IEP 4 (Student Services)
Last Name First Name Meeting Date

Teacher* Teacher*
  If the teacher is not listed in the pop-up, try entering the name or code here:
Provider type (*infants/mental health svcs.) Provider type (*infants/mental health svcs.)

Individual/Group Individual/Group
School* School*
  If the school is not listed in the pop-up, try entering the school name or code here:
Location type* Location type*

Service* Service*
Personnel/responsible agency Personnel/responsible agency
Auxiliary service location Auxiliary service location
Primary service Primary service
Report to CASEMIS
Extended school year Extended school year
Regional program Regional program
Start date* Start date*
End (evaluation) date End (evaluation) date
Frequency code (*infants/mental health svcs.) Frequency code (*infants/mental health svcs.)
Duration Duration
Minutes per session Minutes per session
Sessions per week Sessions per week
Frequency (other) Frequency (other)

LEA district LEA district

Drop date Drop date
Primary drop reason Primary drop reason
Non-primary drop code-reason Non-primary drop code-reason (non-primary service only)
For information only:
Drop date
Primary drop reason - Non-primary drop reason -

*Required items