ࡱ> _a`U@ ,bjbj $2 R-222 < HHH\8@,lD\H"!!!YG[G[G[G[G[G[G$JR6MGH!!!!!GHH4GJ"""!jHHYG"!YG""#AHHF `H&!v E`YGGHiE\N!NF\\HHHHNHF!!"!!!!!GG\$"^\Manifestation Determination Student:____________________________________ Date:______________________ School:_____________________________Grade/Program:_____________________ TO DETERMINE WHETHER A BEHAVIOR IS (or IS NOT) A MANIFESTATION OF THE STUDENTS DISABILITY, COMPLETE THE FOLLOWING: 1. DESCRIBE THE VIOLATION OF THE SCHOOL RULES OR CODE OF CONDUCT. 2. IN CARRYING OUT A REVIEW OF THE MISCONDUCT, THE LEA, PARENT AND RELEVANT MEMBERS OF THE IEP TEAM MUST CONSIDER ALL SOURCES OF INFORMATION. i. PLEASE CHECK ALL INFORMATION CONSIDERED: ____ Assessment/evaluation (List any current assessments/evaluations considered) ____ The students IEP ____ Interviews conducted ____ Teacher observations ____ Information provided by the parent ii. PLEASE NOTE ANY RELEVANT COMMENTS OR OBSERVATIONS: 3. THE RELEVENT MEMBERS OF IEP TEAM MUST ANSWER THE FOLLOWING, IN RELATIONSHIP TO THE ABOVE DETAILED BEHAVIOR: (a) Was the conduct in question caused by the childs disability? ___Yes ___ No (b) Did the conduct in question have a direct and substantial relationship to the childs disability? ___Yes ___ No (c) Was the conduct in question the direct result of the schools failure to implement the students IEP? ___Yes ___ No If the LEA, parent and relevant members of the IEP team determine that the IEP was not implemented, list the steps the district will take to remedy the identified deficiencies: IF YES IS CHECKED FOR ANY ONE OF THE ABOVE, THE BEHAVIOR IS A MANIFESTATION OF THE STUDENTS DISABILITY. COMMENTS: IF NO IS CHECKED TO ALL THE QUESTIONS ABOVE, THE BEHAVIOR IS A NOT MANIFESTATION OF THE STUDENTS DISABILITY. COMMENTS: 4. IF IT IS DETERMINED THAT THE BEHAVIOR IS A MANIFESTATION OF THE STUDENTS DISABILITY AND THE STUDENT DOES NOT HAVE A BEHAVIORAL INTERVENTION PLAN, THE IEP TEAM MUST DEVELOP AN ASSESSMENT PLAN FOR A FUNCTIONAL BEHAVIORAL ASSESSMENT (FBA). DESCRIBE THE PROCEDURES FOR CONDUCTING THE FBA: (Please note that this activity requires the participation of the full IEP team.) 5. IF IT IS DETERMINED THAT THE BEHAVIOR WAS A MANIFESTATION OF THE STUDENTS DISABILITY AND THE STUDENT HAS A BEHAVIORAL INTERVENTION PLAN, REVIEW THE PLAN AND NOTE REVISIONS ON THE IEP AS NECESSARY. (Please note that this activity requires the participation of the full IEP team.) 6. BASED ON THE PRECEDING INFORMATION, THE IEP TEAM HAS DETERMINED THAT: The students behavior was a manifestation of his/her disability. (Therefore, the student may not be removed from his/her current placement beyond 10 days for disciplinary reasons. However, the students placement may be changed through the regular IEP review process.) The students behavior was not a manifestation of his /her disability. State the disciplinary action to be imposed and services to be provided: Persons Participating in the Meeting: Signature of Parent Date Signature of Student (if appropriate) Date Signature of Case Manager Date Signature of Special Education Teacher Date Signature of Regular Education Teacher Date Signature of District Representative Date Signature of Other Participant Date [Summer 2008]  The relevant members of the IEP team are determined by the LEA and the parent.     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" # $ % & ' ( ) * + , Oh+'0(< P\ x   L Manifestation Determination SPECED PECPEC Normal.dot  ckaufmant 6auMicrosoft Word 10.0@Ɣ @$uF@>@e& ՜.+,D՜.+,|8 hp  NJDOEi { L Manifestation Determination TitleT@0H_AdHocReviewCycleID_EmailSubject _AuthorEmail_AuthorEmailDisplayName_ReviewingToolsShownOnce !Manifestation Determination form carol.kaufman@doe.state.nj.usrmKaufman, Caroloauf  !#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIKLMNOPQSTUVWXY\Root Entry F@&^Data 1Table"NWordDocument$2SummaryInformation(JDocumentSummaryInformation8RCompObjj  FMicrosoft Word Document MSWordDocWord.Document.89qRoot Entry FpmHdData 1Table"NWordDocument$2  !#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIKLMNOPQcb @\_AdHocReviewCycleID_EmailSubject _AuthorEmail_AuthorEmailDisplayName_ReviewingToolsShownOnce_PreviousAdHocReviewCycleIDp+Noticescarol.kaufman@doe.state.nj.usKaufman, Carol SummaryInformation(JDocumentSummaryInformation8CompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q՜.+,D՜.+,|8 hp  NJDOEi { L Manifestation Determination Title