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Portland Public Schools

 
Portland, Oregon

501 N. DixonPortland, OR 97227(503) 916-2000

Special Education Forms

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Assistive Technology

PPS Assistive Technology Team consists of specialists with backgrounds in occupational therapy, teaching and speech-language pathology. Their mission is to provide best practice to support the success of learners in our district in the areas of assistive technology (AT) and augmentative and alternative communication (AAC). Their services may include AT and AAC systems and strategies, training and support to educational teams for the adaptation and modification of curriculum. They work in partnership with the building educational team.

Assessment / Evaluation

Many forms around assessment and evaluation are compiled, Including Progress Monitoring and the request form for test manuals and kits, and a template for Academic Reports.

Building Screening Committee

General education interventions are implemented at the building level to help students who are having problems with academics or behavior. These are important because many of these students may never qualify for special education, but still need help in order to learn. This page includes forms to complete the BSC process, including the pre-referral worksheets, the BSC’s recommendations, parent permission and more.

Community Transition Program

The Community Transition Program supports young adults as they transition to life after high school in supports building independence and quality of life.
 
CTP supports students 18-21, who have an IEP and graduated with a modified or extended diploma, a certificate of participation or GED. The program focuses on three areas of learning: Instruction and Coursework, vocational training and community.
 
The forms and documents support the transition to the Community Transition Program, as well as documents that support transition services and transition planning through school age services.

 
 
Direction Services facilitates the Community Resource Team (CRT) In collaboration with Student Services. This multidisciplinary team also includes Child Welfare, Multnomah County Mental Health and Addictions, Multnomah County Developmental Disabilities, Morrison Center Child and Family Services. This collaborative team will also include personnel from Juvenile Justice and NAYA as appropriate.  
 

A modified diploma is a high school completion document that may be earned by students who have demonstrated an inability to meet the full set of academic content standards required for a regular high school diploma, even with reasonable accommodations. To be eligible for a modified diploma, a student must have a documented history of an inability to maintain grade level achievement due to significant learning and instructional barriers, or a documented history of a medical condition that creates a barrier to achievement. This link will provide the forms to determine, plan and receive consent for both modified and extended Diplomas.

Direction Services

Direction Services provides support to students with complex mental health, behavioral and educational needs enrolling in PPS following an extended absence from a public school setting. The forms on this page will allow a team to refer a student for Community Resource Team Collaboration.

English Language Learners

The following documents are presentations by Franklin W. Bender, CCC-SLP ELL/ Sped Consultant from the National Center for Continuing Education. These presentations serve to support our understanding of the pre-referral process for ELL and how to evaluate students who qualify for ELL for special education services.
Please Contact Ellie Baumgartner ebaumgar@pps.net  or Cynthia Velasquez cvelasquez@pps.net if you have questions.

ELL Pre-referral Process Powerpoint Part 1
ELL Pre-referral Process Powerpoint Part 2

Evaluation Stabilization

When a student requires Evaluation/ Stabilization due to safety concerns or an interim alternative setting for weapons, drugs, or serious bodily injury, they may qualify for the Evaluation Stabilization Program. The following forms include the referral form for Evaluation/ Stabilization, the transition summary form and the Intake Timeline that is filled out during the Intake meeting.

Writable PDF - Referral Form Having trouble opening this form? Adobe Fix
Word Doc - Intake Timeline

Extended School Year

Extended School Year (ESY) services are provided during the summer for eligible special education students to help them maintain skills that are related to their Individual Education Plan goals and objectives. Regression and recoupment are factors used to determine if a student is eligible for ESY services. ESY services are not the same as summer school. The forms and documents included provide demonstrate the complete ESY process.

Evacuation Plan

In an effort to support the safety of all students, evacuation plans must be completed for students with limited mobility, behavior or cognitive concerns. These forms provide examples evacuation plans, as well as the forms to complete a plan.

Feeding Team

To request feeding team assistance and evaluation for a student, submit a request for Feeding Team assistance.

Functional Behavior Assessment & Behavior Intervention Planning

Updated FBA/BSP information, tools, & data collection forms can be found on the PPS FBA Weebly Website.

Home Instruction

Students who qualify for special education services, 504 plans, ELL, TAG or are in the process of an evaluation may qualify for instruction due to medical needs, Day 11 Services or following expulsion. Fill out the following application to be submitted for Home Instruction to begin.

IEP Forms

Find meeting minute forms, paperwork checklists, IEP at a Glance documents, intra-district memorandum documents and more.

Motor Team
 
To request motor team assistance and evaluation for a student, submit a Motor Concerns Form.

Word Doc

Oregon Department of Education (ODE)

ODE provides special education forms in multiple languages. Follow these links to find IEP forms, Procedural Safeguards and additional special education forms in English, Spanish, Russian, Chinese, Vietnames and Somali.

IEP Forms
Procedural Safeguards
Additional Special Education Forms


         This page contains general payroll forms as well as the special education IEP meeting and writing time reporting form.
 

In 2011, the Oregon Legislature passed a statute making changes to physical restraint and seclusion practices in schools, effective July 1, 2012. PPS revised its Student Restraint and Seclusion 4.50.060-AD to incorporate the provisions of the new law. PPS continues to use the Nonviolent Crisis Intervention (NCI) program, developed by the Crisis Prevention Institute. These rules apply to ALL students for ANY use of physical restraint or seclusion implemented by school personnel. See the physical restraint and seclusion page for incident report and debrief forms and school search & seizure forms. 
 
Private Schools
          Students attending a private school and receiving special education services must have a service plan and a log must be kept of any service time the student    
          receives. The log should be submitted to your records clerks quarterly. 
                       
Responsibility Grid for Private School Students 
           
Progress Monitoring
         
          Progress monitoring is the documentation of a student’s achievement on a regular basis.  It involves the formal assessment of the  
          student’s progress during instruction in reading and/or math. Progress monitoring documents how a student responds to          
          appropriate instruction, and it may be collected for a single student or for an entire class.  
          Progress monitoring must include a minimum of four data points. These data are typically collected once every two weeks.
          
           Progress Monitoring Worksheet
 
Release of Information

Authorization to Use and/or Disclose Educational and Protected health Information. This form allows a parent to authorize the school district to communicate with outside providers about student information.
 
Read Only PDF
Writable PDF Having trouble opening this form? Adobe Fix


Permission to Release or Exchange Information
 
This universal consent for release of information allows parents or guardians to release and exchange confidential information between Portland Public Schools and outside agencies.

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Link to Additional Languages

School Psychologist

Psycho-Educational Report: Short Form Report

Read Only PDF
 
Review Log Tracking Form

Read Only PDF
 
Floater/Support Request

Request form for School Psychologist Support Word
Request form for School Psychologist Support (Fillable PDF)
 
Speech / Language

Speech and Language: Short Report Form

Read Only PDF
 
Service Plan

When a student participates in a private school and is unilaterally placed by parents, they are still eligible for special education and related services.

Surrogate Parent

The procedure for processing surrogate parent applications is outlined in the Special Education Department Procedures Manual.

Transportation

Students who receive special education services at a school that is not their home school may qualify for transportation services. Transportation services are listed as a related service on the student’s IEP. This page provides the necessary forms and documentation to access special education transportation services.
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