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Student Data Services Information

  • Special Education Data Handbook 2004 (pdf)
      (Handbook information will be updated after implementation of Infinite Campus)

  • Process for Submitting Form 1047
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  • Special Education Codes
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    Woodcock-Johnson® III Information

    Guidelines for Teachers on Temporary Teaching Eligibility Endorsements (TTE's):

    The TTE Guidelines, Application Form, and Verification Form will be available on the Human Resources Licensed website in August, 2005.
    ILP/IEP  Information
    Individual Literacy Plans and The Colorado Basic Literacy Act
    New Exceptional Student Services Forms
    Progress Report Form
         		Progress Report Form
    Sample Progress Report Form
    Sample Progress Report Form
    Notice of Graduation
         		Notice of Graduation
    Manifestation Determination Form
    Checklist for Manififestation Determination
    Safety Plan - Non Sex Offender
         		Safety Plan - Non Sex Offender
    Safety Plan - Sex Offender
         		Safety Plan - Sex Offender
    PDF FILES
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    Document in MicroSoft Word (PC/Mac)
    		 Document in PDF
    Jeffco IEP (revised 8/10/00)
    Jeffco IEP - Office 98 (Macintosh)
    Jeffco IEP (Office 95/Word 6.0) (revised 8/10/00)         		Full Jeffco IEP
    The PDF version above is the FULL FORM, with almost all supplementary forms included. 
      Base Jeffco IEP
    The PDF version above is the BASE FORM.  Supplementary forms must be added (below). 
    1016r - IEP Annual Review (revised 8/10/00) 1016r
    1016a - IEP Addendum (revised 8/17/00) 1016a
    Educational Rights of Parents (See translations) Rights
    1001 - Specialized Referral Conference [Revised 12/14/99] 1001
    1004 - Proposed Intervention-Special Education Assessment 1004
    1005 - Parent-Guardian Permission for Release of Confidential Data 1005
    1007 - Perceptual communicative disability discrepancy worksheet. 1007
    1015 - Conference-Meeting Notification (See translations) 1015
    1021 - Participation in Content Standards 1021
    1022 - Early Childhood Transition Plan 1022
    1023 - Notice/Permission/Reevaluation  (See translations) 1023
    1024 - Communication Plan 1024
    1025 - Vision Literacy Plan 1025
    1028 - Addendum to IEP: PHLOTE Students 1028
    1030 - Determination of Significant Limited Intellectual Capacity Disability 1030
    1031 - Determination of Significant Identifiable Emotional Disability 1031
    Also see:
  • SIED Eligibility Guidelines
  • SIED Worksheet (Word doc) (PDF)

    • 1032 - Determination of Perceptual or Communicative Disability 1032
    1033 - Determination of Hearing Disability 1033
    1034 - Determination of Vision Disability 1034
    1035 - Determination of Speech / Language Disability 1035
    1036 - Determination of Preschool Disability 1036
    1037 - Determination of Physical Disability 1037
    1038 - Determination of Multiple Disabilities 1038
    1047 - Special Education Assessment/Staffing Report (revised 8/10/00)  
    1049 - Extended School Year (ESY) Data Collection Form 1049
    1050 - Special Education Extended School Year Service Plan 1050
    1075 - Short-term school-based social/emotional services 1075
    1099 - Parental Consent for Initial Placement 1099
    Antecedent/Behavior/Consequence Form (ABC) PDF
    Frequency Recording Form PDF
    Scatter Plot Data Sheet PDF
    Behavior Support Plan Form Word
    Functional Behavioral Assessment Interview PDF
    Functional Assessment Observation Form PDF
    Ecological Analysis of Settings PDF

    Translated Forms

    For the most current Spanish translated documents, please call or email Susana Telleri-Wanken @ 303.982.6893 or stelleri@jeffco.k12.co.us.

    For the most current Russian translated documents, please call or email Anna Ellison @ 303.982.8271 or aellison@jeffco.k12.co.us.

    Many of these forms, especially those that deal with parent communication, have been translated into different languages. Please see the Translations Services link under Grants and Entitlement Programs |  Multicultural Student Services on the Jeffco homepage to see which documents are currently available.

    Exceptional Student Services | 1829 Denver West Drive | Golden, CO 80401
    Phone: 303-982-6698  |  Fax: 303-982-6653
     Jefferson County, Colorado