Forms
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- Agreement To Waive Reevaluation: .doc / .pdf
- Evaluation Report (ER): .doc / .pdf
- Functional Assessment Interview Forms: .doc / .pdf
- Functional Assessment Observation Tools: .doc / .pdf
- Functional Assessment Secondary Team Forms: .doc / .pdf
- Functional Behavioral Assessment Worksheet: .doc / .pdf
- Individualized Education Program (IEP): .doc / .pdf
- Invitation to Participate in the IEP Team Meeting or Other Meeting: .doc / .pdf
- Manifestation Determination Worksheet: .doc / .pdf
- Notice of Recommended Educational Placement/Prior Written Notice (NOREP/PWN): .doc / .pdf
- Parental Consent to Excuse Members from Attending the IEP Team Meeting: .doc / .pdf
- Permission to Evaluate — Consent Form: .doc / .pdf
- Permission to Evaluate — Evaluation Request Form: .doc / .pdf
- Permission to Reevaluate — Consent Form: .doc / .pdf
- Permission to Reevaluate — Reevaluation Request Form: .doc / .pdf
- Positive Behavior Support Plan: .doc / .pdf
- Procedural Safeguards Letter: .doc / .pdf
- Procedural Safeguards Notice: .doc / .pdf
- Reevaluation Report (RR): .doc / .pdf
- Summary of Academic Achievement and Functional Performance: .doc / .pdf
Annotated Forms
- Agreement to Waive Reevaluation
- Evaluation Report
- Individualized Education Program (IEP)
- Invitation to Participate in the IEP Team Meeting or Other Meeting
- Notice of Recommended Educational Placement/Prior Written Notice (NOREP/PWN)
- Notice of Recommended Educational Placement/Prior Written Notice for Revocation of Consent for Special Education Services
- Parental Consent to Excuse Members from Attending the IEP Team Meeting
- Permission to Evaluate — Evaluation Request Form
- Permission to Reevaluate — Consent Form
- Permission to Reevaluate — Reevaluation Request Form
- Reevaluation Report
- Summary of Academic Achievement and Functional Performance
Social Worker Forms
- Allegheny General Hospital Authorization for Release of Protected Health Information
- Axiom Family Counseling Services, Inc. Consent for Release of Protected Health Information
- Children's Hospital of Pittsburgh Authorization for Release of Protected Health Information
- Cornerstone Care Counseling Department Release of Information
- Chestnut Ridge Counseling Services, Inc. Authorization for Use/Disclosure of Health Information
- Laurel Pediatrics, PC Authorization for the Release of Medical Record Information
- Monsour Medical Center Authorization to Release/Obtain Information
- Southwood Psychiatric Hospital Authorization to Release Information
- University of Pittsburgh Medical Center Authorization for Release of Protected Health Information
- West Virginia University Health Service Authorization for Release of Information
- WJS Psychological Associates, Inc. Consent for Release of Information
Fayette County Social Worker Forms
- Child and Family Urgent Response and Stabilization Team’s Web Referral Form
- Fayette Area Coordinated Transportation Consumer Welcome Brochure
- Fayette Area Coordinated Transportation Escort Eligibility Physician Verification Form
- The Medical Assistance Transportation Program Basic Informational Brochure
