Your Federal Quarterly Tax Payments are due April 15th Get Help Now >>

Covered Bridge Special Education District - Download as DOC by HC121001172925

VIEWS: 1 PAGES: 1

									Covered Bridge Special Education District                                                                            Rockville Community School Corporation
1320 Walnut Street                                                                                                   South Vermillion Community School Corporation
Terre Haute, Indiana 47807                                                                                           Southwest Parke Community School Corporation
(812) 462-4364                                                                                                       Vigo County School Corporation

                                            CASE CONFERENCE REPORT AND INDIVIDUALIZED EDUCATION PROGRAM

DATE                                                                          PURPOSE(S) OF CASE CONFERENCE                          Initial Case Conference         Move In
TIME                                                                                                                                 Annual IEP Review
LOCATION                                                                                                                             Revise IEP
                                                                                                                                     Manifestation Determination
                                                                                                                                     Other
NAME
                                          Last                                                            First                                             Middle
PARENT/GUARDIAN
ADDRESS
CITY                                                                                      IN 478                      PHONE
STN                                                  GENDER        Male     Female     BIRTHDATE                      GRADE                     SCHOOL YEAR
                                                                           Ethnic Background               Legal Custody Status          Local Program Level
Home School                                Code                               Am.Ind/Nat.American             01 - Parents                 06 – Early Childhood Program
                                                                              Asian or Pacific Islander       02 - Maternal Parent         07 – Elementary Program
Home School Corp.                          Code                               Hispanic                        03 - Paternal Parent         08 – Secondary Program
                                                                              African American                04 - Foster Parents          09 – Language Speech Impairment only
Placement School                           Code                               White (non Hispanic)            05 - Other                       – Homebound
                                                                              Multiracial

CASE CONFERENCE PARTICIPANTS
Public Agency Representative                                                                     Parent(s)/Guardian(s)
Gen. Ed. Teacher(s)
                                                                                                 Student
Teacher of Record                                                                                Specialist(s)


Teacher(s) of Service
                                                                                                 CBSED Representative
Evaluation Team Member(s)                                                                        Other
Instructional Strategist



ELIGIBILITY (Based on Article 7, Special Education Rules)
   The student does not meet eligibility criteria for special education and related services
   The student meets eligibility criteria for the following disability categories: (Mark the primary disability with “1”)
    Autism Spectrum Disorder                     Language Impairment                                                   Multiple Disabilities
    Blind or Low Vision                          Speech Impairment                                                     Other Health Impairment
    Deaf or Hard of Hearing                      Mild Cognitive Disability                                             Orthopedic Impairment
    Deaf Blind                                   Moderate Cognitive Disability                                         Specific Learning Disability
    Developmental Delay                          Severe Cognitive Disability                                           Traumatic Brain Injury
    Emotional Disability
    The student no longer meets eligibility criteria for                                     Code                                          Date


REEVALUATION
Current 3-Year Reevaluation Date                /     /
There is a need for reevaluation information to:
    Reestablish eligibility for special education and related services.
    Determine that the student is eligible for special education and related services under a different or additional eligibility category.
    Determine that the student is no longer eligible for special education and related services.
    Inform the student’s case conference committee of the student’s special education and related services needs.
    There is no need for reevaluation information. If student is in 3-year reevaluation cycle, indicate new 3-year reevaluation date.                         /      /



IEP Form 1                         December 2008                                              Original to CBSED, copy to parent, copy to school, copy to teacher

								
To top