Manifestation Determination Local Forms - UCPS - Exceptional ...
Manifestation Determination Local Forms - UCPS - Exceptional ...
Manifestation Determination Local Forms - UCPS - Exceptional ...
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Programs for <strong>Exceptional</strong> Children<br />
Union County Public Schools<br />
Monroe, North Carolina<br />
Page 2 of 2<br />
MANIFESTATION DETERMINATION WORKSHEET<br />
5. Was the student told about and explained the consequences of the school policy regarding the conduct being considered?<br />
( ) Yes ( ) No<br />
Explain:<br />
E. 1. Is the conduct being considered caused by or have a direct and substantial relationship to the disability?<br />
( ) Yes ( ) No<br />
2. Was the conduct a direct result of the LEA’s failure to implement the IEP. If yes, explain.<br />
( ) Yes ( ) No<br />
* If E1 or E2 are “yes”, the team must determine that the conduct was a manifestation of the disability.<br />
OTHER INFORMATION THAT WILL BE CONSIDERED BY THE TEAM (ex. info from parent):<br />
____________________________________________________________________________________________________________<br />
____________________________________________________________________________________________________________<br />
Based on the above factors, is the conduct being considered a manifestation (or related to) the child’s disability?<br />
NO. The student may be disciplined using procedures applicable to nondisabled students (except that under the IDEA,<br />
educational services may not cease). Parents shall be informed of their procedural safeguards. A new functional behavioral<br />
assessment and behavioral support plan should be completed or existing one(s) revised.<br />
YES. Reevaluate the student’s IEP for appropriateness, including the current placement. A new functional behavioral<br />
assessment and behavioral support plan should be completed or existing one(s) revised. The student may not be removed.<br />
Committee Signatures Position Date<br />
LEA Representative<br />
Regular Education Teacher<br />
Special Education Teacher<br />
Parent<br />
____________________________________________________________________________________________________________<br />
____________________________________________________________________________________________________________<br />
____________________________________________________________________________________________________________<br />
White copy – School Yellow Copy – EC Office Pink Copy – Parent<br />
09/05/08
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