Student / School: / Program:
Case Manager: / Grade: / Ethnicity
☐ Asian ☐ Black ☐ White
☐ Hispanic ☐ American Indian
IEP requires:
☐ ESY ☐ Special Transportation / Related Service
☐ S/L ☐ OT ☐ PT
IEP Annual
Required Document / Complete / Required Document / Complete
GENAZ 09 IEP Meeting Notice / *Student-Led IEP
GENAZ 14 Notice of IEP / *Alternate Assmt Eligibility(from Ad Hoc)
IEP / Annual Progress Report
MET Initial
Required Document / Complete / Required Document / Complete
GENAZ 38 Meeting Notice (ROED) / GENAZ 56-68 Eligibility Page
GENAZ 01 Referral / *GENAZ 66 S/L Eligibility Page
GENAZ 02 Notice of Referral / GENAZ 08 Notice of Eligibility
GENAZ 04 Notice of Evaluation Decision / GENAZ 09 IEP Meeting Notice
GENAZ 05 Parent Permission / GENAZ 10 Notice of Placement
Home Language Report / GENAZ 11 Notice to Implement IEP
GENAZ 07 MET Meeting Notice / IEP
GENAZ 06 MET / *Alternate Assmt Eligibility (from Ad Hoc)
MET Triennial
Document / Complete / Document / Complete
GENAZ 38 Meeting Notice (ROED) / *GENAZ 20 Notice of Termination
GENAZ 19 Notice of Test Intent / GENAZ 09 IEP Meeting Notice
GENAZ 05 Parent Permission / GENAZ 22 Notice of IEP
GENAZ 07 MET Meeting Notice / IEP
GENAZ 06 MET / *Student-Led IEP
GENAZ 56-68 Eligibility Page / * Alternate Assmt Eligibility (from Ad Hoc)
*GENAZ 66 S/L Eligibility Page / Annual Progress Report
GENAZ 08 Notice of Eligibility
Miscellaneous
Class List / Withdrawal From AJUSD
ESY Pathway / Termination From Services PWN
Student Transfer Form / Manifestation
Release & Exchange of Info / Manifestation - PWN
Quarterly Progress Report / Registration Form
New to District
Required Document / Complete / Required Document / Complete
GENAZ 09 - IEP Meeting Request / AD Hoc Doc - Evaluation Review – Psych.
GENAZ 23 - Notice of Transfer / IEP (IF DO doesn’t have)
Transfer IEP
* If Applicable
All paperwork must be completed and an email sent to your school’s Compliance Officer no later than 7 days after the meeting. The Compliance Officer will review and send an email back within 3 days. If corrections are needed, they must be completed within 24 hours. If no corrections are needed, the completed paperwork must be printed and sent to parents and to the District Office no later than 14 days after the meeting.
The attached paperwork has been thoroughly reviewed and found to be in compliance with IDEA 2004, as well as policies and procedures of the AJUSD Special Education Department.
Case manager______Compliance Partner______
Section A: Demographics
❏The information for this section is done by the registrar. Double check to make sure the information is correct.
Section B: IEP Team Members
❏All required members are listed and have signatures and dates in blue ink
❏Parent
❏Student
❏Special Education Teacher/Case Manager
❏General Education Teacher
❏District Representative
❏Individual to Interpret Evaluation Results
Section C: Pertinent Medical Information
❏This section is updated annually
❏Hearing screening is documented with date and results
❏Vision screening is documented with date and results
❏If student is “OHI”, additional medical information is on file in the Nurse’s office
Section D: Summary of Present Levels of Academic Achievement and Functional Performance
❏Transition Services
❏Assessment Results including Age-Appropriate Transition Based Assessments
❏Measurable Post-Secondary Goals
❏Projected Course of Study
❏Standardized Testing
❏Most recent district benchmark results
❏Most recent standardized testing
❏Summary of Current Assessments
❏Any previous cognitive testing results
❏Any previous achievement testing results
❏Any previous “other” testing results- i.e., speech, OT, PT. behavioral
❏Strengths
❏Cognitive
❏Academic
❏Communication
❏Social-Emotional
❏Motor
❏Self Help
❏Health
❏Transition (for students 15 years and older)
❏Needs
❏Cognitive
❏Academic
❏Communication
❏Social- Emotional
❏Motor
❏Self Help
❏Health
❏Transition (for students 15 years and older)
❏Effect of Disability on Progress in the General Curriculum and Needs of Student to Access the General Curriculum
❏Statement of how student’s disability would impede access to the general curriculum without an IEP
❏Parent Input for Enhancing Child’s Education
❏Statement of parent input for improving student’s educational experience
❏Performance in General Education
❏Narrative statement from general education teachers indicating student’s performance in the general education classroom. This might include but is not limited to : current grades, work and study habits, social skills, etc.
❏Progress on IEP Goals
❏Document whether progress is being made. If student is not progressing, mark the correct box and explain why.
Section E: Special Considerations
❏Assistive Technology- this can include pencil grips, slant boards, text readers
❏Behavioral Needs
❏English Language Learners (if applicable)
❏Blind/Visually Impaired
❏Deaf/Hearing Impaired
❏Communication- if speech is provided it needs to be address here
Section F: Annual Goals and Benchmarks or Short Term Objectives
❏Five progress report dates listed
❏Goals are related to needs
❏Goals are measurable
Section G: Statement of Special Education/Related Services
❏Services are in direct relation to needs and goals
❏Provider is listed
❏Location is documented
❏Amount of time is indicated monthly (15 days per month)
❏Date of Initiation
❏Duration of service- date will be one day minus a year
❏Detail description must be added for each service describing why the service is specially designed instruction
❏Transportation must be listed as a related service if student qualifies for specialized transportation
❏Transportation must be addressed as to why they qualify for specialized transportation
❏Nursing services must be listed if student visits the nurse on a regular basis
Section H: Supplementary Aids and Services (Accommodations and Modifications)
❏Accommodations
❏Modifications
❏District Accommodations for testing
❏State Accommodations for testing
Section I: Least Restrictive Environment
❏Effects of Disability
❏Potential harmful effects
❏Extent of time student will not be with non-disabled peers