JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
MARSS STUDENT INFORMATION FORM
2023-2024 MARSS Student Data
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Teacher Name
*
Your answer
Student Name
*
Your answer
Grade
*
Choose
EC
K
1
2
3
4
5
6
7
8
9
10
11
12
MARSS Number
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Date of IEP/IFSP
*
MM
/
DD
/
YYYY
Date of Evaluation
*
MM
/
DD
/
YYYY
Status Change Date
MM
/
DD
/
YYYY
Resident District
*
Your answer
Servicing District
*
Your answer
Evaluation Status
*
Choose
1 - Student does not require evaluations
2 - Student has been evaluated but does not required special education services
3 - Student has been evaluated and requires special education services but is not currently participating in a special education program
4 - Student has been evaluated and is receiving special education services
5 - Student was evaluated and qualified for special education services but parent refused the services
6 - Student was evluated and is receiving services through an IIIP and receiving services through another public agency other than the school district
7 - Student has an IEP/IIIP, the objectives have been met and the IEP/IIIP has been terminated during the current school year
Disability Class
*
Choose
00 - No IEP/IIIP, nondisabled student
01 - Speech/language impaired
02 - Developmental Cognitive Disabilities: Mild-Moderate
03 - Developmental Cognitive Disabilities: Severe-Profound
04 - Physically impaired
05 - Deaf-Hard of hearing
06 - Visually impaired
07 - Specific learning disabilities
08 - Emotional/behavioral disorders
09 - Deaf-blindness
10 - Other health disabilities
11 - Autism Spectrum Disorder
12 - Developmental Delay
14 - Traumatic brain injury disabled
16 - Severely multiply impaired
54 - Section 504 Plan
Instructional Setting
*
Choose
00 - No IEP/IFSP/IIIP, non-disabled student
01 - Outside regular class room less than 21% of school day
02 - Resource Room between 21% and 60% of school day
03 - Separate classroom more than 60% of school day
04 - Public separate day school facility greater than 50% of school day
05 - Private separate school facility greater than 50% of school day
06 - Public residential facilities greater than 50% of school day
07 - Private residential facilities greater than 50% of school day
08 - Homebound/hospital placement
11 - Designed for children with development delays
12 - Designed for typically developing children
13 - Home
14 - Hospital (inpatient)
15 - Residential Facility
16 - Service provider location
17 - Other setting
31 - EC/KG (non sped ed) min. 10 hrs/wk: majority of serv in setting
32 - EC/KG (non sped ed) min. 10 hrs/wk: majority of serv other location
33 - EC/KG (non sped ed) max. 10 hrs/wk: majority of serv in setting
34 - EC/KG (non sped ed) min. 10 hrs/wk: majority of serv other location
41 - Separate class
42 - Separate school
43 - Residential facility
44 - Service provider location
45 - Home
Special Transportation
*
Yes
No
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Braham Area Schools.
Report Abuse
Forms
