Follow the steps to successfully complete the form

1. Click the 'Get Form' button to obtain the form and open it in your preferred editor.
2. Begin by entering the claimant's name. If the document allows, attach a label with this information.
3. Provide the name of the school associated with the child's records in the designated field.
4. Respond to the first question regarding any recent evaluations or testing of the child. If applicable, specify the types of tests or evaluations and include the corresponding dates.
5. For the second question, indicate if the child has been referred for an assessment team evaluation or placement services. Provide the details of whom the child was referred to and the relevant dates.
6. Fill out the current instructional levels by providing standardized assessment instruments and their scores or percentile ranks for reading, math, and written language.
7. In the next section, note any grades that the child has repeated by checking the appropriate boxes.
8. Identify any educational disabilities which apply by checking the relevant boxes.
9. Detail the placement and related services, checking all applicable options and noting any hours per week for special education services.
10. Use the additional comments section to continue answers from page one or to provide any further relevant information.
11. Finally, provide your name, title, date, and phone number in the designated fields, as well as those of anyone else who assisted in completing the form.
12. Once all sections are completed, save your changes, and then download, print, or share the form as needed.

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