Sample Special Education Forms

• Printable version of all forms: English (Updated 12/10) --- Spanish Version (Updated 8/2009)
• Guide to Special Education Forms, Updated January 2011 to address frequency and amount. Model IEP team forms developed by the DPI serve as a guide and also the primary tool for documenting compliance with federal and state special education requirements related to the IEP team process. This companion document provides guidance on the use of the forms. It includes a discussion of the specific requirements relating to each form, directions for the use of each form, and tips for implementing the IEP team process.
• December 2010: Forms IE-1 and ER-2 Updated to reflect changes in SLD Evaluation requirements.
• Current Changes - September 2011: Eligibility Checklists for SLD revised.
• History of Changes to the Sample Special Education Forms

Individual Forms REVISED/REFORMATTED

IDEA 2004 and changes to state special education law, Subchapter V of Chapter 115, Wis. Stats., resulted in the need to develop new special education forms and modify others. Due to the number of form changes needed, including some modification in the sequence in which the forms were used, they were recoded/renumbered to more closely reflect the forms use. The chart below identifies the numbering used in the 2005-06 school year and the numbering used beginning with the 2006-07 school year.

New No.	Form Title	Status	Old No.
R-1	Referral Form - Special Education and Related Services	Revised 7/06	A-1
IE-1	Notice of Receipt of Referral and Start of Initial Evaluation - En Espanol	Revised 12/10	A-2
IE-2	Initial Evaluation: Notice that No Additional Assessments Needed	Revised 10/06	A-3
IE-3	Initial Evaluation: Notice and Consent Regarding Need to Conduct Additional Assessments	Revised 10/06	A-4
RE-1	Notice of Reevaluation	Revised 7/06	A-6
RE-2	Notice of Agreement to Conduct a Reevaluation More Than Once a Year	Revised 7/06	A-6-A
RE-3	Notice of Agreement That a Three-Year Reevaluation Not Needed	Revised 7/06	A-6-B
RE-4	Reevaluation: Notice That No Additional Assessments Needed	Revised 10/06	A-7
RE-5	Reevaluation: Notice and Consent Regarding Need to Conduct Additional Assessments	Revised 10/06	A-8
EW-1	Worksheet For Consideration of Existing Data to Determine if Additional Assessments or Evaluation Materials Are Needed	Revised 7/06	I-1
ER-1	Evaluation Report, including Determination of Eligibility and Need for Special Education	Revised 10/06	I-3, I-5, I-5-A
ER-2	Additional Documentation Required When Child is Evaluated for Specific Learning Disabilities - En Espanol Notes to Accompany DPI Sample Special Education Form ER 2 (6/11)	Revised 12/10	I-6
ER-3	Evaluation Report: Documentation for Determining Braille Needs for a Child With a Visual Impairment	No Change	I-7
ER-4	Notice of IEP Team Findings That Child is Not a Child With a Disability	Revised 7/06	A-5
I-1	Invitation To a Meeting of the Individualized Education Program (IEP) Team	Revised 10/06	A-9
I-1-A	Request to Invite Outside Agency Representative(s) to the IEP Meeting	New 10/06
I-2	Agreement on IEP Team Participant Attendance at IEP Meeting	Revised 10/06	A-10
I-3	Evaluation Report and IEP Cover Sheet	Revised 10/06	I-2
I-4	IEP: Present Level of Academic Achievement and Functional Performance	Revised 10/06	I-11
I-5	IEP: Special Factors	Revised 7/06	I-10
I-6	IEP: Annual Goal	Revised 10/06	I-12
I-7	IEP: Participation in Statewide Assessments	Revised 11/07	I-9-A
I-7-A	Wisconsin Alternate Assessment for Students with Disabilities (WAA-SwS) Participation Checklist	Revised 9/07	I-9-B
I-7-B	Guidelines for Oral Test Administration to Students with Visual Impairments on the Wisconsin Knowledge and Concepts Examination (WKCE) or the Wisconsin Alternate Assessment for Students with Disabilities (WAA-SwS) - En Espanol	New 4/09
I-8	IEP: Transition Services	Revised 10/06	I-9, I-13
I-9	IEP: Program Summary	Revised 10/06	I-14
EE-1	Data Worksheet for Determining Environment Codes - En Espanol - Additional Information/Directions 2/28/07	Revised 7/10	EC-1
I-10-A	Changes to IEP	Revised 7/06	I-14-B
I-10-B	Notice of Changes to IEP Without an IEP Team Meeting	Revised 7/06	I-14-A
I-11	Extended School Year	No Change	I-15
I-12	Manifestation Determination Review	Revised 10/06	I-18
P-1	Determination and Notice of Placement: Consent for Initial Placement	Revised 12/08	I-16
P-2	Determination and Notice of Placement	Revised 7/06	I-17
P-3	Notice of Graduation	Revised 7/06	M-4
P-4	Notice of Ending of Services Due to Age	Revised 7/06	M-5
P-5	Parent Revocation of Consent for Special Education	New 12/08	none
P-6	Notice of Cessation of Special Education and Related Services in Response to Parental Revocation of Consent	New 12/08	none
M-1	Notice of Response to an Activity Requested by a Parent	Revised 7/06	M-3
M-2	Notice of Agreement to Extend Time Limit to Complete Evaluation for Transfer Student	Revised 7/06	M-1-A
M-3	Agreement to Extend the Time Limit to Complete the Evaluation of a Child Suspected of having a Specific Learning Disability	New 10/06
M-4	Parent Refusal of Consent for Special Education	New 10/06
M-5	Consent to Bill Wisconsin Medicaid for Medically-related Special Education and/or Related Services - En Espanol	Revised 5/10
PI-2115	Request for a Due Process Hearing - En Espanol - Hmong	Revised 7/09
PI-2117	IDEA State Complaint Form - En Espanol - Hmong	Revised 7/09
	Request for Special Education Mediation	No Change
	Eligibility Checklists and Criteria, SLD initial and reevaluation revised 9/2011	Revised

For questions about this information, contact Courtney Reed Jenkins (608) 267-9183

Last updated on 4/5/2012 2:55:27 PM