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:  
  Conduct a Functional Behavioral Assessment  
 
  Review the current Behavior Plan  
 
  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