Carlton - Does NOT Qualify for ECSE

Carlton - Does NOT Qualify for ECSE

Carlton staff only - Fill out this form for EC students who are evaluated but is determined not to receive services at this time. The evaluation hours are still reportable. OR if a MARSS # was given but there are no evaluation hours to report.

Questions in Bold and with an * are required

IEP/IFSP/IIIP Manager Name
 
Your email (if you want a copy of the data submitted sent to you via email):
 
Student First and Last Name*
 
Attending District
 
Resident District
 
Evaluation Start Date
 (mm/dd/yyyy)
 
Evaluation End Date
 (mm/dd/yyyy)
 
Evaluation Hours
 
End Status Code for Special Education










EC evaluation only, child not eligible for services
EC withdrawal by parent
EC transition at age 3, Part B eligible, Exiting Part C
Not eligible for Part B, exiting Part C with referrals
Not eligible for Part B, exiting Part C no referrals



 50 - Change in Sp Ed evaluation status or instructional setting 


 N/A

 

Comments: 

 

 

 



Security Measure