Pre-Expulsion
Individualized Education Program Team Meeting Manifestation Determination

Student , Gender Birthdate
 
School Grade Language:  
 
  Home
 
  Student
 
Parent/Legal Guardian Phone
 
Within 10 school days of any decision to change the placement of a child with a disability because of a violation of a code of student conduct, the LEA, the parent, and relevant members of the IEP team (as determined by the parent and the LEA) shall review all relevant information in the student’s file, including the child’s IEP, any teacher observations, and any relevant information by parents.
 
School Policy Violated
Evidence relating to the Manifestation Determination:
  1. Was the conduct in question caused by or had a direct and substantial relationship to, the child’s disability?
  2. Was the conduct in question a direct result of the local educational agency’s failure to implement the IEP?
If the LEA, the parent, and relevant members of the IEP Team make the determination that the conduct was a manifestation of the child’s disability, the IEP Team shall:
  Check only one item
 
 
  Recommendations for modifications to the Behavior Plan
 
Comments
IEP Team Recommendations

PERSONS WHOSE SIGNATURE APPEAR BELOW AFFIRM THAT THEY PARTICIPATED IN THIS MEETING:
             
 

 
 
 
Administrator/Designee   Parent   Educational Specialist    
 
 

 
 
 
School Psychologist   School Nurse   Regular Classroom Teacher    
 
 

 
 
 
Site Administrator   Special Education Teacher   Student