Forms

Launch the media gallery 1 player

Forms used by the public schools:

Parent Request Flow Chart 8/2020

ISP Screener Permission Form

OT ISP Request Form

PT ISP Request Form

Articulation SAT Form (speech only concerns)

ISP Articulation Only Concern Tier 1

Behavior Referral Form (fill out when requesting assistance from the school psychologist)

Parent Guardian Questionnaire (updated 6.2020)

Parent Guardian Questionnaire Spanish (updated 6.2020)

• Student Observation Form (Time on Task)*
• Narrative Observation Form

*Indicates forms needed for referrals

Forms used by the private schools

Student Assistance Team (SAT) Forms:      

• SAT Brochure (Catholic Schools)
• SAT Brochure ORLS
• SAT Brochure (Spanish)
• Student Information Summary*
• Parent Guardian Questionnaire Spanish (updated 6.2020)
• SAT Screening Permission (New)
• SAT Meeting Agenda (example)
• SAT Checklist
• Teacher's Request for Assistance from SAT *
• Articulation SAT Form (speech only concerns)
• OT ISP Request Form
• PT ISP Request Form
• Student Observation Form (Time on Task)*
• Narrative Observation Form
• Intervention Plan*
• Intervention Plan Change
• Data Collection Graph*
• Referral Information Sheet (Required for both initial and reevaluations)

*Indicates 5 Required Forms for SAT Referrals     (For Speech and/or Language only referrals, consult with building Speech Language Pathologist)

Exchange of Information

• Educational Release
• NPPSD HIPAA

Additional Forms:

• SAT Plan DNQ (revised 6/2016)
• Informal Attention Checklist
• Medication Monitoring Form
• Daily Medication Tracking Form
• End of the SAT Review Form (revised)

________________________________________________________________________________________________________________________

Special Education Technical Assistance Document

Location of MDT & Psychological Information Within Buildings

Accommodations:

• NDE Accommodations
• Extended Indicators Information
• NSEA Approved Accommodations (9/2016)
• Alternate Assessment Criteria and Checklist
• Alternate Assessment Parent Pamphlet

Assistive Technology:

• NPPS Assistive Technology Website
• Assistive Technology Referral Form (Fillable PDF)

Autism: 

• DAT Brochure
• DAT Referral Form
• Strengths & Challenges Form (updated 6/2020)
• District Autism Team Referral Flowchart (updated 9/2013)

Behavior: 

• SPED Disciplinary Procedure
• Restraint Seclusion Log
• Behavior Monitoring Questionnaire 
• Manifest Determination 
• Behavior Intervention Plan

Caseloads:

• SPED Roster Instructions
• SPED Roster
• SPED Caseload Sheet
• FTE Calculation Sheet 2016

Discontinuation of Services:

• Considering Dismissal of Special Education Services (Revised 12/2013)
• Procedural Requirements for Discontinuation of Services
• SRS Procedures for Dismissing Students

Exchange of Information:

• Educational Release
• Medical/Health Release

Extended School Year:

• ESY Consideration Form (Fillable PDF)

Forms:

• Access to Confidential Files Form
• OHI Physician's Report Form
• Orthopedic Impairment Physician's Report Form

IEP Team Forms:

• Consent for Excusal from IEP Meeting (revised 10/2016)

Initial Evaluation Required Parent Documents:

• Parental Rights English
• Parental Rights Spanish
• Parental Rights Vietnamese
• Rule 55 English
• Rule 55 Spanish
•  

Nebraska Department of Education:

• A to Z List
• Rules and Regulations
• Rule 51 (2017)
• Bobbing for Answers

Paraprofessional:

• Para Evaluation Form
• Para Orientation Checklist

Reevaluation Process/Forms:

• Reevaluation Procedure  (updated 8/2015)                                                       
• Reevaluation Cover Letter 2016
• Staffing Report Form

Surrogate Parent:

• Steps in Designating a Surrogate Parent

• NPPS Surrogate Parent Agreement

• Parent Contact Sheet

• Foster Care Parent Handout

Timelines and Service Percentage:

• Click Here to View SPED Timelines
• Percentage of Special Education Time in Program

Transition:

• Transition Form (Fillable PDF) Completed by case managers

Transfer Student Process:

• Process for Receiving Transfer Students 2017
• NDE IEP Handout Receiving Transfer Students

Click Here to Go to Student Records System (SRS)

• SRS New Student Entry
• Things to Remember about SRS
• Special Education NSSRS Data Element Definitions
• Deactivating a Student When They have Moved Out of District
• SRS Procedures for Dismissing Students