Folder Worksheet

FOLDER WORKSHEET

Student Campus/Staff / ______

Type of ARD Disability FIE Date

Folder Review Completed by Date

AREA YES NO N/A COMMUNICATION SECTION Record of Contact Record of Access to Special Education Folders Initial Distribution of Notice of Procedural Safeguards English Language Learner (ELL): Proc Safeguards in native language Transfer of Rights 17 English Language Learner (ELL): Transfer in native language Transfer of Rights 18 English Language Learner (ELL): Transfer in native language MISCELANEOUS SECTION Teacher’s and/or Service Provider’s Receipt of IEP Information Consent to Access SHARS Benefits and Release Records English Language Learner (ELL): Consent in native language State Assessment Results Use of Restraint English Language Learner (ELL): Restraint letter in native language Consent for Disclosure of Confidential Information English Language Learner (ELL): Consent in native language Documentation of the Use of Restrictive Time-Out English Language Learner (ELL): Time-Out letter in native language EVALUATION SECTION NOTICE AND CONSENT Notice and Consent for Evaluation English Language Learner (ELL): Notice/Consent in native language EVALUATION FIE Re-evaluation (3-year timeline: month-day-year) Initial Evaluation (60 calendar days) Referral Information Disability Reports (LD (2007-now ) & SI (2008-now) are part of FIE Related Service Evaluations Related Services Disability Reports ARD COMMITTEE / IEP DEVELOPMENT SECTION NOTICES Notice of ARD (sent at least 5 school days prior to ARD) English Language Learner (ELL): Notice in native language CONSENTS Consent for Initial Placement (If initially placed in sp ed in this district) English Language Learner (ELL): Consent in parent’s native language

AREA YES NO N/A ARD/IEP Temporary Placement to 30 Day ARD held in Timeline (30 school days) 11/2/2009 Page 1 of 2 Page 1 – correct boxes checked at top; all dates listed in section I; yes/no on REED; disability(ies) listed and boxes checked Page 1 – ELL: - interpreter present checked: Deliberations state ARD was taped, Interpreter signed signature page Page 2 – strengths listed; parent concerns noted; sections C/D/E completed Page 3 – section F (BIP in ARD if 2nd box checked); G/H completed Page 4 – IEPs as appropriate (see schedule page) Progress reports coded at report card time & copies filed in folder on top of current ARD; Final coded IEPs filed in folder on top of ARD Accommodations Page (all possible electives listed); duration dates; may have 2 accommodation pages State Assessment Pages: current grade level and next year’s grade level All appropriate areas completed on pages V. Determination of Services page: A /B /C completed; VI. LRE completed: items checked B. Instructional Setting Page completed (1, 2, 3, or 4) 5. / 6. Potential Harmful Effects completed as appropriate 7. Schedule Page(s) 1 for current school year 1 for next school year + and/or △; yes/no and time columns completed per needs of student Related/instructional services listed and rows completed; time included in schedule; Special transportation? If yes – 630 completed (annual ARD) & copy filed with ARD Site determination and duration of services Instructional Arrangement Speech Indicator Code RDSPD completed Commensurate School Day (see schedule page) 8. Campus: campus supports determination of campus VII. Supplements: supplements included are checked or there are none VIII. Deliberations: page included IX. Signature page included all required members of ARDC Included as appropriate: AI VI LPAC CTE BIL/ESL teacher Evaluation Parent not in attendance parent followup is completed and in folder IEPs, accommodations, related services and schedule page all match Transition plan by age 14 DISCIPLINARY REMOVALS MDR (after 10 days of removal) held within 10 days of decision to remove FBA / BIP for MDR students completed and reviewed at ARD Notification of parents & provision of safeguards English Language Learner (ELL): Notification in native language MDR page in ARD and completed

11/2/2009 Page 2 of 2