CHANGES IN PLACEMENT *This form must be completed by the case manager after every IEP meeting. Student Name:_____________________________ Case Manager:_____________________________ Effective Date:________________
New IEP
Amendment
Changes/Determinations: (Please indicate if consult only) Disability: No Change
New Identification: _______
Not Identified
Added Services:
OT
PT
Speech
Nurse
Social Worker Sweetser SW
Dismissed from:
OT
PT
Speech
Nurse
Social Worker Sweetser SW
Exited to Regular Education Other: ________________________________
% of time in Regular Education Time arriving at school (getting off the bus): Time departing school (getting on the bus): Total time at school daily (hrs. or mins.) Time in SPED: Specially Designed Instruction: SW: S/L: OT: PT: Total time in pull out SPED:
daily daily daily daily daily daily
weekly weekly weekly weekly weekly weekly
* Be sure that SPED time includes only time spent in a SPED setting (Lunch, recess, & specials do not count in percentage of SPED even when supported by an ed. tech.) Determine percent of time in SPED: ___________ Record percent of time in Regular Ed:_________
(Divide total SPED hours by total School hours)
Less than 40% in Reg. Ed. daily Between 40% and 79% in Reg. Ed. daily
Testing
Changes in Placement-3.pdf
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