IEP Forms

Office of Special Services & Inclusive Education

The following are the forms that the Maine Department of Education Special Services & Inclusive Education team requires, forms that are for local use as required, and forms for local use that are optional.

Individualized Education Program (IEP) IEP Form

The Individualized Education Program, often called the IEP is a document under the United States law that is developed for each public school child in the U.S. who needs special education. (Effective 08.01.2020)

7 Day Waiver 7 Day Waiver

A form indicating that parents of a student understand that a proposal to initiate or change the student's placement or programming will often not be implemented until seven days from when the SAU gives written knowledge to the parents but agrees to waive that notice requirement so that a proposal can be implemented in the time set forth. Updated to include language to clarify that a description of proposals or refusals should be documented, not just proposals by the SAU.

Advance Written Notice of IEP  Advanced Written Notice

Form to notify parents of students enrolled in an Individual Education Plan (IEP) or Individual Family Service Plan (IFSP) of team meetings in advance in order to assure parents the opportunity to attend if they so wish.

Adverse Effect (updated 08/01/2019)  Adverse Effect

Form to be completed by the IEP Team whenever there is a meeting to determine eligibility or consider a change in eligibility (including dismissal from special education). Form to be attached to and referenced in the Written Notice.

Excusal of Member Whose Curriculum Area is Being Discussed  Excusal of a Member Whose Content Area is Being Discussed

Form to excuse a member of the Team during a meeting that involves a modification to or discussion of the member's area of the curriculum or related service. Requires the parent and public agency to consent in writing to the excusal, and for the member to submit their input into IEP/IFSP development in writing prior to the meeting.

Excusal of Member Whose Curriculum Area is not Being Discussed  Excusal of a Member Whose Content Area is  NOT Being Discussed

A form indicating a Team member is not required to attend the meeting, in whole or in part if the parent and public agency agree in writing that the member's attendance is not necessary because their area of the curriculum is not being modified or discussed during the meeting.

Parental Consent for Evaluation  Parental Consent For Evaluation

Form for parental consent to child's evaluation for eligibility or continuing eligibility in IEP/IFSP.

Parental Consent for Outside Agencies  Parental Consent for Outside Agencies

Form for parental consent for outside agencies to attend IEP Team meeting for discussion of child's post-secondary goals.

Referral for Special Education (Optional)  Optional Referral for Special Education

This form provides an opportunity for the referring party to document academic and functional strengths and weaknesses of the child, relevant local and state assessment data, and attempted interventions.  This form is considered optional and is not required in the referral of a child suspected of having deficits to the degree that requires special education services.

Instructions for Referral - optional (updated 08/01/2019)

Revocation of Parental Consent for Special Education Programs or Services  Revocation of Parental Consent for Special Education Programs or Services

Form for a parent to revoke consent for the provision of special education services to a child. Districts must have parental consent to provide special education programs and services to eligible students. Parents can withdraw consent at any time.

Specific Learning Disability Eligibility Form  Specific Learning Disability Eligibility Form

Specific Learning Disability: a disorder in one or more of the basic psychological processes involved in using language, spoken or written, that may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations. Form to calculate eligibility.

Speech or Language Impairment Eligibility Form  Speech or Language Impairment Eligibility Form

Form to establish if a child meets at least one of four listed criteria to a degree that it adversely affects educational performance so that a child requires special education services.

Summary of Performance  Summary of Performance

Form to summarize a child's academic achievement. Completion required under the IDEA. Important to assist children graduating from high school to higher education, training, and/or employment.

Written Notice  Written Notice

Form to be given to parents at least 7 days prior to the school unit's proposal or refusal to initiate or change the identification, evaluation or educational placement of a child enrolled in IEP/IFSP services. Updated to include the phone number for Southern Maine Parent Awareness which is listed in the resources for parents to contact in receiving assistance in understanding or obtaining the procedural safeguards.