1. Required training for 2014-2015 Professional Learning SECTIONS OF THE ESC- 99

2. LEDM NOTIFICATION If you notice there is only one LEDM listed on the 99, be sure to check Consent Form 2 for another LEDM. Both LEDMs must be notified even though only one signature is required.

3. LEDM NOTIFICATION If you notice there is only one LEDM listed on the 99, be sure to check Consent Form 2 for another LEDM. Both LEDMs must be notified even though only one signature is required.

4. DATES This is the date the 99 was completed (cannot be prior to the meeting date). This is the date(s) the IEP team met.

5. METHOD OF ATTEMPTS BOX (This box is commonly mistaken for documenting meeting notification.) The purpose of this box is to document at least 3 attempts (using at least 2 different delivery methods) to provide the ESC-99 to the LEDMs. This is completed for both LEDMs (if separate addresses).

6. TOP CHECKBOXES The checkboxes at the top of the 99 should not be left blank. Only psychs and/or SLPs (for speech-only) will check the top box. The bottom 3 checkboxes can be checked in any combination as long as they represent the team discussion.

7. IDENTIFICATION/ELIGIBILITY SECTION A This section is only completed by the psych or an SLP (for a speech-only IEP). Psychs and SLPs should always remember to fill in the exceptionality.

8. INITIAL SERVICES & PLACEMENT SECTION B Section B is only checked by a psych or an SLP. This section is checked when a student is determined to be eligible for special education, and the team develops and IEP for the student.

9. CHANGE IN SERVICES &/OR PLACEMENT SECTION C & D Check section C when there is any change in service. C1 for changes in service C2 for material change in services Check section D when there is any change in placement. D1 for changes in placement D2 for substantial change in placement

10. SECTIONS E AND F This is ALWAYS checked unless it is an initial IEP/Eligibility/Evaluation meeting. Examples include changes to: Goals PLEPS This box is used by psychs and SLPs (speech-only) when a student referred for an initial eval is NOT eligible for services -or- when working with Coop admin as a result of the district refusing to initiate or change an item requested by the LEDM.

11. PROPOSED/REFUSED ACTION SECTION 1 If you checked B, C2, and/or D2, explain it here and include frequency, location, and duration for each action/service. If you checked C1, D1, E, and/or F, explain it here and include frequency, location, and duration for each action/service.

12. EXPLANATION OF ACTION SECTION 2 Indicate here the reason for why the team determined the proposed/refused action was appropriate/not appropriate.

13. OPTIONS CONSIDERED SECTION 3 Teams must always consider LRE as an option. Explain here LRE discussion/options here, as well as any other options considered. If options were discussed, but the team decided against some of the options, then indicate why they were rejected.

14. DESCRIPTION OF DATA SECTION 4 Examples can include data such as evaluation, local assessments, IEP team discussion, progress reports, etc.

15. OTHER RELEVANT FACTORS SECTION 5 What other factors did the team consider that were related to the proposed/refused action? For example: “The team determined the benefits of special education services outweigh any potentially, harmful effects such as time away from peers.”

16. REQUEST FOR CONSENT This box is only checked/signed by LEDM(s) if you marked B, C2, and/or D2. If a LEDM checks this box, an administrator should be notified. Parent/LEDM may check/sign both boxes.