Livingston Parish Public Schools
          School Board Office Location:
         13909 Florida Blvd.
         Livingston, La.  70754

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FORMS

Special Education Forms

Speech Therapy Forms

Assistive Technology Forms

Gifted / Talented Forms

SBLC Forms

504 Forms

 

 

 

 

 

                                          

 

 

 

 

 

 

504 Forms

504 SDC

  1. 504 Initial Procedural Checklist

  2. Grievance Procedures For 504

  3. 504 Tracking Report

  4. Procedures for Gifted/Talented

 

Review of Records

Pupil Appraisal Review and Eligibility

 

 

Evaluation Close Out Forms

  1. Parent Close Out Letter

  2. Report of Close Out Conference

 

 

Characteristics of ADHD

  1. ADHD Checklist

  2. Developmental History (3 pages)

  3. Teacher Interview

  4. ADHD Rating Scale

  5. Home and School Situation Questionnaires

  6. Observation (2 pages)

  7. Assessment for Characteristics of ADHD (Cover page)

  8. Evaluation (6 pages) page 1   Page 2  Page 3  Page 4    Page 5-6    

  9. Medical Statement

  10. Authorization for Release of Medical Information

  11. Functional Behavior Assessment for Characteristics of ADHD (2 pages)

 

Characteristics of Dyslexia

  1. Dyslexia Checklist

  2. Dyslexia Assessment Plan

  3. Parent Interview (2 pages)

  4. Documentation of Data Gathering (3 pages)                                    Page 1      Page 2     Page 3

  5. Speech/Language Screening (2 pages)

  6. Teacher Interview

  7. MSL Refusal

  8. Assessment for Characteristics of Dyslexia (Cover page)

  9. Notice of Findings/Evaluation (3 pages)

 

 

Academic Deficits in the Area of Math

  1. Evaluation Checklist

  2. Parent Interview (2 pages)

  3. Teacher Interview

  4. Review of Student’s Records

  5. Assessment of Academic Deficits in the Area of Mathematics Evaluation Cover Page

  6. Evaluation for Academic Deficits in Area of Math (6 pages)           Page 1     Page 2      Page 3      Page 4     Pages 5 & 6 

 

Social/Emotional Evaluation

  1. Evaluation Checklist

  2. Parent Interview (3 pages)  

  3. Teacher Interview

  4. Functional Behavioral Assessment (2 pages)

  5. Behavior Intervention Plan

  6. Review of Student’s Records

  7. Evaluation Cover Page

  8. Evaluation for Social/Emotional Deficits (6 pages)                         Page 1       Page 2     Page 3      Page 4       Page  5 &  6

 

Medical Condition Evaluation

  1. Evaluation Checklist

  2. Release of Medical Information

  3. Medical Statement

  4. Individual Health Plan (IHP)
    Cumulative Record Review (2 pages)

  5. Teacher Interview

  6. Assessment of Medical Condition Evaluation Cover Page

  7. Evaluation for Medical Condition (4 pages)                Page 1      Page 2     Page 3    Page 4

 

Individual Accommodation Plan (IAP)

  1. IAP

  2. Test Verification Form

  3. IAP Teacher Interview

 

Reevaluations

  1. Reevaluation Checklist

  2. Teacher Interview

  3. Student Interview

  4. Parent Interview

  5. Reevaluation Cover Page

  6. Reevaluation Report (4 pages)

 

Discipline

  1. Functional Behavioral Assessment

  2. Behavior Intervention Plan

  3. Grievance Procedure

  4. Behavior Interventionist Strategist Referral Request

  5. Discipline Form

  6. Teacher Interview

  7. Manifestation Determination

 

Parental Participation Forms

  1. Parental Participation Documentation

  2. Full Effective Notice

  3. 504 Parental Consent

  4. Dyslexia Parental Consent

 

Option III

Teacher Interview

 

Miscellaneous

  1. Record of Examination of Confidential Files

  2. Notice of Change

  3. Occupational Therapy Screening Procedures

  4. Occupational Therapy Screening Form

 

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