• Special Education Forms

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    Assessment/Evaluation

    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.
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    Assistive Technology

    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.
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    Building Screening Committee

    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.
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    Community Transition Program

    Community Transition Program

    The Community Transition Program (click for program webpage) 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.
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    Diploma Options

     

     

    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.
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    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
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    Evacuation Plan

    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.
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    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
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    Extended School Year

    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.
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    Feeding Team

    Feeding Team

    The PPS Feeding Team is comprised of registered nurses, speech-language pathologists and occupational therapists. The team supports students who are potentially at risk when eating at school, developing procedures and written protocols for safe eating, training school staff in safe feeding/eating protocols, providing regular follow-up to school staff, and referring families to community medical agencies as necessary.
    To request feeding team assistance and evaluation for a student, submit a request for Feeding Team assistance.
     
     
     
    Feeding team request (PDF Form)
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    Home Instruction

    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.
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    IEP Forms

    IEP Forms

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

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

     

    Motor Team Evaluation Request
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    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 froms in English,Spanish, Russian, Chinese, Vietnamese and Somali. 

    IEP Forms
    Procedural Safeguards
    Additional Special Education Forms
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    Payroll Forms

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

     
     
    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. 
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    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 clerk quarterly. 
                           
    Responsibility Grid for Private School Students 
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    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
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    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.
    Writable PDF Having trouble opening this form? Adobe Fix
    Link to Additional Languages
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    School Psychologist

    School Psychologists website

    School Psychologist Document Page

    For school psychologist floater assistance please fill out the floater assistance form.

    School Psychologist Floater Request 

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    Service Plan

    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.
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    Speech / Language

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    Surrogate Parent

    Surrogate Parent

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

    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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