IEP Forms

Forms are currently available in .pdf format. If you do not have the free Adobe PDF Reader, you can download it here: Adobe Make sure you download the correct version for your operating system.

If the link below has a * behind it, you will be able to type directly into the form on your computer. You can then save it, or even upload it into iStart. More forms will be converted as time allows. If you are typing into the form, make sure you use Adobe Reader, and not Preview. Preview will let you type into the form, and save your work, but not reopen it for further editing.

NOTE: 8/18/12 All forms have been revised and will need to be re-formatted so you can type into them. * will be added as they are completed.

If you would like to view a video tutorial with instructions how to open the form in Adobe Reader, click here.

Page Links:

Some forms may be listed more than once if they fit under multiple categories to make them easier to locate.

Description Description

IEP Conference Forms

Notice of Case Conference (Blank)*

Notice of Implementation (Signature Page)

Medicaid Signature Page

Procedural Safeguards

Procedural Safeguards (Spanish)

CC Notes and Sign-in Sheet (MS Word Format)

CC Sign In Sheet only

Blank Non Transition IEP (for students not yet 14)*

Blank Transition IEP (for students 14 and older)

Transportation (Online form)

Evacuation Plan

Health Plan

ESY Worksheet

Consent to Excuse Participant

IEP Appointment Log

Record of Attempts to Arrange a Conference

TOR Assurance Form

Training Verification Form

Certificate Track

Certificate of Completion Graduation Requirements

Course of Study Worksheet*

Community Transportation

Permission for Community

Swim Information Form

Transition Forms

Taking the Next Step Manual/ Spanish Version

Transition Assessments

VRS Release of Information (Formerly "OVR")

Job Shadow Agreement

Work Experience Agreement

Anticipated Services

INTERN Application

So You are Going to be 18

Behavior Forms

Behavior Intervention Plan *

FBA/BIP Student Interview

FBA/BIP Staff/Parent Interview

BEST Protocol

Staffing Form

Help! I have an MDC!

Tiered Behavioral Intervention Guidelines

Elopement Plan ---Sample


Expulsion Chart

Suspension Chart

Students Not Yet Determined Eligible for Special Education and Related Services

Continuum of Services Matrix

Behavior Monitoring 1

Behavior Monitoring 2

Behavior Monitoring 3

Behavior Monitoring 4

Surveys and Questionnaires

Parent Questionnaire

Student Questionnaire

GE Teacher Questionnaire 1

GE Teacher Questionnaire 2

GE Teacher Questionnaire 3

GE Teacher Questionnaire 4

GE Teacher Questionnaire 5


Medical Referral for Homebound Instruction

Homebound Instruction Worksheet

Teacher Forms

Accommodations Chart

Accommodations Checklist

Student Profile Sheet

GE Teacher Progress Check

Teacher of Record Letter to Teachers

Teacher of Record Letter to Parents

IEP Distribution Verification Form*

Teacher of Record Change Request

iStart 7 Stationery (MS Word Format)

Consultation Notes (MS Word format)

IEP Appointment Log

IEP Review Checklist

Data Collection Sheets

Course of Study Worksheet

Course Selection Sheet for Grades 5 & 6

CEIS forms

CEIS for Success *

CEIS for Co Teaching *


Requesting accessible materials through Indiana's Center for Accessible Materials

ICAM Form 1 (Documenting need for materials)

ICAM Form 2 (Determination of Formats)

ICAM Form 3 (Yearly Materials Request Form)

ICAM Form 4 (Verification by Competant Authority)


Evaluation Forms

Initial Referrals for Public School:


Initial Referral K-8

Initial Referral for HS

Initial Referral for Preschool


Initial Referral Parent (All Grades)

Initial Referrals for Non Public Schools:


Initial Non Public Referral K-6 Teacher

Initial Non Public Referral 7-12 Teacher


Initial Non Public Referral K-6 Parent

Initial Non Public Referral 7-12 Parent



Reevaluation Referral Teacher (Preschool)

Reevaluation Referral Teacher(K-6)

Reevaluation Referral Teacher (7-12)


Reevaluation Referral Parent (Preschool)

Reevaluation Referral Parent (K-6)

Reevaluation Referral Parent (7-12)

Parental Request for Evaluation

Parental Request for Reevaluation

Withdrawal of Request for Evaluation

Notice of Ineligibility

Notice of Evaluation Refusal *

Medicaid Letter to Physician

Medical Referral for OI, OHI, TBI

OT/PT Checklist

Cat Referral

Recommendation to Test Hearing

Audiological Evaluation Report

SLD Checklist

ASD-DSM-5 Checklist

Speech Forms

Parental Request for LSI Evaluation

Parental Request for LSI Re-evaluation*

Referral for Multidisciplinary Team LI

Referral for Multidisciplinary Team SI

M Team Language Impairment Report

M Team Report Artic

M Team Report Fluency

M Team Report Voice

Social/Developmental History (for initials)

Social/Developmental History (Spanish for initials)

-For reevaluations, please use the Parent form

Hearing Screening Recommendations

Permission / Release Forms

Enrollment Form *

Notice of Discontinuation of Special Education

Permission for New Enrollees *

Permission for Prescription Medication

Permission for Release of Publicly Identifiable Information

FERPA-HIPPA - Authorization for Release of Medical and Education (In Spanish)

Permission for Termination due to Graduation

Withdrawal Form

Miscellaneous Forms

Appointment of Educational Surrogate Parent

Educational Surrogate Parent Request

Blind/Low Vision Medical Referral

Confidentiality Communication Protocol with Non SBCSC Professionals

Confidentiality Communication Agreement for Non SBCSC Staff

Consultation Notes (MS Word format)

Description of FAPE worksheet

IEP Review Checklist

IREAD 3 Exemption Form

iStart 7 Stationery (MS Word Format)

Rejection of Services in a Public School

Teacher of Record Change Request

Teacher of Record Letter to Parents*

Teacher of Record Letter to Teachers*

Minutes/Percentages Charts

High School Course Numbers, Minutes and Percentages

High School Course Descriptions

Intermediate Course Numbers, Minutes and Percentages

Preschool/Primary Minutes and Percentages

Co-Teaching Forms

PowerPoint from August 18, 19 workshop

Handout from August 18.19 workshop

Planning for Co-Teaching a Unit of Study

Co-Teaching Approach: Teaching and Observing

Co-Teaching Approach: Station Teaching

Co-Teaching Approach: Parallel Teaching

Co-Teaching Approach: Alternative Teaching

Co-Teaching Approach: Teaming

Co-Teaching Approach: Teaching and Assisting

Progress Reports/Data keeping

Accommodations Chart

Accommodations Checklist

Student Profile Sheet*

GE Teacher Progress Check

Progress Report Cover Sheet

Data Collection Sheets

Data Collection Sheets:

Data Sheet 1

Data Sheet 1*


Data Sheet 2

Data Sheet 2*


Data Sheet 2

Data Sheet 3*


Data Sheet 4

Data Sheet 4*


Data Sheet 5

Data Sheet 5


Task Analysis Sheet

Task Analysis Sheet

Weekly Data

Weekly Data Sheet


Data Behavior 1

Behavior Data Sheet 1

Data Behavior 2

Behavior Data Sheet 2

Data Behavior 3

Behavior Data Sheet 3

Data Behavior 4

Behavior Data Sheet 4