Feedback on Draft DPI Sample IEP Forms

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Please describe your role(s).

Check all that apply.

Parent of family member of a child with an IEP (i.e. child receiving special education services)

Someone who had an IEP (i.e. special education services)

General education teacher

Special education teacher

Related service provider (e.g. SLP, OT, PT, O&M, Audiologist, Interpreter, School Psychology/Nursing/Counseling/Social Work)

Special education or pupil service Director

Paraprofessional

Family support or advocacy organization representative

Other:

Check any of the IEP team or special education evaluation roles you have:

LEA Representative role on IEP team

Assist with conducting assessments to determine eligibility for special education

Assist IEP teams with analyzing assessment results to determine eligibility for special education

None of the above

Other:

Check any of the disability category criteria you have been a member of an IEP team to identify whether a student/child meets the criteria.

All or most of the disability category criteria below

None of the disability category criteria below

Autism

Blind and Visually Impaired

Deaf and Hard of Hearing

Deafblind

Emotional Behavioral Disability

Intellectual Disability

Other Health Impairment

Orthopedic Impairment

Significant Developmental Delay

Specific Learning Disability

Speech and Language

Traumatic Brain Injury

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