Iep Revision Form - South Bend Community School Corporation Special Education Department Page 9

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South Bend Community School Corporation
Special Education Department
IEP Revision
Student: ______________________________ STN: ______________________ Revise IEP of ____________________
Effective Dates:
Begin date: _____________________________ End date: __________________________________
Provisions
Services and other Provisions:
Special Education Services
Description
Initiation
Frequency
Length
Duration
Location
To Support
(date)
(time)
(date)
Related Services
Description
Initiation
Frequency
Length
Duration
Location
To Support
(date)
(time)
(date)
Transportation:
If the student’s transit time or needs are different from that of non-disabled peers, please describe and justify these needs.
Please, record as a related service if additional provisions are necessary.
Additional Accommodations
Rationale for changes made
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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