Forms

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)

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)

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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

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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