Forms

Here are several forms you will find beneficial in providing the necessary behavior support for your students as well as for IEP support teams. Click on the "View PDF" link next to the form you wish to save or open.

***NEW***

The Restraint Report Form is now available as a Google Doc for easy filing and sharing! To access the Google Doc click here. When prompted, make sure to "make a copy" on your Google Drive. Make sure to rename your copy and to share the document with your Special Ed supervisor, building principal and Ken Sutter.

FORMS (Worksheet)DESCRIPTION

Functional Behavioral Assessment (FBA)

FBA is a of process gathering information to understand the function (purpose) of behavior in order to write an effective Positive Behavior Support Plan. This publication provides information about when an FBA must be conducted, who conducts the FBA, and the process of determining the appropriate level of FBA required.

Manifestation Determination

This publication explains Manifestation Determination, which is a process required by the Individuals With Disabilities Education Act (IDEA 2004). A Manifestation Determination is conducted when considering the exclusion of a student with a disability that constitutes a change of placement.

Positive Behavior Support Plan

This publication assists IEP teams in developing goals, specially designed instruction and related services when a student’s behavior interferes with his or her learning or the learning of others.

Restraint Report Form

This form is to be completed by the staff member who initiated the restraint and submitted to the building principal and special education supervisor following the restraint. The student’s parents will be notified within one school day of the restraint by the principal or supervisor. Staff completing this form should keep a copy for his or her records.

IU9 Procedure on the Use of Emergency Physical Restraints with Students

(Revised October 13, 2013): These procedures have been developed in order to guide staff in the use of emergency physical restraints that is consistent with state regulatory requirements (14.133 Positive Behavior Support); nothing in this procedure should be taken to supersede relevant regulations.