Sample Special Education Forms

  • Printable version of all forms: English (Updated 3/2014) --- Spanish Version (Updated 3/2014)
  • 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.
  • History of Changes to the Sample Special Education Forms
  • Current Changes - March 6, 2014: IEP Model Forms I-7 Update (See further details via the "History of Changes" link above)
Form No. Form Title Status
R-1 Referral Form - Special Education and Related Services Revised 7/2006
IE-1 Notice of Receipt of Referral and Start of Initial Evaluation Revised 12/2010
IE-2 Initial Evaluation: Notice that No Additional Assessments Needed Revised 10/2006
IE-3 Initial Evaluation: Notice and Consent Regarding Need to Conduct Additional Assessments Revised 10/2006
RE-1 Notice of Reevaluation Revised 7/2006
RE-2 Notice of Agreement to Conduct a Reevaluation More Than Once a Year Revised 7/2006
RE-3 Notice of Agreement That a Three-Year Reevaluation Not Needed Revised 7/2006
RE-4 Reevaluation: Notice That No Additional Assessments Needed Revised 10/2006
RE-5 Reevaluation: Notice and Consent Regarding Need to Conduct Additional Assessments Revised 10/2006
EW-1 Worksheet For Consideration of Existing Data to Determine if Additional Assessments or Evaluation Materials Are Needed Revised 7/2006
ER-1 Evaluation Report, including Determination of Eligibility and Need for Special Education Revised 10/2006
ER-2

Additional Documentation Required When Child is Evaluated for Specific Learning Disability (SLD)

Additional Guidance for form ER-2

Revised

12/2010

ER-2A Required Documentation for Specific Learning Disability (SLD) - Initial Evaluation

New

9/2013

ER-2B Required Documentation for Specific Learning Disability (SLD) - Reevaluation

New

9/2013

ER-2C Required Documentation for Specific Learning Disability (SLD) - Initial Evaluation Using Significant Discrepancy

New

9/2013

ER-3 Evaluation Report: Documentation for Determining Braille Needs for a Child With a Visual Impairment  
ER-4 Notice of IEP Team Findings That Child is Not a Child With a Disability Revised 7/2006
I-1 Invitation To a Meeting of the Individualized Education Program (IEP) Team Revised 10/2006
I-1-A Request to Invite Outside Agency Representative(s) to the IEP Meeting New 10/2006
I-1-B

Request to Invite Birth to 3 Program Representative(s) to the Initial Individualized Education Program (IEP) Meeting

New

5/2012

I-1-C Request to Invite Others with Knowledge or Special Expertise to an Individualized Education Program (IEP) Meeting

New

5/2012

I-2 Agreement on IEP Team Participant Attendance at IEP Meeting Revised 10/2006
I-3 Evaluation Report and IEP Cover Sheet Revised 10/2006
I-4

IEP: Present Level of Academic Achievement and Functional Performance

Guidance for Determining Participation in General Education Standards and Curriculum to Support DPI Model Form (I-4)

Revised 9/2013
I-5 IEP: Special Factors Revised 7/2006
I-6 IEP: Annual Goal Revised 10/2006
I-7-A Participation Guidelines for Alternate Assessment Revised 3/2014
I-7-ACCESS for ELLs®/Alt. ACCESS for ELLs™ IEP: Participation in Statewide Language Assessment Checklist and Accommodations

New

3/2014

I-7 ACT/WorkKeys (Coming soon)  

I-7 ASPIRE Early High School

(Coming soon)  
I-7-District-Wide Assessment IEP: Participation in Assessments

New

3/2014

I-7 DLM

(Coming soon)  
I-7-SBA IEP: Participation in Statewide Assessments (Smarter Balanced Assessment)

New

3/2014

I-7-WAA-SwD IEP: Participation in Statewide Assessments (Wisconsin Alternate Assessment for Students with Disabilities)

New

3/2014

I-7-WKCE IEP: Participation in Statewide Assessments (Wisconsin Knowledge and Concepts Examination)

New

3/2014

I-8 IEP: Transition Services Revised 3/2014
I-9 IEP: Program Summary Revised 10/2006
EE-1 Data Worksheet for Determining Environment Codes - Additional Information/Directions 2/28/07 Revised 7/2010
I-10-A Changes to IEP Revised 7/2006
I-10-B Notice of Changes to IEP Without an IEP Team Meeting Revised 7/2006
I-11 Extended School Year  
I-12 Manifestation Determination Review Revised 10/2006
P-1 Determination and Notice of Placement: Consent for Initial Placement Revised 12/2008
P-2 Determination and Notice of Placement Revised 7/2006
P-3 Notice of Graduation Revised 7/2006
P-4 Notice of Ending of Services Due to Age Revised 7/2006
P-5 Parent Revocation of Consent for Special Education New 12/2008
P-6 Notice of Cessation of Special Education and Related Services in Response to Parental Revocation of Consent New 12/2008
M-1 Notice of Response to an Activity Requested by a Parent Revised 7/2006
M-2 Notice of Agreement to Extend Time Limit to Complete Evaluation for Transfer Student Revised 7/2006
M-3 Agreement to Extend the Time Limit to Complete the Evaluation of a Child Suspected of having a Specific Learning Disability New 10/2006
M-4 Parent Refusal of Consent for Special Education New 10/2006
M-5 Consent to Bill Wisconsin Medicaid for Medically-related Special Education and/or Related Services - En Espanol Revised 3/2013
PI-2115 Request for a Due Process Hearing - En Espanol - Hmong Revised 7/2009
PI-2117 IDEA State Complaint Form - En Espanol - Hmong Revised 6/2013
   Request for Special Education Mediation

Revised

10/2012

  Eligibility Checklists and Criteria, SLD initial and reevaluation revised 9/2011 Revised 9/2011

 

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