achievement and Functional Performance / Y N NA
If NO, describe: / Y N NA
If NO, describe: / Y N NA
If NO, describe: / Y N NA
If NO, describe:
Assessments were administered by trained and knowledgeable personnel
300.304(c)(1)(iv)
4.02(4)(5) / Evaluation Report
Staff licensure list / Y N
List titles: / Y N
List titles: / Y N
List titles: / Y N
List titles:
A variety of technically sound assessment tools and strategies were used to gather relevant information about the child, including information provided by the parent
300.304(b)
4.02(4)(5) / Evaluation Report / List assessment tools, administered by whom, date administered: / List assessment tools, administered by whom, date administered: / List assessment tools, administered by whom, date administered: / List assessment tools, administered by whom, date ministered:
Evaluation materials are selected and administered so as not to be discriminatory on a racial or cultural basis
300.304(c)(1)(i)
4.02(4)(5)
AND
Evaluation materials are provided and administered in the child’s native language or other mode of communication and in the form most likely to yield accurate information on what the child knows and can do
300.304(c)(1)(ii)
4.02(4)(5) / Evaluation Report
Look for: impact of culture and/or second language on education, prior formal schooling, refugee status, ACCESS scores and interpretation, parent input, ELA teacher input, language spoken in the home as well as by the student
If standardized assessments were administered was language taken into consideration? / Y N N/A
Describe the process and BOE if student is CLD: / Y N N/A
Describe the process and BOE if student is CLD: / Y N N/A
Describe the process and BOE if student is CLD: / Y N N/A
Describe the process and BOE if student is CLD:
Child was assessed in all areas of suspected disability
300.304(c)(4)
4.02(4)(5) / Evaluation Report / Y N
If NO, describe: / Y N
If NO, describe: / Y N
If NO, describe: / Y N
If NO, describe:
Evaluation was sufficiently comprehensive to identify all of the child’s special education and related services needs
300.304(c)(6)
4.02(4)(5) / Evaluation Report
IEP Section 6: Student Needs and Impact of Disability
Look for: Were assessment scores reported and interpreted? Were data triangulated? / Y N
If NO, describe: / Y N
If NO, describe: / Y N
If NO, describe: / Y N
If NO, describe:
Meeting to discuss initial evaluation was held within a reasonable period of time
4.02(6)(a) / Prior Notice and Consent for Initial Provision of Special Education and Related Services
IEP Section 2: Dates of Meetings / Y N
Date of meeting: / Y N
Date of meeting: / Y N
Date of meeting: / Y N
Date of meeting:
A group of qualified professionals (including the child’s regular education teacher and at least one person qualified to conduct individual diagnostic examinations of children, such as a school psychologist, or remedial reading teacher) and the parent of the child determined whether the child is a child with a disability
300.306(a)(1)
2.20
3.04
4.02(4) through (6) / Evaluation Report
IEP Section 5: IEP Participants / Y N
List titles: / Y N
List titles: / Y N
List titles: / Y N
List titles:
Eligibility questions were considered by the IEP team: / Policies and Procedures:
Comprehensive Plan / Please note that you are answering Yes or No to whether the team considered the questions. You are not answering the question itself. Note if there is a discrepancy with any other information in the IEP.
·  Can the child receive reasonable educational benefit from general education alone?
300.306(b)(1)(i)
2.08 / Determination of Disability (for specific disability/disabilities considered) / Y N / Y N / Y N / Y N
·  Is the child’s performance due to the lack of instruction in reading and/or math?
300.306(b)(1)(ii)
2.08 / Determination of Disability (for specific disability/disabilities considered) / Y N / Y N / Y N / Y N
·  For the child whose primary language is other than English, is limited English acquisition the primary cause of the child’s learning problems?
300.306(b)(1)(iii)
2.08 / Determination of Disability (for specific disability/disabilities considered) / Y N / Y N / Y N / Y N
Is the information above in contradiction with any information in the evaluation report or the IEP? / Determination of Disability (for specific disability/disabilities considered) / Y N
If yes, describe: / Y N
If yes, describe: / Y N
If yes, describe: / Y N
If yes, describe:
Pertinent and specific information regarding determination of eligibility was considered for suspected disability
300.8
2.08 / Determination of Disability form (for specific disability/disabilities considered) / Y N
Review the specific eligibility determination form. Ensure that information in the checked boxes is supported by information in the Evaluation Report.
If requirements are met, brief notes can be captured here. If there are concerns use the specific eligibility determination form. / Y N
Review the specific eligibility determination form. Ensure that information in the checked boxes is supported by information in the Evaluation Report.
If requirements are met, brief notes can be captured here. If there are concerns use the specific eligibility determination form. / Y N
Review the specific eligibility determination form. Ensure that information in the checked boxes is supported by information in the Evaluation Report.
If requirements are met, brief notes can be captured here. If there are concerns use the specific eligibility determination form. / Y N
Review the specific eligibility determination form. Ensure that information in the checked boxes is supported by information in the Evaluation Report.
If requirements are met, brief notes can be captured here. If there are concerns use the specific eligibility determination form.
A copy of the Evaluation Report and Determination of disability was provided to the parent
300.306(a)(2)
4.02(6) / Determination of Disability form / Y N / Y N / Y N / Y N
Reevaluation and eligibility meeting held to determine change of disability, including exit from special education
300.305(e)
4.02(6)(c) / Y N NA / Y N NA / Y N NA / Y N NA
Reevaluation conducted at least every 3 years, unless:
300.303(a)(1)(2)
4.02(5) / Date of previous eval: / Date of previous eval: / Date of previous eval: / Date of previous eval:
·  Evidence exists that the parent and the AU determine that a reevaluation is unnecessary
300.305(d)(1)
4.02(5) / NA
Or describe: / NA
Or describe: / NA
Or describe: / NA
Or describe:
Per ECEA once a written special education referral has been initiated, the initial IEP is completed within 90 calendar days form the point of initiation of the special education referral
4.03(1)(d) / Prior Notice & Consent for Evaluation
IEP Section 2: Dates of Meetings
INITITAL AND REEVALUTION COMMENTS:
s
IEP DEVELOPMENT – Start here if the file is for an Annual Review
Section 2: Review Timelines
·  Confirm dates with evidence in file.
Evidence that IEP was written within 365 days of prior IEP
300.324(b)(1)(i); 4.03(3) / IEP Section 2: Dates of Meetings
File / Date of last IEP: / Date of last IEP: / Date of last IEP: / Date of last IEP:
Reevaluation conducted at least every 3 years, unless:
300.303(a)(1) and (2)
4.02(5) / IEP Section 2: Dates of Meetings
File / Date of last eval: / Date of last eval: / Date of last eval: / Date of last eval:
Section 3: Review Student and Family Information
·  Be sure to look at student demographics above and check whether the parent’s language would have required an interpreter.
Interpreter was provided if required
300.322(e); 4.03(7)(a) / IEP Section 3: Student and Family Information / Y N N/A / Y N N/A / Y N N/A / Y N N/A
Surrogate parent was assigned if required
300.519; 2.13; 2.33; 6.02(8) / IEP Section 3: Student and Family Information / Y N N/A / Y N N/A / Y N N/A / Y N N/A
Section 4: Procedural Safeguards
parents were given copies of procedural safeguards:
300.504; 6.02
NOTE: If an initial, parents may have already received at time of consent for evaluation. / IEP Section 4: Procedural Safeguards
Prior Notice & Consent for Evaluation
File /
Y N /
Y N /
Y N /
Y N
Section 5: IEP Participants
·  Reference the Notice of Meeting as well as the attendance page. Be sure attendees match invitees. If NOM and signature page do not match, check for documentation that parent approved any extra attendees.