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COMPREHENSIVE REVIEW INTAKE FORM

Please complete the information below and upload any records you would like reviewed. The more information and documentation you provide, the more detailed and comprehensive your review can be.

SECTION 1: STUDENT INFORMATION

Student Name

Age

Date of Birth

Grade

School District

Disability Classification

Upcoming Meeting Date

Type of Meeting

SECTION 2: PARENT / GUARDIAN INFORMATION

Parent / Guardian Name

Relationship to Student

Email Address

Phone Number

SECTION 3: WHY ARE YOU REQUESTING THIS REVIEW?

Please describe the main concerns that led you to request this review.

There is no need to use special education terminology. Simply explain your concerns in your own words.

SECTION 4: WHAT HAS HAPPENED SO FAR?

Please provide a brief timeline or summary of important events, concerns, incidents, evaluations, communication issues, disciplinary actions, service concerns, safety concerns, or other issues you believe are important.

This does not need to be perfect. Include as much information as you feel is relevant.

SECTION 5: WHAT ARE YOUR BIGGEST CONCERNS RIGHT NOW?

Examples may include:
• Safety
• Bullying
• Academic progress
• Services and supports
• Communication
• Behavior
• Transition planning
• Graduation
• Placement
• Adult services
• Transportation
Please describe your concerns in your own words.

SECTION 6: WHAT OUTCOME ARE YOU HOPING FOR?

Examples may include:
• Additional services
• Better communication
• More support
• Different placement
• Safety planning
• Additional evaluations
• Improved transition planning
• Better transition planning
• Independent Educational Evaluation (IEE)
Please describe what you would like to see happen.

SECTION 7: TOP PRIORITY CONCERNS

Please list your most important concerns.

Concern #1

Concern #2

Concern #3

Concern #4

Concern #5

SECTION 8: RECORDS FOR REVIEW

Please upload any records you would like reviewed. Examples may include:
• Current IEP • Draft IEP • Prior IEPs • Evaluations • Re-evaluations • Progress Reports • Related Service Reports • Incident Reports • School Emails • Meeting Notes • Behavior Plans • Functional Behavioral Assessments (FBA) • Behavior Intervention Plans (BIP) • DASA Complaints • Discipline Records • Other Relevant Documents

SECTION 9: ADDITIONAL INFORMATION (OPTIONAL)

Is there anything else you would like us to know?

SECTION 10: ACKNOWLEDGMENT

I understand that this review is provided for educational and informational purposes only. It is not legal, medical, psychological, or therapeutic advice, does not create an attorney-client relationship, and does not determine whether a school district has violated federal, state, or local law.

I understand that any observations, recommendations, or comments provided are professional educational opinions intended to help me better understand my child's educational records and prepare for discussions with my child's educational team.

I understand that I am voluntarily submitting my child's educational records for review. While reasonable efforts are made to protect submitted information, no method of electronic transmission or storage can be guaranteed to be completely secure.

Acknowledgment