Mr. Jay Lebrun, Superintendent
49 Broad St., Plattsburgh, NY 12901

District Special Education Office

Teacher Forms

The following forms are in PDF format. Please print out and complete.

1:1 Aide & Worksheet

Abilities and Needs Matrix

Assistive Technology Justification

Assistive Technology - Procedures for Borrowing Resources

Assistive Technology Referral

Authorization to Release Information

Chapter 408 Staff Agreement

Chapter 408 Service Provider Sign Off

Criteria for 1:1 Aide (web page)

DFC Monthly Report

Health Form

Manifestation Determination

Notice of Receipt of Referral and Parent Consent for Assessment

Occupational and Physical Therapy Referral

OT and PT Level Procedures

OT and PT Screening Request

Placement Protocol - Building to Building

Policy on Withdrawal of Referrals

Recommendations Upon Declassification (web page)

Referral Form (please read attached memo prior to completing a CSE referral)

Referral for Speech Evaluation

Request for Change in IEP Meeting

Request for Due Proceedings

Request to Special Ed Office for Records

Requisition Form

Revocation of Consent for Special Education

Screening Profile

Social History