FORM 25A MANIFESTATION
DETERMINATION
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 cannot 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(s)/guardian/surrogate/adult
student agreed with the findings
[Excerpted from the State SELPA IEP Manual, July, 2013]