Denver Public Schools - Colorado Department of Education



Comprehensive Colorado Student Record Review Form

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|Student Information: |

|USE THIS SECTION FOR INITIAL EVALUATIONS or REEVALUATIONS |

|PWN was provided to parents, describing| | | | | |

|evaluation procedures proposed | |Y N |Y N |Y N |Y N |

|300.503(b)(3) | | | | | |

|300.304(a) | | | | | |

|4.02(3)(b) | | | | | |

|PWN contains the required elements: |Prior Notice & Consent for | |

|300.503; 6.02(3) |Evaluation | |

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| |Note: look for separate PWN if AU | |

| |doesn’t use PWN and Consent for | |

| |Eval form | |

|Description of the action proposed or | |Y N |Y N |Y N |Y N |

|refused | | | | | |

|An explanation of why the AU proposed | |Y N |Y N |Y N |Y N |

|or refused that action | | | | | |

|Procedural safeguards were provided | |Y N |Y N |Y N |Y N |

|Sources for the parent to contact | |Y N |Y N |Y N |Y N |

|Description of the information used as | |Y N |Y N |Y N |Y N |

|a basis for the proposed or refused | | | | | |

|action | | | | | |

|Description of other relevant factors | |Y N |Y N |Y N |Y N |

|Provided in the parent’s native | |Y N |Y N |Y N |Y N |

|language or other mode of communication| | | | | |

| |Note any exemplars | | | | |

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| |Describe any element for which you | | | | |

| |answer NO | | | | |

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|Parental consent for initial evaluation|Prior Notice & Consent for | | | | |

|was obtained prior to evaluation |Evaluation |Y N |Y N |Y N |Y N |

|300.300(a)(1)(i) |Note date consent received-if this | | | | |

|2.10 |isn’t recorded, note date signed | | | | |

|4.01 | |Date consent received: |Date consent received: |Date consent received: |ssDate consent received: |

|4.02(4)(a) | | | | | |

|Parental consent for reevaluation was |Prior Notice & Consent for | | | | |

|obtained prior to evaluation |Evaluation |Y N NA |Y N NA |Y N NA |Y N NA |

|300.300(c)(1)(i) |Note date consent received-if this | | | | |

|2.10 |isn’t recorded, note date signed |Date consent received: |Date consent received: |Date consent received: |Date consent received: |

|4.02(4)(a) | | | | | |

|4.02(5) | | | | | |

|If parental consent was not obtained, | | | | | |

|reasonable efforts were made and | |Y N NA |Y N NA |Y N NA |Y N NA |

|documented to obtain consent (re-eval | | | | | |

|only) | | | | | |

|300.330(c)(2)(i)(ii) | | | | | |

|4.02(4)(a) | | | | | |

|4.02(5) | | | | | |

|If no additional assessments were | | |

|determined to be necessary | | |

|Parent was informed of the decision and|PWN | | | | |

|the reason for it | |Y N NA |Y N NA |Y N NA |Y N NA |

|300.305(d)(1)(i) | | | | | |

|4.02(4) | | | | | |

|Parent was informed of their right to |PWN | | | | |

|request an assessment | |Y N NA |Y N NA |Y N NA |Y N NA |

|300.305(d)(1)(ii) | | | | | |

|4.02(4) | | | | | |

|Parents were provided procedural |Prior Notice & Consent for | | | | |

|safeguards at request for initial |Evaluation |Y N |Y N |Y N |Y N |

|consent for evaluation | | | | | |

|300.504(a)(1) through (4) |IEP Section 4: Procedural | | | | |

|4.02(3)(b) |Safeguards | | | | |

|Parental consent for initial provision |Prior Written Notice and Consent | | | | |

|of services was obtained prior to onset|for Initial Provision of Special |Y N NA |Y N NA |Y N NA |Y N NA |

|of services |Education and Related Services | | | | |

|300.503 |Note Date | | | | |

|4.01 |Not necessary to go back beyond | | | |Date consent received: |

| |current year |Date consent received: |Date consent received: |Date consent received: | |

|PWN and Consent for Provision of | | |

|Services contains the required | | |

|elements: | | |

|300.503 | | |

|6.02(3) | | |

|Description of the action proposed or | |Y N |Y N |Y N |Y N |

|refused | | | | | |

|An explanation of why the AU proposed | |Y N |Y N |Y N |Y N |

|or refused the action | | | | | |

|Procedural safeguards were provided | |Y N |Y N |Y N |Y N |

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|Sources for parents to contact | |Y N |Y N |Y N |Y N |

|Description of the information used as | |Y N |Y N |Y N |Y N |

|a basis for the proposed or refused | | | | | |

|action | | | | | |

|Description of other options considered| |Y N |Y N |Y N |Y N |

|and why they were rejected | | | | | |

|Description of other relevant factors | |Y N |Y N |Y N |Y N |

|Provided in the parent’s native |Please note the native language |Y N |Y N |Y N |Y N |

|language or other mode of communication|even if English | | | | |

| | |Native language: |Native language: |Native language: |Native language: |

| |Note any exemplars | | | | |

| |Describe any element for which you | | | | |

| |answered NO | | | | |

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|Follow up to vision and hearing |Evaluation Report | | | | |

|screening (preschool, kindergarten, | |Y N NA |Y N NA |Y N NA |Y N NA |

|grades 1,2, 3,5, 7 and 9 yearly) | | | | | |

|Appropriate educational referrals were | | | | | |

|made if the child was suspected of | |If NO, describe: |If NO, describe: |If NO, describe: |If NO, describe: |

|having an educationally significant |OR | | | | |

|vision or hearing loss and | | | | | |

|Parents were informed of any need for | | | | | |

|further medical evaluation |IEP Section 6: | | | | |

|4.02(2)(c)(iii) |Present Levels of Academic | | | | |

| |Achievement and Functional | | | | |

| |Performance | | | | |

|Assessments were administered by |Evaluation Report |Y N |Y N |Y N |Y N |

|trained and knowledgeable personnel | | | | | |

|300.304(c)(1)(iv) |Staff licensure list |List titles: |List titles: |List titles: |List titles: |

|4.02(4)(5) | | | | | |

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|A variety of technically sound |Evaluation Report |List assessment tools, |List assessment tools, |List assessment tools, |List assessment tools, |

|assessment tools and strategies were | |administered by whom, date |administered by whom, date |administered by whom, date |administered by whom, date |

|used to gather relevant information | |administered: |administered: |administered: |ministered: |

|about the child, including information | | | | | |

|provided by the parent | | | | | |

|300.304(b) | | | | | |

|4.02(4)(5) | | | | | |

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|Evaluation materials are selected and |Evaluation Report | | | | |

|administered so as not to be | |Y N N/A |Y N N/A |Y N N/A |Y N N/A |

|discriminatory on a racial or cultural |Look for: impact of culture and/or | | | | |

|basis |second language on education, prior|Describe the process and BOE |Describe the process and BOE |Describe the process and BOE |Describe the process and BOE |

|300.304(c)(1)(i) |formal schooling, refugee status, |if student is CLD: |if student is CLD: |if student is CLD: |if student is CLD: |

|4.02(4)(5) |ACCESS scores and interpretation, | | | | |

|AND |parent input, ELA teacher input, | | | | |

|Evaluation materials are provided and |language spoken in the home as well| | | | |

|administered in the child’s native |as by the student | | | | |

|language or other mode of communication| | | | | |

|and in the form most likely to yield |If standardized assessments were | | | | |

|accurate information on what the child |administered was language taken | | | | |

|knows and can do |into consideration? | | | | |

|300.304(c)(1)(ii) | | | | | |

|4.02(4)(5) | | | | | |

|Child was assessed in all areas of |Evaluation Report | | | | |

|suspected disability | |Y N |Y N |Y N |Y N |

|300.304(c)(4) | | | | | |

|4.02(4)(5) | |If NO, describe: |If NO, describe: |If NO, describe: |If NO, describe: |

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|Evaluation was sufficiently |Evaluation Report |Y N |Y N |Y N |Y N |

|comprehensive to identify all of the | | | | | |

|child’s special education and related |IEP Section 6: Student Needs and |If NO, describe: |If NO, describe: |If NO, describe: |If NO, describe: |

|services needs |Impact of Disability | | | | |

|300.304(c)(6) | | | | | |

|4.02(4)(5) |Look for: Were assessment scores | | | | |

| |reported and interpreted? Were | | | | |

| |data triangulated? | | | | |

|Meeting to discuss initial evaluation |Prior Notice and Consent for |Y N |Y N |Y N |Y N |

|was held within a reasonable period of |Initial Provision of Special | | | | |

|time |Education and Related Services |Date of meeting: |Date of meeting: |Date of meeting: |Date of meeting: |

|4.02(6)(a) | | | | | |

| |IEP Section 2: Dates of Meetings | | | | |

|A group of qualified professionals |Evaluation Report |Y N |Y N |Y N |Y N |

|(including the child’s regular | | | | | |

|education teacher and at least one |IEP Section 5: IEP Participants |List titles: |List titles: |List titles: |List titles: |

|person qualified to conduct individual | | | | | |

|diagnostic examinations of children, | | | | | |

|such as a school psychologist, or | | | | | |

|remedial reading teacher) and the | | | | | |

|parent of the child determined whether | | | | | |

|the child is a child with a disability | | | | | |

|300.306(a)(1) | | | | | |

|2.20 | | | | | |

|3.04 | | | | | |

|4.02(4) through (6) | | | | | |

|Eligibility questions were considered |Policies and Procedures: |Please note that you are answering Yes or No to whether the team considered the questions. You are not answering the |

|by the IEP team: |Comprehensive Plan |question itself. Note if there is a discrepancy with any other information in the IEP. |

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|Can the child receive reasonable |Determination of Disability (for |Y N |Y N |Y N |Y N |

|educational benefit from general |specific disability/disabilities | | | | |

|education alone? |considered) | | | | |

|300.306(b)(1)(i) | | | | | |

|2.08 | | | | | |

|Is the child’s performance due to the |Determination of Disability (for |Y N |Y N |Y N |Y N |

|lack of instruction in reading and/or |specific disability/disabilities | | | | |

|math? |considered) | | | | |

|300.306(b)(1)(ii) | | | | | |

|2.08 | | | | | |

|For the child whose primary language is|Determination of Disability (for |Y N |Y N |Y N |Y N |

|other than English, is limited English |specific disability/disabilities | | | | |

|acquisition the primary cause of the |considered) | | | | |

|child’s learning problems? | | | | | |

|300.306(b)(1)(iii) | | | | | |

|2.08 | | | | | |

|Is the information above in |Determination of Disability (for |Y N |Y N |Y N |Y N |

|contradiction with any information in |specific disability/disabilities | | | | |

|the evaluation report or the IEP? |considered) |If yes, describe: |If yes, describe: |If yes, describe: |If yes, describe: |

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|Pertinent and specific information |Determination of Disability form | | | | |

|regarding determination of eligibility |(for specific |Y N |Y N |Y N |Y N |

|was considered for suspected disability|disability/disabilities considered)| | | | |

|300.8 | | | | | |

|2.08 | |Review the specific |Review the specific |Review the specific |Review the specific |

| | |eligibility determination |eligibility determination |eligibility determination |eligibility determination |

| | |form. Ensure that information|form. Ensure that information|form. Ensure that information|form. Ensure that information|

| | |in the checked boxes is |in the checked boxes is |in the checked boxes is |in the checked boxes is |

| | |supported by information in |supported by information in |supported by information in |supported by information in |

| | |the Evaluation Report. |the Evaluation Report. |the Evaluation Report. |the Evaluation Report. |

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| | |If requirements are met, brief|If requirements are met, brief|If requirements are met, brief|If requirements are met, brief|

| | |notes can be captured here. |notes can be captured here. |notes can be captured here. |notes can be captured here. |

| | |If there are concerns use the |If there are concerns use the |If there are concerns use the |If there are concerns use the |

| | |specific eligibility |specific eligibility |specific eligibility |specific eligibility |

| | |determination form. |determination form. |determination form. |determination form. |

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|A copy of the Evaluation Report and |Determination of Disability form | | | | |

|Determination of disability was | |Y N |Y N |Y N |Y N |

|provided to the parent | | | | | |

|300.306(a)(2) | | | | | |

|4.02(6) | | | | | |

|Reevaluation and eligibility meeting | | | | | |

|held to determine change of disability,| |Y N NA |Y N NA |Y N NA |Y N NA |

|including exit from special education | | | | | |

|300.305(e) | | | | | |

|4.02(6)(c) | | | | | |

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|Reevaluation conducted at least every 3| |Date of previous eval: |Date of previous eval: |Date of previous eval: |Date of previous eval: |

|years, unless: | | | | | |

|300.303(a)(1)(2) | | | | | |

|4.02(5) | | | | | |

|Evidence exists that the parent and the| |NA |NA |NA |NA |

|AU determine that a reevaluation is | | | | | |

|unnecessary | |Or describe: |Or describe: |Or describe: |Or describe: |

|300.305(d)(1) | | | | | |

|4.02(5) | | | | | |

|Per ECEA once a written special |Prior Notice & Consent for | | | | |

|education referral has been initiated, |Evaluation | | | | |

|the initial IEP is completed within 90 | | | | | |

|calendar days form the point of |IEP Section 2: Dates of Meetings | | | | |

|initiation of the special education | | | | | |

|referral | | | | | |

|4.03(1)(d) | | | | | |

|INITITAL AND REEVALUTION COMMENTS: |

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|IEP DEVELOPMENT – Start here if the file is for an Annual Review |

|Section 2: Review Timelines |

|Confirm dates with evidence in file. |

|Evidence that IEP was written within 365|IEP Section 2: Dates of Meetings |Date of last IEP: |Date of last IEP: |Date of last IEP: |Date of last IEP: |

|days of prior IEP | | | | | |

|300.324(b)(1)(i); 4.03(3) |File | | | | |

|Reevaluation conducted at least every 3 |IEP Section 2: Dates of Meetings |Date of last eval: |Date of last eval: |Date of last eval: |Date of last eval: |

|years, unless: | | | | | |

|300.303(a)(1) and (2) |File | | | | |

|4.02(5) | | | | | |

|Section 3: Review Student and Family Information |

|Be sure to look at student demographics above and check whether the parent’s language would have required an interpreter. |

|Interpreter was provided if required |

|300.322(e); 4.03(7)(a) |

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|parents were given copies of procedural safeguards: |

|300.504; 6.02 |

|NOTE: If an initial, parents may have already received at time of consent for evaluation. |

|Meeting was scheduled at a mutually |Notice of Meeting |

|agreed-upon time and place | |

|300.322(a)(2); 4.03(7) |IEP Section 5: IEP Participants |

|4.03(8) | |

|parent |IEP Section 5: IEP Participants |Y N |Y N |Y N |Y N |

|300.321(a)(1); 4.03(5) | | | | | |

|special education provider of the child |IEP Section 5: IEP Participants |Y N |Y N |Y N |Y N |

|300.321(a)(3); 4.03(5) | | | | | |

|special education director/designee |IEP Section 5: IEP Participants |Y N |Y N |Y N |Y N |

|300.321(a)(4); 4.03(5)(a) | | | | | |

|an individual who can interpret the |IEP Section 5: IEP Participants |

|instructional implications of evaluation| |

|results |Note: This can be sped teacher, slp |

|300.321(a)(5); 4.03(5) | |

|parent and LEA agreed in writing |

|300.321(e)(1) and (2)(i); 4.03(5) |

|Strengths of the child |IEP Section 6: Present Levels of |Y N |Y N |Y N |Y N |

|300.324(a)(1)(i); 4.03 |Academic Achievement and Functional| | | | |

| |Performance | | | | |

|The IEP team considered the most recent |IEP Section 6: |Y N |Y N |Y N |Y N |

|evaluation of the child |Present Levels of Academic | | | | |

|300.324(a)(iii); 4.03 |Achievement and Functional | | | | |

| |Performance |If no, provide specific |If no, provide specific |If no, provide specific |If no, provide specific |

| | |information |information |information |information |

| |Note: For CLD students, look for | | | | |

| |input pertinent to second language | | | | |

| |(e.g., ACCESS scores, ELA input, | | | | |

| |parental input) | | | | |

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|Statement of the child’s present levels |IEP Section 6: Present Levels of |Y N |Y N |Y N |Y N |

|of academic achievement and functional |Academic Achievement and Functional| | | | |

|performance |Performance | | | | |

|300.320(a)(1); 4.03 | | | | | |

|Academic, developmental, and functional needs of the child |

|300.324(a)(1)(iv); 4.03 |

| Behavior plan |

|300.324(a)(2)(i); 4.03 |

|Beginning with the first IEP to be in effect when the child turns 15, or no later than the end of 9th grade, (or earlier if deemed appropriate by the team) the IEP includes: |

|300.320(b); 4.03(6)(d) |

|Invitation indicates that a purpose of the meeting will be postsecondary goals and transition planning 300.322(b)(2)(i)(A); 4.03(7)(b)(i)(A) |

|Section 9: Annual Goals / Objectives |

|Record the number of goals, and the number of goals that are measurable.. |

|Goals should be aligned with information in the Evaluation Report and the PLAaFP. |

|Number of goals |Number of goals that are measurable| | | | |

| |300.320(a)(2)(i); 4.03 | | | | |

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|For children with disabilities who take |IEP Section 9: Annual Goals and/or|Y N N/A |Y N N/A |Y N N/A |Y N N/A |

|alternate assessments benchmarks or |Objectives | | | | |

|short-term objectives are written in the| | | | | |

|area in which student is taking the | | | | | |

|alternate | | | | | |

|300.320(a)(2)(ii); 4.03(6)(f) | | | | | |

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|A description of how the child’s |IEP Section 9: Annual Goals and/or|Y N |Y N |Y N |Y N |

|progress toward meeting the annual goals|Objectives | | | | |

|will be measured, and when periodic | | | | | |

|reports on the child’s progress will be | | | | | |

|provided | | | | | |

|300.320(a)(3)(i) and (ii); 4.03 | | | | | |

|Section 10: Accommodations and Modifications |

|Review to ensure that accommodations and modifications align with student needs. |

|program accommodations and/or modifications or supports for school personnel |

|300.320(a)(4); 300.320(a)(6)(i); 4.03 |

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|ESY was considered |

|300.106; 4.03 |

|A statement of participation on district assessments |

|300.320(a)(6)(i); 4.03 |

|special education services |IEP Section 13: Service Delivery |Y N |Y N |Y N |Y N |

|300.320(a)(4); 2.43; 4.03 |Statement | | | | |

|IEP was implemented as soon as possible |IEP Section 13: Service Delivery |Y N |Y N |Y N |Y N |

|following IEP meeting |Statement |If no, note date of |If no, note date of beginning |If no, note date of beginning |If no, note date of beginning |

|300.103(c) | |beginning of services: |of services: |of services: |of services: |

| |Service provider logs | | | | |

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|IEP was in effect at the beginning of |IEP Section 13: Special Education |Y N |Y N |Y N |Y N |

|the school year |and Related Services | | | | |

|300.323(a); 4.03(1)(a) | | | | | |

|Section 14: Recommended Placement in the LRE |

|Placement decision was made by a group |IEP Section 5: IEP Participants |Y N |Y N |Y N |Y N |

|of persons | | | | | |

|including the parents, and other persons| | | | | |

|knowledgeable about the child, the | | | | | |

|meaning of the evaluation data, and the | | | | | |

|placement options | | | | | |

|300.116(a)(1); 2.28; 2.50 | | | | | |

|4.03(8); 5.01(2)(c); | | | | | |

|is not removed from education in age |IEP Section 14: Recommended |Y N |Y N |Y N |Y N |

|appropriate regular classrooms solely |Placement in the Least Restrictive | | | | |

|because of needed modifications in the |Environment |Describe alignment of LRE to|Describe alignment of LRE to |Describe alignment of LRE to |Describe alignment of LRE to |

|general education curriculum. | |need, goals, services, |need, goals, services, |needs, goals, services, |needs, goals, services, |

|Is removed from regular education | |placement: |placement: |placement: |placement: |

|environment only when the nature or | | | | | |

|severity of the disability cannot be | | | | | |

|achieved satisfactorily even with | | | | | |

|supplementary aids and services | | | | | |

|Child participates with nondisabled | | | | | |

|children to the maximum extent | | | | | |

|appropriate to identified needs | | | | | |

|300.116(d); 300.116(e); 300.114(2)(i) | | | | | |

|and (ii); 5.01(2)(c) | | | | | |

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|An explanation of the extent, if any, to which the child will not participate with nondisabled children |

|300.320(a)(5); 4.03 |

|PWN was provided when the AU proposed or refused to initiate or change … |

|300.503; 6.02(3) |

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