UPDATES to SE Student Data Card
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Teacher of Record
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Student First Name
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Student Last Name
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LRE Number
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Primary Eligibility
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Secondary Eligibility
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Related Services (Check all that apply)
Audiology
Physical Therapy
Transportation
Interpreting Services
Parent Counseling
Occupational Therapy
Nursing Services
Counseling Services
Orientation and Mobility Services
Other
Date of Conference
MM
/
DD
/
YYYY
Select the Purpose(s) (Check all that apply)
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Initial Evaluation
Initial (First Steps)
Initial following lack of progress in response to interventions
Re-evaluation review
Annual
Move-in
Manifestation determination
Revise IEP
Exit secondary education
Consider placement in an alternative program
Consider placement at a state school
Consider placement at a private facility
Consider Service Plan
Public agency placement with different public agency of service
Interim alternate educational setting
Out-of-school placement -- 60 day review
Revise IEP without meeting
Transition
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Special Comments or Concerns
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