Iep Revision Form - South Bend Community School Corporation Special Education Department Page 5
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13South Bend Community School Corporation
Special Education Department
IEP Revision
Student: ______________________________ STN: ______________________ Revise IEP of ____________________
Effective Dates:
Begin date: _____________________________ End date: __________________________________
FOR MDC Conference:
Date of Incident: ____________________________
Describe the alleged misconduct and the action taken as a result of this misconduct:
Was the conduct in question caused by, or had a direct and substantial relationship to the student's disability?
Yes -
The conduct in question was caused by, or had a direct and substantial relationship to the student's disability.
No -
The conduct in question was not caused by, or had a direct and substantial relationship to the student's disability.
Was the behavior in question the direct result of the public agency’s failure to implement the student’s Individualized
Educational Program?
Yes –The conduct in question
has been determined to be the direct result of the public agency's failure to implement the
student’s individualized education program.
Describe the deficiencies in implementing the student's individual education program and the immediate steps that
the public agency will take to remedy these deficiencies
No -The conduct in question has been determined not to be the direct result of the public agency’s failure to
implement the student’s individual educational Program.
The conduct ____has ____has not been determined to be a manifestation of the student’s disability. If not, then
disciplinary procedures apply to the student, and the student will continue to receive appropriate services.
Additional findings regarding manifestation determination:
This form is only to be used when an IEP has been finalized for future dates, and a revision is required for the currently
valid IEP. It is not to be used when there are questions of eligibility or state assessment.
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