MANIFESTATION DETERMINATION FORM

 

The Manifest Determination form is used to report findings for a Manifest Determination Review each time the Local Education Agency (LEA) / recommends a student in special education (or on a 504 Plan) for expulsion and/or when the student is removed from his/her current educational placement (is suspended for more than 10 consecutive days or suspended for more than 10 days in a school year if the behavior constitutes a pattern).

 

Legal Citations: Title 34 Part CFR §300.530 -300.536; 27 EC 48900; 27 EC 48915

 

·         Part I.  Student Information 

Lines 1 through 6 – fill in information about the student as stated

 

·         Date of the Current IEP is the date of the last agreed upon, signed IEP (by the parent/guardian)

 

·         Date of Last Assessment – List the date of the last three year triennial or complete psycho-educational assessment conducted (it may be an assessment that was conducted as part of the Manifest Determination).

 

·         Disability – State the “primary” disability of the student

 

·         Current Educational Setting – List the current placement (i.e., special class, regular education class, etc.)

 

·         Description of the Behavior – Write a brief statement about the behavior that occurred (it is best to list factual information or investigation findings/outcomes)

 

·         Disciplinary Action Taken and Date – This refers to suspension and the first date of the suspension

 

Part II.  In determining whether the student's behavior was a manifestation of his/her disability, the manifestation determination team considered the following:

 

·         Evaluation and diagnostic results – Check this box if formal assessment results helped the team to make the decision regarding whether or not the behavior was a manifestation of the student’s disability.  List the specific evaluations/dates used).

 

·         Observations – Check this box if student observation data was used to help the team make the decision regarding whether or not the behavior was a manifestation of the student’s disability.  List who observed and when.

 

·         Student's IEP, services, and placement – Check this box if the IEP, services or placement of the student at the time of the behavior incident were used to help the team make the decision regarding whether or not the behavior was a manifestation of the student’s disability.  Describe how used (relevant information from IEP).

 

·         Other relevant information – List any other information that contributed to the decision such as past discipline history of the student, reports from staff, etc.

 

 

Part III. The Manifestation Determination team determined that, in relation to the behavior subject to disciplinary action the following is true:

 

·         Check “yes” if the team feels the behavior was caused by or had a direct or substantial relationship to the disability.  Check no if team feels it did not.

 

·         Check “yes” if the team feels the behavior was the direct result of a failure to implement the IEP (for example, if all the supports and services listed on the IEP were not taking place as outlined as the time of the incident)

 

Part IV.  The Manifestation Determination team decided that the student's behavior (check one of the following two boxes as appropriate based on the boxes check above:

 

·         Check the first box “was a manifestation of his/her disability” if the answer to the two questions above (steps 12 and 13) were “yes” – if this box is check the discipline proceedings may not go forward (in most cases this will mean that the case can not go forward to the Board of Education for to recommend expulsion)

 

·         Check the second box if one of the answer to both of the two questions above was “no.”  This means the behavior was not a manifestation of his/her disability.

 

·         On this line indicate “yes” or “no” to indicate if the parent agreed with the findings.

 

 

[Excerpted from the State SELPA IEP Manual, July 2009. For the 2008-2009 form set.]