Introduction: Policies and Procedures Sample Special Education Forms & Notices

Annual Monitoring

Policies and Procedures

  • Model Special Education Policies and Procedures: - Revised July 2011 - Model Policies for 2r Charter Schools, Revised July 2011
  • PI-3201-B, LEA Assurances - Special Education Model Forms/Policies and Procedures Fillable
    This form is required once. Annual assurance, thereafter, is provided through the Additional Data Report in the web portal.

Sample Special Education Forms

The Special Education Team provides sample forms and notices for use in the IEP team process to assist districts comply with state (Chapter 115) and federal (IDEA) special education requirements. The Sample Forms and the Reference Materials posted at this site have been updated to reflect changes in the Individuals with Disabilities Education Improvement Act of 2004 and its regulations.

  • Sample special education forms, English - (Updated 9/2015) - Spanish Version (Updated 3/2014)
  • Guide to Special Education Forms, Updated October 2014 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.

Through a stakeholder process, the Special Education Team has revised several Sample Special Education Forms to align with the new accountability system, Reading Drives Achievement: Success through Literacy. This new accountability system balances the monitoring of procedural compliance with improved student outcomes. New prompts on the Sample Forms encourage IEP teams to consider if a student has disability-related needs that affect reading and to develop goals, services and progress monitoring to address the needs and improve student outcomes. The revised Sample Forms are currently in DRAFT version while being piloted by a number of volunteer districts throughout the state. The department plans to finalize the Sample Forms in the spring of 2016. District staff, parents and students are encouraged to review the DRAFT Sample Forms and consider how the forms will enhance discussions around improving student outcomes, while ensuring procedural compliance. Questions or comments about the DRAFT Sample Forms may be directed to

Draft Pilot Forms - DRAFT Sample IEP Forms Significant Revisions

Other Forms and Notices