Form EE-1-2 "Extended Evaluation Form" - Massachusetts

What Is Form EE-1-2?

This is a legal form that was released by the Massachusetts Department of Elementary and Secondary Education - a government authority operating within Massachusetts. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 16, 2000;
  • The latest edition provided by the Massachusetts Department of Elementary and Secondary Education;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form EE-1-2 by clicking the link below or browse more documents and templates provided by the Massachusetts Department of Elementary and Secondary Education.

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Download Form EE-1-2 "Extended Evaluation Form" - Massachusetts

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School District Name:
School District Address:
School District Contact Person/Phone #:
Extended Evaluation Form
Evaluation Dates: from
to
Student Name:
DOB:
ID#:
Grade/Level:
Why is an extended evaluation period being recommended? (Check one)
The Team found the student eligible for special education and developed a
partial IEP/
full IEP
but recommended further assessment. (Check one box within the sentence itself.)
The Team found the student eligible for special education but recommended further assessment before developing an IEP.
Important Details from State Regulation —
§603 CMR 28.00: An extended evaluation should be used when evaluation
information is inconclusive and should not be used to deny programs or services determined necessary by the Team. If the Team
has determined eligibility and some necessary objectives and services, then the Team should write a partial IEP and, with parent
acceptance, immediately implement the partial IEP while the extended evaluation is occurring. The evaluation may extend from one
to eight school weeks but no longer than eight school weeks. The Team may meet at intervals during this period and should
reconvene promptly when the evaluation is complete to make any final decisions about IEP services. The extended evaluation
should not be used to allow extra time to complete required assessments and is not considered a placement.
1. What are the current evaluation findings?
2. What type(s) of additional information is needed?
3. How will the additional information be obtained? Identify
4. What time period (longer than one week but not to exceed
personnel, specific evaluators and assessments, if known,
eight school weeks) is needed to complete the necessary
and locations for assessments.
evaluation(s)?
5. Should the Team meet at intervals during the extended
6. What date will the Team reconvene to complete an IEP?
evaluation period? If yes, please specify meeting dates and
Please specify meeting date and time.
times.
Massachusetts ESE/Extended Evaluation Form
REVISED (11/16/00)
EE-1
Page
of
School District Name:
School District Address:
School District Contact Person/Phone #:
Extended Evaluation Form
Evaluation Dates: from
to
Student Name:
DOB:
ID#:
Grade/Level:
Why is an extended evaluation period being recommended? (Check one)
The Team found the student eligible for special education and developed a
partial IEP/
full IEP
but recommended further assessment. (Check one box within the sentence itself.)
The Team found the student eligible for special education but recommended further assessment before developing an IEP.
Important Details from State Regulation —
§603 CMR 28.00: An extended evaluation should be used when evaluation
information is inconclusive and should not be used to deny programs or services determined necessary by the Team. If the Team
has determined eligibility and some necessary objectives and services, then the Team should write a partial IEP and, with parent
acceptance, immediately implement the partial IEP while the extended evaluation is occurring. The evaluation may extend from one
to eight school weeks but no longer than eight school weeks. The Team may meet at intervals during this period and should
reconvene promptly when the evaluation is complete to make any final decisions about IEP services. The extended evaluation
should not be used to allow extra time to complete required assessments and is not considered a placement.
1. What are the current evaluation findings?
2. What type(s) of additional information is needed?
3. How will the additional information be obtained? Identify
4. What time period (longer than one week but not to exceed
personnel, specific evaluators and assessments, if known,
eight school weeks) is needed to complete the necessary
and locations for assessments.
evaluation(s)?
5. Should the Team meet at intervals during the extended
6. What date will the Team reconvene to complete an IEP?
evaluation period? If yes, please specify meeting dates and
Please specify meeting date and time.
times.
Massachusetts ESE/Extended Evaluation Form
REVISED (11/16/00)
EE-1
Page
of
Extended Evaluation Form
Evaluation Dates:
from
to
Student Name:
DOB:
ID#:
Additional Information
Response Section
School Assurance
I certify that the evaluation(s) in this Extended Evaluation are those recommended by the Team and that the indicated
evaluation(s) will be provided.
Signature and Role of LEA Representative
Date
Parent Options / Responses
It is important that the district knows your decision as soon as possible. Please indicate your response by checking at
least one (1) box and returning a signed copy to the district. Thank you
.
I accept the recommended Extended Evaluation.
I reject the recommended Extended Evaluation.
I reject the following portions of the Extended Evaluation with the understanding that any portion(s) that I do not reject will
be considered accepted and implemented immediately. Rejected portions are as follows:
I reject the offer of an Extended Evaluation and wish to have an IEP immediately developed.
I request a meeting to discuss the rejected Extended Evaluation or rejected portion(s).
Signature of Parent, Guardian, Educational Surrogate Parent, Student 18 and Over*
Date
*Required signature once a student reaches 18 unless there is a court appointed guardian.
Parent Comment: I would like to make the following comment(s) but realize any comment(s) made that suggest changes to the
proposed Extended Evaluation will not be implemented unless the Extended Evaluation form is amended.
Massachusetts ESE/Extended Evaluation Form
REVISED (11/16/00)
EE-2
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of
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