Forms/Documents

Welcome to the Index of Forms/Documents Page. Here you will find many of the forms/documents that you will need to complete on a daily basis ALL IN ALPHABETICAL ORDER.

Many of these forms are available in Infinite Campus and are noted. Unless absolutely necessary (In cases where Infinite Campus is unavailable, these forms should be completed in Infinite Campus and saved there. If the form cannot be completed in Infinite Campus, The version may be completed from this page, saved and uploaded to Infinite Campus later.

.doc file format requires Microsoft Word, Word Pad, or similar document reader.

.xls file format requires Microsoft Excel or similar spreadsheet program that can read .xls files.

.pdf file format requires Adobe Acrobat Reader. To download the Adobe Reader for free, visit the Adobe website.

.ppt file format requires Microsoft PowerPoint or PowerPoint Reader

=Form to be completed on computer-these forms as a rule will not print correctly for completion by hand.	=Printable Form/Document intended to be completed by hand. These forms cannot be completed on the computer correctly and have lines for handwriting.
Accommodations form to determine appropriate accommodations for testing (Printable Document to accompany IEP, should be completed at each IEP meeting). This form is in Infinite Campus and should be used and saved there whenever possible.	Accommodations form to determine appropriate accommodations for testing (Printable Document to accompany IEP, should be completed at each IEP meeting).This form is in Infinite Campus and should be used and saved there whenever possible.
ARC Parent Contact Letter This form is in Infinite Campus and should be used and saved there whenever possible.
	Alternative Portfolio Guidelines and Performance Dimensions Revised 10-22-09 This form is in Infinite Campus and should be used and saved there whenever possible.
	Attention Checklist for Disrupting Behaviors
Authorization for Appointment of Student Representative for Educational Decisions	Authorization for Appointment of Student Representative for Educational Decisions
NEW 2011Autism Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011Behavioral Intervention Plan This form is in Infinite Campus and should be used and saved there whenever possible.
Behavioral Incident Form
Behavioral Log
	Behavioral Monitoring Form for Alertness and Concentration
Behavioral Observation	Behavioral Observation
	Classroom Teacher Report This form is in Infinite Campus and should be used and saved there whenever possible.
NEW COMMUNICATION FORMS-FEBRUARY 2012
Communication Behavior Observation	Communication Behavior Observation
Communication Rating Scale Fluency	Communication Rating Scale Fluency
Communication Rating Scale Language	Communication Rating Scale Language
Communication Rating Scale Speech Sound Production and Use	Communication Rating Scale Speech Sound Production and Use
Communication Rating Scale Voice	Communication Rating Scale Voice
Communication Written Report	Communication Written Report
Fluency Assessment Summary	Fluency Assessment Summary
Language Assessment Summary	Language Assessment Summary
Speech Sound Production and Use Assessment Summary	Speech Sound Production and Use Assessment Summary
Teacher Parent Interview Fluency	Teacher Parent Interview Fluency
Teacher Parent Interview Language	Teacher Parent Interview Language
Teacher Parent Interview Preschool	Teacher Parent Interview Preschool
Teacher Parent Interview Speech Sound Production	Teacher Parent Interview Speech Sound Production
Teacher Parent Interview Voice	Teacher Parent Interview Voice
Voice Assessment Summary	Voice Assessment Summary

	Consent for release of Information
NEW 2011Conference Summary New LRE Sections as revised by KDE This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011 Conference Summary Manifest Determination This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011Consent to Evaluate This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011Consent for Special Education and Related Services This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011Deaf Blind Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011Developmental Delay Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
Determination Of Student Representative This form is in Infinite Campus and should be used and saved there whenever possible.
Discipline Tracker	Discipline Tracker
NEW 2011Emotional Behavioral Disability Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
	Evaluation Descriptions Must be attached to every Conference Summary This form is in Infinite Campus in the Conference Summary and should be used and saved there whenever possible.
Evaluation Planning Form This form is in Infinite Campus and should be used and saved there whenever possible.
	Extended School Year (ESY) Procedures and Forms Thanks to Henderson School District
	Excusal From ARC Meetings This form is in Infinite Campus and should be used and saved there whenever possible. This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011Functional Behavioral Assessment/ Behavioral Intervention Plan
NEW 2011Functional Mental Disability Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
	Head Start/Kindergarten Teacher Report
NEW 2011Hearing Impairment Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
	Hearing Screening Form
NEW!!! Request for Hearing Impaired services through KVEC. This form has additional services listed, but Visually Impaired and Hearing Impaired Services are the only services we have contracts for with KVEC at this time. USE THIS FORM ONLY FOR VI AND HI SERVICES. Complete this form and fax it to the special education office. No services can be performed without this form.
NEW 2011 IEP This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011 IEP Extra Goal Page This form is in Infinite Campus and should be used and saved there whenever possible.
IEP Implementation Acknowledgement This form is in Infinite Campus and should be used and saved there whenever possible.	IEP Implementation Acknowledgement This form is in Infinite Campus and should be used and saved there whenever possible.
	Intervention Strategies This form is in Infinite Campus and should be used and saved there whenever possible.
Log of Inspection Newly Updated (Teachers you should replace all unsigned Logs in your folders with this copy) This form is in Infinite Campus and should be used and saved there whenever possible.	Log of Inspection Updated (Teachers you should replace all unsigned Logs in your folders with this copy) This form is in Infinite Campus and should be used and saved there whenever possible.
	Medical Evaluation Request
	Medication Administration Record (use to record medications that are administered at school)
	Medication (Permission to administer)
NEW 2011Mild Mental Disability Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011Multiple Disability Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
	Medicaid Release of Information This form is in Infinite Campus and should be used and saved there whenever possible.
	Medicaid Release of Information in Spanish
Motor Screening Form Thanks to Henderson County	Motor Screening Form Thanks to Henderson County
Non-Programmatic IEP Change Form This form is to be completed each time an IEP is unlocked to make changes without an ARC. Note this form only allows for changes or mistakes made on an IEP that are outlined in this document. Any other changes require an ARC to make changes to an IEP. This form is in Infinite Campus and should be used and saved there whenever possible.	Non-Programmatic IEP Change Form This form is to be completed each time an IEP is unlocked to make changes without an ARC. Note this form only allows for changes or mistakes made on an IEP that are outlined in this document. Any other changes require an ARC to make changes to an IEP. This form is in Infinite Campus and should be used and saved there whenever possible.
	Notice of Record Destruction-Should be completed at all ARC Meetings This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011 Notice of ARC This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011Other Health Impaired Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
	Other Health Impaired Medical Statement
NEW 2011Orthopedic Impairment Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
	Orthopedically Impaired/Physically Disabled Medical Statement
	Preschool Referral for Physical Therapy, Occupational Therapy, or Speech Services
NEW 2011 Private School Service Plan
	PT/OT Checklist
	NEW!! Procedural Safeguards (Spanish)
	2008 Version of Procedural Safeguards (reformatted to fit on 17 pages)
	2008 Version of Procedural Safeguards (Large version, 35 pages total, Use this version with all new referrals)
Record of Parent Contacts This form is in Infinite Campus and should be used and saved there whenever possible.	Record of Parent Contacts This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011 Referral and Intervention Strategies This form is in Infinite Campus and should be used and saved there whenever possible. This is a required form in Infinite Campus!!!!	NEW 2011Referral This form is in Infinite Campus and should be used and saved there whenever possible. This is a required form in Infinite Campus!!!!
	Request for OTPT evaluation
	Request for Integrated Report This form is in Infinite Campus and should be used and saved there whenever possible.
	Request for OTPT services
	Release of Records
Related Services Change in Services Form-Must be filled out every time a related service is changed, added, or a dismissed student is dismissed from a related service.	Related Services Change in Services Form-Must be filled out every time a related service is changed, added, or a dismissed student is dismissed from a related service.
Request for Screening Use this form to request vision, hearing and Speech/Language screenings before referral or reevaluation.	Request for Screening Use this form to request vision, hearing and Speech/Language screenings before referral or reevaluation.
	Request for Speech Language Services
NEW!!!Safe Crisis Management Documentation Report (Use this form to document all incidents where SCM is used-Thanks to Owensboro School District)	NEW!!!Safe Crisis Management Documentation Report (Use this form to document all incidents where SCM is used-Thanks to Owensboro School District)
Social and Developmental History This form is in Infinite Campus and should be used and saved there whenever possible. NOTE: You can complete this form on your computer, but you cannot save the information that is typed in it.	Social and Developmental History This form is in Infinite Campus and should be used and saved there whenever possible. NOTE: You can complete this form on your computer, but you cannot save the information that is typed in it.
NEW 2011Specific Learning Disability Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
NEW 2011Speech Language Impairment Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
	Special Education Teacher Report
	Speech Eligibility Guidelines (Acrobat Reader Required)
	Student Information Sheet (Guidelines for completing)
	Student Information Sheet (complete before referral)-use guidelines above
	Summary Performance Report for LCPS
	Temporary Placement Records Checklist (Use this form when a student moves in from another district or state and is placed on Temporary Placement for 30 school days while records are received or evaluation is conducted to determine eligibility)
	Transition-ARC Responsibility Checklist. This is a checklist that is divided by student age.
	Transition Planning Consent Form (Gives permission for other agencies to attend ARC Meetings for transition planning)
	Transition Parent Survey
	Transition Student Survey
	Transition-Transfer of Rights at age of 18 notice.
Transportation Eligibility Flowchart and Change in Related Services form.	Transportation Eligibility Flowchart and Change in Related Services form.
NEW 2011Traumatic Brain Injury Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
	Traumatic Brain Injury Medical Statement
	Vision Screening Form
NEW!!! Request for Visually Impaired services through KVEC. This form has additional services listed, but Visually Impaired and Hearing Impaired Services are the only services we have contracts for with KVEC at this time. USE THIS FORM ONLY FOR VI AND HI SERVICES. Complete this form and fax it to the special education office. No services can be performed without this form.
NEW 2011Visual Impairment Eligibility This form is in Infinite Campus and should be used and saved there whenever possible.
	WJ3 Teacher Checklist Classroom Teacher Report-Required for all Initial and re-evaluations.

Send mail to wiremanr@magoffin.k12.ky.us with questions or comments about this web site. Copyright © MMXII Magoffin County Schools Special Education Department Last modified: 02/15/12 04:34 PM

Send mail to wiremanr@magoffin.k12.ky.us with questions or comments about this web site.
Copyright © MMXII Magoffin County Schools Special Education Department
Last modified: 02/15/12 04:34 PM