ESE / Student Services
Attendance Forms
-
Educational Planning Team Recommendation--Attendance Intervention--STU-819-007
STU-819-007 - Educational Planning Team Recommendation Form--Attendance Intervention.pdf 159.63 KB (Last Modified on October 2, 2018) -
Notice for Child to Attend School - STU-2223-011
This is the Spanish version of the Skyward "Notice for Child to Attend School" form.
STU-2223-011 - Notice for Child to Attend School in Espanol.pdf 93.73 KB (Last Modified on January 9, 2023) -
Parent-Guardian Contact Log - by Attendance Officer - STU-2223-004 (Word).pdf
STU-2223-004 - Parent-Guardian Contact Log - by Attendance Officer-WORD.docx 25.69 KB (Last Modified on September 8, 2022) -
Parent-Guardian Contact Log - By School - STU-2223-005 (Word)
STU-2223-005 - Parent-Guardian Contact Log - By School-WORD.docx 24.27 KB (Last Modified on September 8, 2022) -
Truancy Affidavit for Parental Prosecution (Elem)-STU-819-009.pdf
STU-819-009 - Truancy Affidavit for Parental Prosecution - Elementary.pdf 271.4 KB (Last Modified on April 18, 2023) -
Truancy Intervention Documentation (Middle-High)--STU-819-010.pdf
STU-819-010 - Truancy Intervention Documentation Middle-High.pdf 243.74 KB (Last Modified on April 21, 2023)
Discipline Forms
-
Alternative Learning Center Referral Form - STU-718-010.pdf
STU-718-010 - Alternative Learning Center Referral Form.pdf 165.94 KB (Last Modified on October 29, 2021) -
Bullying Complaint Report Form - Spanish - STU-920-016.pdf
Spanish Version
STU-920-016 - Bullying Complaint Report Form - Spanish.pdf 172.33 KB (Last Modified on March 30, 2023) -
Character Counts Center - Admission Checklist--STU-2223-002.pdf
STU-2223-002 - Character Counts Admission Checklist.pdf 305.43 KB (Last Modified on Wednesday at 8:56 AM) -
Law Enforcement Notification of Student Arrest - STU-819-012.pdf
STU-819-012 - Law Enforcement Notification of Student Arrest.pdf 81.3 KB (Last Modified on October 2, 2018) -
Suspension Reduction Alternative/Application Form--STU-920-006.pdf
STU-920-006 - Suspension Reduction Alternative-Application Form.pdf 84.46 KB (Last Modified on July 2, 2019)
Driving Privilege-Related Forms & Links
ESE Eligibility
-
Documentation of Staffing/Notice of Eligibility--ESE-920-010.pdf
ESE-920-010 - Documentation of Staffing - Notice of Eligibility.pdf 357.68 KB (Last Modified on August 11, 2023) -
Information for Parents on Funding Levels at Initial ESE Placement, ESE-819-009
ESE-819-009 - Information for Parents on Funding Levels at Initial ESE Placement.pdf 226.59 KB (Last Modified on December 8, 2022) -
Informed Notice and Consent for Initial Placement - ESE-819-003.pdf
ESE-819-003 - Informed Notice and Consent for Initial Placement.pdf 316.94 KB (Last Modified on August 21, 2019) -
Informed Notice and Consent for Initial Placement - Pre-Kindergarten--ESE-920-014.pdf
ESE-920-014 - Informed Notice and Consent for Initial Placement - Pre-K.pdf 317.44 KB (Last Modified on August 23, 2019) -
Informed Notice of Ineligibility - Pre-K - ESE-920-016.pdf
ESE-920-016 - Informed Notice of Ineligibility - Pre-K.pdf 289.74 KB (Last Modified on September 9, 2019) -
Informed Notice/Change of Placement or Dismissal--ESE-920-012.pdf
ESE-920-012 - Informed Notice-Change of Placement or Dismissal.pdf 355.28 KB (Last Modified on February 27, 2020) -
Multidisciplinary Evaluation Team Written Report for SLD and LI-ESE-920-008
ESE-920-008 - Multidisciplinary Evaluation Team Written Report for SLD and LI A.pdf 469.07 KB (Last Modified on December 6, 2019) -
Multidisciplinary Team Report/Students w-Intellectual Disabilities--ESE-920-002
ESE-920-002 - Multidisciplinary Team Report-Students w Intell Disabilities A.pdf 300.24 KB (Last Modified on January 29, 2020)
ESE Evaluation/Re-Evaluation
-
Informed Notice and Consent for Initial Evaluation--ESE-021-001.pdf
ESE-021-001 - Informed Notice and Consent for Initial Evaluation.pdf 179.46 KB (Last Modified on April 28, 2020) -
Informed Notice and Consent for Re-Evaluation--ESE-920-011.pdf
ESE-920-011 - Informed Notice and Consent for Re-evaluation.pdf 239.32 KB (Last Modified on January 31, 2023) -
Pragmatic Language Evaluation Report--ESE-819-010.pdf
ESE-819-010 - Pragmatic Language Evaluation Report.pdf 265.33 KB (Last Modified on October 30, 2018) -
Referral Checklist for Re-Evaluation (Change-Add Program) ESE-718-003.pdf
ESE-718-003 - Referral Checklist for Re-Evaluation - Change-Add Program.pdf 423.4 KB (Last Modified on March 2, 2022) -
Referral Checklist for Reevaluation--Current Program Only - ESE-718-004.pdf
ESE-718-004 - Referral Checklist for Re-Evaluation--Current Program Only.pdf 298.34 KB (Last Modified on February 24, 2022)
ESE Forms - General
-
Admission Checklist Supplement for ESE Students
ESE-819-018 - Horizon Center Admission Checklist Supplement for ESE Students.pdf 177.13 KB (Last Modified on September 16, 2022) -
Curriculum-Based Vocational Assessment (CBVA) Rating Form--ESE-819-015.pdf
ESE-819-015 - Curriculum-Based Vocational Assessment CBVA Rating Form.pdf 154.76 KB (Last Modified on October 30, 2018) -
Guidelines for Consideration of Paraprofessional Support Services - ESE-819-001.pdf
ESE-810-001 - Guidelines for Consideration of Paraprofessional Support Services.pdf 615.56 KB (Last Modified on October 7, 2020) -
Interagency Release of Information-Records--ESE-920-015.pdf
ESE-920-015 - Interagency Release of Information-Records.pdf 184.45 KB (Last Modified on August 30, 2022) -
Parental Consent for Medicaid Reimbursement - ESE-021-003
ESE-021-003 - Parental Consent for Medicaid Reimbursement.pdf 186.35 KB (Last Modified on October 6, 2020) -
Parental Consent for Medicaid Reimbursement - Espanol - ESE-021-003
ESE-021-003 - Parental Consent for Medicaid Reimbursement-Espanol.pdf 154.56 KB (Last Modified on October 1, 2021) -
Procedures for Collaboration of Public Private Instructional Personnel ESE-920-017
ESE-920-017 - Procedures for Collaboation of Public Private Personnel Agreement.pdf 250.61 KB (Last Modified on September 9, 2019) -
Transfer of Rights at Age of Majority-Description of Rights 17 - ESE-920-019.pdf
ESE-920-019 - Transfer of Rigths at Age of Majority-Descirption of Rights 17.pdf 189.24 KB (Last Modified on February 2, 2021) -
Transfer of Rights at Age of Majority-Parent Notification 18 - ESE-920-018.pdf
ESE-920-018 - Transfer of Rights at Age of Majority-Parent Notification 18 A.pdf 172.71 KB (Last Modified on November 6, 2019) -
Transfer of Rights at Age of Majority-Student Notification 18 - ESE-920-020.pdf
ESE-920-020 - Transfer of Rights at Age of Majority-Student Notification 18 A.pdf 153.24 KB (Last Modified on November 6, 2019) -
Waiver of State Standardized Assessment--ESE-021-002.pdf
ESE-021-002 - Waiver of State Standardized Assessment.pdf 262.93 KB (Last Modified on April 28, 2020)
ESE Hospital Homebound
-
Homebound/Hospital Status of Exit or Withdrawal--ESE-920--007.pdf
ESE-920-007 - Homebound-Hospital Status of Exit or Withdrawal.pdf 146.09 KB (Last Modified on August 6, 2019) -
Physician's Report for Re-entry of Student to School--ESE-819-026.pdf
ESE-819-026 - Physicians Report for Re-entry of Student to School.pdf 26.64 KB (Last Modified on November 14, 2018) -
Student-Parent Agreement for Hospital Homebound Services - ESE-718-010.pdf
ESE-718-010---Student-Parent-Agreement-for-Hospital-Homebound-Services.pdf 132.728 KB (Last Modified on March 16, 2018)
ESE Transition / CBVE
-
Transition Assessment (Ages 11-13) Form A - ESE-2324-004
ESE-2324-004 - Transition Assessment--Ages 11-13--Form A.pdf 188.73 KB (Last Modified on July 7, 2023) -
Transition Assessment (Ages 11-13) Form B - ESE-2324-005
ESE-2324-005 - Transition Assessment--Ages 11-13--Form B.pdf 174.02 KB (Last Modified on July 7, 2023) -
Transition Assessment (Ages 11-13) Form C - ESE-2324-006
ESE-2324-006 - Transition Assessment--Ages 11-13--Form C.pdf 135.75 KB (Last Modified on July 7, 2023) -
Transition Assessment (Ages 14-16) Form A - ESE-2324-007
ESE-2324-007 - Transition Assessment--Ages 14-16--Form A.pdf 162.94 KB (Last Modified on July 7, 2023) -
Transition Assessment (Ages 14-16) Form B - ESE-2324-008
ESE-2324-008 - Transition Assessment--Ages 14-16--Form B.pdf 137.35 KB (Last Modified on July 7, 2023) -
Transition Assessment (Ages 14-16) Form C - ESE-2324-009
ESE-2324-009 - Transition Assessment--Ages 14-16--Form C.pdf 187.84 KB (Last Modified on July 7, 2023) -
Transition Assessment (Ages 16+) Form A - ESE-2324-010
ESE-2324-010 - Transition Assessment--Ages 16 Plus--Form A.pdf 139 KB (Last Modified on July 7, 2023) -
Transition Assessment (Ages 16+) Form B - ESE-2324-011
ESE-2324-011 - Transition Assessment--Ages 16 Plus--Form B.pdf 140.08 KB (Last Modified on July 7, 2023) -
Transition Assessment (Ages 16+) Form C - ESE-2324-012
ESE-2324-012 - Transition Assessment--Ages 16 Plus--Form C.pdf 157.15 KB (Last Modified on July 7, 2023)
Gifted EP
-
Gifted Consultation-Support Facilitation--ESE-819-006.pdf
ESE-819-006 - Gifted Consultation-Support Facilitation.pdf 125.51 KB (Last Modified on August 27, 2020)
Gifted Referral Forms
-
Checklist of Gifted Characteristics--ESE-819-005.pdf
ESE-819-005 - Checklist of Gifted Characteristics A.pdf 106.7 KB (Last Modified on December 6, 2019) -
Gifted Pre-Referral Data Summary Sheet--ESE-819-008.pdf
ESE-819-008 - Gifted Pre-Referral Data Summary Sheet.pdf 121.48 KB (Last Modified on October 23, 2018) -
Invitation to Educational Planning Conference - Gifted - ESE-819-002.pdf
ESE-819-002 - Invitation to Educational Planning Conference - Gifted.pdf 155.72 KB (Last Modified on September 11, 2018) -
Parent Consent for Gifted Program Screening and Pre-Referral--STU-819-016.pdf
STU-819-016 - Parent Consent for Gifted Program Screening and Pre-Referral.pdf 41.23 KB (Last Modified on October 5, 2018) -
Plan B Gifted Eligibility Determination Form - ESE-920-001.pdf
ESE-920-001 - Plan B Gifted Eligibility Determination Form.pdf 242.56 KB (Last Modified on July 16, 2019) -
Plan B Student Nomination and Environmental Indicator--STU-819-015.pdf
STU-819-015 - Plan B Student Nomination and Environmental Indicator Form.pdf 59.75 KB (Last Modified on October 5, 2018) -
Screening Checklist of Student Characteristics--ESE-819-004.pdf
ESE-819-004 - Screening Checklist of Student Characteristics.pdf 284.57 KB (Last Modified on September 21, 2018)
McKay Scholarship
-
Letter of Intent to Participate in McKay Scholarship, ESE-122-002.pdf
ESE-122-002 - Letter of Intent to Participate in McKay Scholarship.pdf 320.49 KB (Last Modified on August 9, 2021)
Pre-Referral Forms
-
Educational Planning Team Recommendation Form--STU-819-024.pdf
STU-819-024 - Educational Planning Team Recommendaton Form.pdf 165.32 KB (Last Modified on October 10, 2018) -
Functional Behavioral Assessment-FBA--STU-819-002.pdf
STU-819-002 - Functional Behavior Assessment - FBA.pdf 412.22 KB (Last Modified on February 13, 2020) -
Hours of Academic Intervention Worksheet--STU-819-023.pdf
STU-819-023 - Hours of Academic Intervention Worksheet.pdf 118.66 KB (Last Modified on October 10, 2018) -
Monitoring Problem and Replacement Behavior Observation Form 2 - STU-819-022.pdf
STU-819-022 - Monitoring Problem and Replacement Behavior Observation Form--Form 2.pdf 90.86 KB (Last Modified on October 24, 2018) -
Monitoring Problem and Replacement Behavior Observation Form-1--STU-819-021.pdf
STU-819-021 - Monitoring Problem and Replacement Behavior Observation Form--Form 1.pdf 47.16 KB (Last Modified on October 9, 2018) -
Parent Notice of Educational Planning Team Meeting - STU-122-005.pdf
STU-122-005 - Parent Notice of Educational Planning Team Meeting.pdf 106.23 KB (Last Modified on April 6, 2021) -
Pre-K Educational Planning Team Screening Record--STU-819-020.pdf
STU-819-020 - Pre-K Educational Planning Team Screening Record.pdf 89.7 KB (Last Modified on October 9, 2018) -
Private and Home School Educational Screening Record - ESE-2324-003
ESE-2324-003 - Private and Home School Educational Screening Record.pdf 182.18 KB (Last Modified on March 29, 2023) -
Referral Checklist for Initial Speech Evaluation - ESE-819-028.pdf
ESE-819-028 - Referral Checklist for Initial Speech Evaluation.pdf 89.09 KB (Last Modified on February 24, 2022) -
Referral Checklist for New Evaluation (Disabilities) - STU-819-017.pdf
STU-819-017 - Referral Checklist for New Evaluation - Disabilities.pdf 359.2 KB (Last Modified on September 1, 2022)
Section 504 Forms
-
Manifestation Determination Form - Section 504--STU-819-027.pdf
STU-819-027 - Manifestation Determination Form - Section 504.pdf 35.2 KB (Last Modified on October 10, 2018) -
Notice and Consent for Initial Section 504 Evaluation - STU-021-001.pdf
STU-021-001 - Notice and Consent for Initial Section 504 Evaluation.pdf 162.07 KB (Last Modified on November 19, 2021) -
Notice to Parent: Rights Afforded by Section 504 of the Rehabilitation Act of 1973-STU-122-006.pdf
STU-122-006 - Page Two Only-Rights Afforded by Section 504 Committee Meeting.pdf 164.07 KB (Last Modified on February 23, 2023) -
Parent Notice of Section 504 Committee Meeting--STU-122-006.pdf
STU-122-006 - Parent Notice of Section 504 Committee Meeting.pdf 256.21 KB (Last Modified on February 23, 2023)
Student Records Forms
-
Educational Records Disclosure/Request Log--STU-819-028.pdf
STU-819-028 - Educational Records Disclosure-Request Log.pdf 220.46 KB (Last Modified on October 10, 2018) -
Notarized Affidavit of Birth Information--STU-920-005.pdf
STU-920-005 - Notarized Affidavit of Birth Information.pdf 164.57 KB (Last Modified on July 2, 2019) -
Release of Student Information Between Agencies - STU-021-012.pdf
STU-021-012 - Release of Student Information Between Agencies.pdf 194.37 KB (Last Modified on July 15, 2021) -
Release of Student Education Record Form to ACPS - STU-819-030.pdf
STU-819-030 - Release of Student Education Record Form to Alachua County.pdf 185.66 KB (Last Modified on February 3, 2021)
Student Services Forms - General
-
ACCEL 18 Credit Standard Diploma Option Agreement--STU-819-032.pdf
STU-819-032 - ACCEL 18 Credit Standard Diploma Option Agreement.pdf 35.67 KB (Last Modified on October 11, 2018) -
Assurance to Parents of Rights for Parental Input at Meetings--STU-819-033.pdf
STU-819-033 - Assurance to Parents of Rights for Parental Input at Meetings.pdf 52.13 KB (Last Modified on October 11, 2018) -
Community Service Registration--Volunteer Service Record, STU-920-017
STU-920-017 - Community Service Registration--Volunteer Service Record.pdf 230.27 KB (Last Modified on January 10, 2023) -
Early Warning System Educational Planning Team Recommendation-STU-920-011.pdf
STU-920-011 - Early Warning System Educational Planning Team Recommendation.pdf 285.51 KB (Last Modified on July 10, 2019) -
Industry Certification Substitution Consent Form - STU-920-010.pdf
STU-920-010 - Industry Certification Substitution Consent Form.pdf 149.7 KB (Last Modified on July 10, 2019) -
McKinney-Vento Residency Questionnaire - STU-2223-009.pdf
STU-2223-009 - McKinney-Vento Residency Questionnaire.pdf 253.34 KB (Last Modified on October 12, 2022) -
McKinney-Vento Residency Questionnaire -- Español - STU-2223-009
STU-2223-009 - McKinney-Vento Residency Questionnaire -- Spanish.pdf 287.24 KB (Last Modified on October 12, 2022) -
Mental Health Interventions Referral Form - STU-819-039.pdf
STU-819-039 - Mental Health Interventions Referral form.pdf 71.37 KB (Last Modified on December 10, 2018) -
Notice of Intent to Withdraw from Traditional School - STU-819-005.pdf
STU-819-005 - Notice of Intent to Withdraw from Traditional School.pdf 154.55 KB (Last Modified on October 31, 2019) -
Paid Work Guidelines & Work Hours Log - STU-2223-010
STU-2223-010 - Paid Work Guidelines and Work Hours Log.pdf 247.35 KB (Last Modified on September 15, 2023) -
Referral for Mental Health Counseling Services Form - STU-920-002.pdf
STU-920-002 - Referral for Mental Health Counseling Services Form.pdf 252.65 KB (Last Modified on May 19, 2022)
Student Service/ESE Form Links
Suicide Prevention Forms
-
Columbia-Suicide Severity Rating Scale (C-SSRS) - STU-2223-001
STU-2223-001 Columbia-Suicide Severity Rating Scale.pdf 326.61 KB (Last Modified on September 26, 2022)
TAP (Teenage Parenting)
TAP (Teenage Parenting) Form Links
Title IX
-
Formal Complaint of Sexual Misconduct - Title IX - STU-021-009.pdf
STU-021-009 - Formal Complaint of Sexual Misconduct - Title IX.pdf 134.88 KB (Last Modified on November 4, 2020) -
Title IX Report of Sexual Misconduct - STU-718-001.pdf
STU-718-001 - Title IX Report of Sexual Misconduct.pdf 386.55 KB (Last Modified on November 4, 2020)