Site Visit with Student File and Special Education File Review

• School Name

• Site Visit Date

  Date

• Prepared by

• Start Time

  Date

• School Personnel Involved

• Required Monthly Rubric Items

• Other Items Discussed

• Technical Assistance or Guidance Provided by Sponsor

• Areas of Strength

• Compliance Concerns or Suggestions

• Overall Assessment

• Items Requiring Follow-up

• End Time

  Date

Student Files

• Student File Checklist

Student File

• Sign-In Sheet Included?

  Yes

  No

  N/A

Biographical Information

• Student Initials

• Student ID Number

• Grade Level

• Birth Certificate with Proper Name/Spelling

  Yes

  No

  N/A

• Explanation

• Proof of Residency

  Yes

  No

  N/A

• Explanation

Health Information

• Signed Emergency Medical Release

  Yes

  No

  N/A

• Explanation

• Immunization Chart

  Yes

  No

  N/A

• Immunizations Current?

  Yes

  No

  N/A

• Explanation

• Explanation

• Vision Screening

  Yes

  No

  N/A

• Vision Current? (K, 1, 3, 5, 7, 9, new students)

  Yes

  No

  N/A

• Explanation

• Explanation

• Hearing Screening

  Yes

  No

  N/A

• Hearing Current? (K, 1, 3, 5, 9, new students)

  Yes

  No

  N/A

• Explanation

• Explanation

Academic Information

• Did student transfer from a different school?

  Yes

  No

  N/A

• Records Release

  Yes

  No

  N/A

• Explanation

• Transcript from Previous School

  Yes

  No

  N/A

• Number of Release Requests Documented

• Date of Most Recent Request

  Date

• Most Recent School Grade Report

  Yes

  No

  N/A

• Explanation

• State Test Results

  Yes

  No

  N/A

• Explanation

Overall Assessment

• General Comments or Concerns

• Student File Follow-up Needed?

  Yes

  No

  N/A

Special Education Files

• Special Education File Checklist

Special Education File

• Sign-in Sheet Included?

  Yes

  No

  N/A

Biographical Information

• Student Initials

• Student ID Number

• Grade Level

ETR

• Date Current (ETR must be done every three years)

  Yes

  No

  N/A

• Is the current ETR the student's original ETR?

  Yes

  No

  N/A

• Referral (PR-04) in original ETR

  Yes

  No

• Referral (PR-04)

  Yes

  No

• Prior Written Notice (PR-01)

  Yes

  No

  N/A

• Parent Invitation (PR-02)

  Yes

  No

  N/A

• Parent Consent (PR-05)

  Yes

  No

  N/A

• ETR Body (PR-06)

  Yes

  No

  N/A

• Appropriate Signatures <br>(district rep, regular ed teacher, special ed staff, parent, student (if present))

  Yes

  No

  N/A

• Missing Signatures/Explanation

• ETR Comments/Concerns

IEP

• Date Current (IEP must be done every year)

  Yes

  No

  N/A

• Parent Invitation (PR-02)

  Yes

  No

  N/A

• Future Planning, Special Instructional Factors, Profile (Sections 1-3)

  Yes

  No

  N/A

• Post-Secondary Transition (Sections 4/5)

  Yes

  No

  N/A

• Was the student invited to the IEP meeting? (required for 14+)

  Yes

  No

  N/A

• Explanation

• Goals and Specially Designed Services (Sections 6/7)

  Yes

  No

  N/A

• Services Aligned with Goals

  Yes

  No

  N/A

• Explanation

• Least Restrictive Environment (Section 11)

  Yes

  No

  N/A

• Statewide and District-Wide Testing Accommodations (Section 12)

  Yes

  No

  N/A

• Is the student approved for alternate assessment?

  Yes

  No

  N/A

• Appropriate Signatures<br>(district rep, regular ed teacher, special ed staff, parent, student (if present))

  Yes

  No

  N/A

• Missing Signatures/Explanation

• Documentation that School is Providing Related Services

  Yes

  No

  N/A

• IEP Progress Reports

  Yes

  No

  N/A

• Explanation

• IEP Comments/Concerns

Overall Assessment

• General Comments or Concerns

• Special Ed File Follow-up Needed?

  Yes

  No