School Age Sample Forms

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Related Forms	Form Number	PDF	RTF
Authorized for Release of Information Form (English revised 6/07)	581-1196-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Consent to Disclose Educational Records to Oregon's Medicaid Agency (English revised 4/07)	581-1336-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese

Braille available upon request.

Oregon Standard IEP
The Oregon Standard IEP form, revised to comply with IDEA 2004 and the federal regulations

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Bradley J. Lenhardt (503) 947-5755
Special Education Monitoring, Systems, & Outcomes - Alternate Assessment Specialist

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Form	Form Number	PDF	RTF
Manifestation Determination (English revised 6/07)	581-1279-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Summary of Performance (English revised 6/07)	581-1278-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Agreement Between Parents and the District (English revised 7/07)	581-1281-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Prior Notice of Special Education Action (English revised 6/07)	581-5148y-p	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Prior Notice About Evaluation / Consent for Evaluation (English revised 6/07)	581-5150b-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Prior Notice and Consent for Initial Provision of Special Education Services (English revised 6/07)	581-5148p-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Notice of Team Meeting (English revised 6/07)	581-5148s-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Medical Statement or Health Assessment (English revised 4/12)	581-5149o-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Statement of Eligibility Autism Spectrum Disorder (English revised 6/07)	581-5148l-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Statement of Eligibility Communication (English revised 6/07)	581-5148g-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Statement of Eligibility Emotional Disturbance (English revised 1/12)	581-5148j-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Statement of Eligibility Deafblind (English revised 6/07)	581-5148m-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Statement of Eligibility Hearing Impairment (English revised 6/07)	581-5148f-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Statement of Eligibility Intellectual Disability (Revised 7/11)	581-5148k-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Statement of Eligibility Orthopedic Impairment (English revised 6/07)	581-5148h-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Statement of Eligibility Other Health Impairment (English revised 6/07)	581-5148n-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Statement of Eligibility Specific Learning Disability (Revised 7/11)	581-5148i-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Statement of Eligibility Traumatic Brain Injury (English revised 6/07)	581-5148o-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Statement of Eligibility Vision Impairment (English revised 6/07)	581-5148e-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese
Special Education Placement Determination (English revised 6/07)	581-5138b-P	Chinese English Russian Spanish Vietnamese	Chinese English Russian Spanish Vietnamese