Clear Form
SPECIAL EDUCATION AND RELATED SERVICES REQUIRED FOR STUDENTS WITH DISABILITIES ASSIGNED TO
INDOOR SUSPENSION (SCSI)
Student:______________________________ SCSI (date/s)____________________________
Assigned Teachers/Therapists:_______________________________________________________
The following information must be completed by all teachers and therapists assigned to this student. Return required
work assignments to (designated LEA administrator) ____________________________ by
________________________________________.
Impact of SCSI Suspension on Curriculum Mastery or IEP Goal Mastery
This indoor suspension will result in adverse effects on mastery of content material or the mastery of IEP goals by the
end of the grading period.
_____yes
_____no
During this indoor suspension, the student will miss (check all that applies):
_____study for test _____collaborative project work _____independent work _____test or quiz
_____new concept introduction _____class discussion _____other (please specify)_________________
Work to be Completed during SCSI Suspension
During this indoor suspension, there are assignments to be completed to ameliorate the adverse effects of this absence
from school.
_____yes
_____no
Assignments to be completed during indoor suspension:
_____________________________________________________________________________________
Make‐Up to be Completed upon Return
Action plan for completion of class work or make up for any missing activity listed above which will not be possible to
complete during the indoor suspension days.
_____________________________________________________________________________________
Related Services Required to Progress in the General Education Curriculum and/or Progress toward Meeting IEP Goals
during Suspension
_____Counseling _____Speech/Language _____OT/PT _____Other
Date/Time Scheduled: _______
Teacher/Therapist Signature_________________________________Class/Period:________Date:_____
Assignments Attached_____
No Work is Necessary_____
State and federal law requires that students with disabilities who have been assigned indoor suspension are given
the opportunity to progress in the general education curriculum and progress toward meeting their IEP goals;
otherwise it is counted as an outdoor suspension. Each teacher must determine the extent of special education and
related services necessary to meet this requirement.
FM-7429 (09-10)