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Home > Data Center > Reporting Forms > Special Services State & Federal Programs- Program Review


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


As Required

15th of each month

Report of Services to Students with Disabilities Parts I & II EF-S-05 Login Page


Request for Subsidy Allocation of Tuition & Board for Students with Disabilities MEDMS/EF-S-07



Local Entitlement Application -- Special Education EF-S-08


Annual Financial Report of Federal Program Expenditures -Education of Handicapped - IDEA Local Entitlement EF-S-09E


Year-End Report of Special Purpose Private Schools (CARES)  EF-S-10


EPS High Cost Out-of-District Placement Adjustment EF-S-214 in XLS

FY 12 EF-S-214 Instructions   Word



Denise Towers or Nancy Connolly

Tel:  207-624-6655      Fax:  624-6683



Also available in Arabic, French, Khmer, Mandarin, Somali, Spanish and Vietnamese

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


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


Cindy Brown

Tel:  207-624-6660      Fax:  207-624-6661


Speech Severity Matrix and Supporting Documents

Also available in Arabic,French, Khmer, Mandarin, Somali and Spanish and Vietnamese

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)  



Teacher Input -

  • Articulation (Model Form) (MS Word)
  • Functional Communication (Model Form) (MS Word)
  • Language  (Model Form) (MS Word)



(for local use only)