SPECIAL SERVICES STATE / FEDERAL PROGRAMS

Form Name	Due Date
Request for Tuition Placement of Students with Disabilities EF-S-01	As Required
Request for Special Education Contract Approval EF-S-03 in (MS Word) Instructions (MS Word)	15-Oct or As Required
State Agency Client Request for Reimbursement Report EF-S -04A-B Instructions Regulations and Statutes Recorded Webinar	As Required 15th of each month
Report of Services to Students with Disabilities Parts I & II EF-S-05 Login Page	31-Dec
Request for Subsidy Allocation of Tuition & Board for Students with Disabilities MEDMS/EF-S-07	17-Sept
Local Entitlement Application -- Special Education EF-S-08	15-Sept
Annual Financial Report of Federal Program Expenditures -Education of Handicapped - IDEA Local Entitlement EF-S-09E	1-Sept
Year-End Report of Special Purpose Private Schools (CARES) EF-S-10	31-Aug
EPS High Cost Out-of-District Placement Adjustment EF-S-214 in XLS FY 12 EF-S-214 Instructions Word	16-Apr
*Contacts:* Denise Towers or Nancy Connolly Tel: 207-624-6655 Fax: 624-6683

SCHOOL FORMS

Form Name	August 1, 2012 New DOE Logo
Advance Written Notice of I.E.P./I.F.S.P. Team Meeting MS Word	(for local use only)
Determination of Adverse Effect on Educational Performance MS Word	(for local use only)
Parental Consent for Evaluation MS Word	(for local use only)

Individualized Education Program (IEP) IEP form (MS Word) IEP with Guidance and Exemplars (MS Word) IEP Guidance Document (MS Word) IEP Additional Goals	(for local use only)
Written Notice (MS Word)	(for local use only)
Documentation for Excusal of IEP Team Member Whose Curriculum Area IS Being Discussed in (MS Word)	(for local use only)
Documentation of Agreement of Non-Attendance for IEP Team Member Whose Curriculum Area IS NOT Being Discussed (MS Word)	(for local use only)
Learning Disability Evaluation Report (MS Word)	(for local use only)
Summary of Performance (MS Word) Sample 1: (MS Word) Sample 2:(MS Word)

*Contact:* Susan Parks Tel: 207-624-6644 Fax: 207-624-6641
Form Name	Date
Individualized Family Service Plan (Part C IFSP) in RTF or MS Word (Sample IFSP is being developed and will be placed on the website when it is completed.)	As Required
Contact: Cindy Brown Tel: 207-624-6660 Fax: 207-624-6661

Form Name	August 1, 2012 New DOE logo
Severity Rating Scales/Guidelines for Speech/Language Communications Services (MS Word)
Speech/Language Eligility Criteria (MS Word)
MODEL FORMS: Teacher Input - Articulation (Model Form) (MS Word) Fluency (Model Form) (MS Word) Functional Communication (Model Form) (MS Word) Language (Model Form) (MS Word) Voice (Model Form) (MS Word)	(for local use only)