Kentucky Compliance Record Review Form 2013-2014

The name of the party seeking access;

The date access was given; AND

The purpose for which the party is authorized to use the record(s).

The LEA provides a written invitation to the parent(s) at least

seven (7) calendar days before an ARC meeting.

NOTE: This also applies to initial ARC meetings for preschoolers transitioning from First Steps.

There is documentation of the district’s attempts to arrange a mutually agreed-on time and place.

The purpose of the meeting;

For children who are in 8th grade or age 14 and older,

the purpose of the meeting indicates the ARC discussion

of postsecondary needs and/or services;

 The time of the meeting;

The date of the meeting;

 The location of the meeting;

The role of participants attending the meeting

 An option for the parent(s) to note the need for alternative meeting times,

dates, locations, and means of participation;

 A statement informing the parent(s) they may bring

persons to assist them in the meeting;

For children transitioning from First Steps, an invitation to the initial  ARC meeting

is sent to the First Steps Service Coordinator or other representatives of the Part C

system if the parent requests.

  For children who are in 8th  grade or age 14 and older: the child is invited to the meeting.

Parent (in attendance) OR  

In cases where the parent did not attend,

documentation shows that all of the following occurred:  

Parents received written notification of the meeting;

  Parents were offered alternative meeting time and location;

Parents were given the opportunity for alternate means of participation

  (e.g., informal conference, phone conference, ARC conference call, e-mail,

   homevisit, survey);

and, Parents were sent a copy of the IEP and ARC Conference Summary

  (as indicated on ARC Conference Summary by method and date).

A regular education teacher of the child; 

A special education teacher of the child OR a special education teacher 

knowledgeable of the suspected disability;

A representative of the school district, qualified to provide, or supervise the

provision of specially designed instruction, knowledgeable of the curriculum and

district resources; 

An individual who can interpret the instructional implications of evaluation 

results who may be a member of the team described in 16-18; 

Related services personnel, as appropriate; 

For children who are in 8th grade or age 14 and older, the child is

involved in the ARC process relative to transition planning. 

OR 

In cases where the child did not attend, documentation shows that all of the

following occurred: 

The child was invited to the meeting; AND,

Other steps are taken to ensure that the child’s preferences and

interests are considered.

If a member of the ARC is excused from attending the ARC meeting in

whole or in part, the parent and the district agree to the excusal in writing

prior to the meeting. 

If a member of the ARC is excused, the member must submit input into the

development of the IEP in writing to the parent(s) and the ARC, if the

member’s area of curriculum or related service is to be modified or

discussed in the meeting.  Input must be submitted prior to the meeting. 

A description of each evaluation procedure test, record, or report used as a basis

for proposed or refused action; 

boxes are checked for each evaluation procedure, test, record or report

the district used as a basis for the proposed or refused action 

AND 

a description of assessment instruments and procedures included.

A description of the action proposed or refused; 

An explanation of why the LEA proposed/refuses to take action;

A description of any other options and reasons those options were rejected;

A description of any other factors related to the LEA’s proposal or refusal; 

(Look at Section VI of the Conference Summary)

A statement that the parents have protection under the procedural safeguards (i.e.,

Parent Rights) and if this is not an initial referral for evaluation, the means by which a

copy of the Parent Rights can be obtained. 

For preschoolers transitioning from First Steps, an LEA representative

participates in transition conferences arranged by First Steps (e.g., copy of

Individual Family Service Plan [IFSP] or Conference Summary with LEA

representative signature). 

For preschoolers transitioning from Part C, the IFSP was considered in 

developing the IEP. 

Review date: date by which the IEP will be reviewed by the ARC, within 365 days of the last IEP review date. 

 Communication Status;

Academic Performance;

Health/Vision/Hearing/Motor Abilities; 

Social and Emotional Status; 

General Intelligence 

Transition Needs (for children in 8th  grade or age 14 and older).

NOTE:  There must be a minimum of one area (instruction; related

service; community experience; development of employment and other

post school adult living objectives; and if appropriate, acquisition of daily

living skills and provision of a functional vocational evaluation) addressed; 

Functional Vision/Learning Media/Assessment; 

A summary statement, included in the Present Levels, of how the 

child’s disability affects the child’s involvement and progress in the general

curriculum 

Behavior; 

Limited English proficiency; 

Blind or visually impaired; 

Communication needs; 

Deaf or Hard of Hearing; 

Assistive technology needs. 

Statement of measurable annual goals 

Mark "YES" if annual goals relate directly to the present levels of academic achievement and

functional performance and incorporate the general curriculum (i.e., Kentucky Core

Assessment Standards; Program of Studies) to enable the child to be involved and make

progress in the general curriculum, OR meets the child’s other educational needs that result

from the disability; AND, 

The annual goals are measurable and must include the (a) audience (student’s name), (b)

behavior, (c) circumstances, (d) degree/criteria and (e) evaluation/method of measurement.

Statement of specially designed instruction

SDI in its simplest form is "what the teacher does" to instruct, assess, and re-teach the child.

The SDI documents what the teacher does, as appropriate, to adapt the content, to adapt the

methodology, or to adapt the delivery of instruction.  If instruction is required for the child to

use an assistive technology device, material, supplementary aid, strategy or service, it should

be described as specially designed instruction on the IEP.

Statement of how the child’s progress toward annual goals will be measured 

(method of measurement)

Statement of when the parent(s) will be regularly informed of progress 

toward the goals

 Evidence of progress data collection and analysis for each annual goal 

Supplementary aids and services 

Supplementary Aids and Services (SAS) in its simplest form is what the child needs in order to 

advance appropriately toward attaining the goal(s) and be involved and make progress in the

general curriculum, to participate in extracurricular  and other nonacademic activities, and be

educated and participate with other children with and without disabilities. SAS includes strategies,

aids, and services. 

If the child requires specific materials, resources, aids, strategies or services to gain access

to the general education curriculum, as supported in evaluation data, the IEP should describe

them as supplementary aids and services based on peer-reviewed research to the extent practicable.

Statement of individual accommodations for participation in the state or 

district-wide assessment

Statement of decisions and reasons for meeting the requirements for 

Alternate Assessment Program

Statement of program modifications and supports for school personnel to be

provided for the child to: 

Advance appropriately toward attaining the annual goals;

Be involved and progress in the general curriculum; 

Participate in extracurricular and other nonacademic activities; and  

Be educated and participate with other children with or without disabilities.

 An explanation of the extent, if any to which the student will not participate 

with nondisabled children in regular education classes (content area).

Anticipated frequency of service; 

Anticipated amount of time (duration); 

Projected beginning and ending dates; 

Anticipated location.

Anticipated frequency of service; 

Anticipated amount of time (duration); 

Projected beginning and ending dates; 

Anticipated location.

The ARC considers the concerns of the parent in the development of 

the IEP.

For children in the 8th grade or age 14 and older, the child has a

multi-year course of study as outlined in the child’s Individual Learning

Plan.

The ARC considered extended school year (ESY) services according 

to individual child need. 

 Mark 49a "YES" only if 49a1 and 49a2 (and 49a3 if appropriate) are yes.

The IEP includes appropriate measurable postsecondary goals related to:

training or education 

employment

when appropriate, independent living skills. 

The IEP includes transition services that will reasonably enable the child to 

reach the postsecondary goals.

For transition services likely to be provided or paid for by another agency, the 

other agency is invited to send a representative, if appropriate.

Mark "YES" if the Notice of Admissions and Release Committee Meeting indicates an outside agency that is likely

to be responsible for providing or paying for transition services that are needed to assist the child in reaching

postsecondary goals was invited to the meeting. 

Mark "YES" if the ARC documented that the need for an outside agency was not appropriate or the child’s IEP

did not include transition services that required another agency. 

Outside agencies may include Office of Vocational Rehabilitation; Commission for Children with Special Health

Care Needs; Department of Mental Health.  

There may be transition services listed that involve another agency, but will not be implemented until the child’s

senior year, this may be noted as an agency involved, but marked on the invitation that an invitation for the agency

to send a representative to the ARC is not appropriate at this time.  

The conference summary describes the decisions made in this process. For more information regarding transition

requirements, see Indicator 13 Kentucky Transition Requirements. 

If an agency was invited to send a representative signed Consent for Outside

Agency Invitation is included.

Mark "YES" if documentation includes a signed, dated parent(s) (or emancipated youth) Consent for Outside Agency Invitation

obtained prior to the Notice of Admissions and Release Committee Meeting, if a representative of an outside agency that is

likely to be responsible for providing or paying for transition services is invited to the ARC meeting.  

Mark "YES" if Item 49c indicates that the ARC documented need for other agency was not appropriate or child’s IEP

did not include transition services that required another agency.  

As a transition service, the child has a multi-year course of study as outlined in 

the Individual Learning (Graduation) Plan.   

Annual goal(s) included in the IEP are related to the transition service needs.

Measurable postsecondary goals are based on age-appropriate transition 

assessment.

The child is invited to the ARC meeting where transition services were discussed.

The measurable postsecondary goals are updated annually.

For students who have reached the age of 16 and older, all the Item 49 (a-i)

requirements are met:    

By the student’s 16th  birthday, all of the requirements above are met. 

At least one year prior to the child reaching the age of majority, the IEP 

includes a statement that the child and parent have been informed of the child’s

rights and that the rights will transfer to the child upon reaching the age of

majority. 

The ARC considered potentially harmful effects of the placement on 

the child or the quality of services.

Documentation shows that removal of the child from the regular 

educational environment occurs only if education in the regular education

environment with the use of supplementary aids and services cannot be

satisfactorily achieved due to the nature or severity of the disability.

(Documentation shows that placement in regular class is the first

placement option considered.) 

Mark "NA" if placement was not an action proposed/refused during the ARC meeting.

For children initially referred during the current (reporting) school year, 

the ARC completed the evaluation within 60 school days from receipt of

Consent for Evaluation to the receipt of Consent for Services for children

found eligible; 

Or,  

For ineligible students, 60 school days from receipt of Consent for

Evaluation to date of Eligibility ARC.

For children initially referred during the current (reporting) school 

year, the ARC developed the IEP within 30 calendar days from

determining eligibility to developing the IEP.  

The ARC conducts a review of the IEP annually (i.e., within the 

calendar year) to determine whether the annual goals for the child are

being achieved and revise the IEP as appropriate.  Mark this item "NA" if

child has been receiving special education less than one year.

 The ARC conducted a reevaluation in the current (reporting) year 

(which may consist of review of existing data, if appropriate) within 3

calendar years from the date of the last Eligibility ARC meeting.

For children exiting Part C, documentation shows that the IEP was 

developed and implemented by the child’s third birthday. 

The IEP is in effect at the beginning of the school year.

For students graduating or aging out, documentation shows that the 

child was provided a summary of the child’s academic achievement and

functional performance including recommendations on how to assist the

child in meeting postsecondary goals. 

The Referral Form is complete.

Documentation shows the child was provided:

Appropriate, relevant research-based instruction and intervention services;

Delivered in regular education settings;

Delivered by qualified personnel; AND 

Documentation shows: 

Data-based documentation of repeated assessments of achievement and behavior 

Collected and evaluated at reasonable intervals

Documentation of correspondence to the parents 

The ARC identified a suspected disability and planned an appropriate 

evaluation as documented on Consent to Evaluate/Reevaluate form.

A review and analysis of the referral information (for initial evaluation)

OR progress monitoring data of the child (for reevaluation); AND  

the information was sufficient to support a suspected disability; AND 

the tests and procedures necessary to assess the child were documented.   

 The ARC conducted a full and individual evaluation related to all areas of the 

suspected disability. 

The ARC used a variety of assessment tools and procedures to determine the 

child was a child with a disability and to determine an appropriate educational

program for the child. 

The ARC provided and administered the assessment in the native language or 

mode of communication appropriate for the child; OR documentation exists that it

was clearly unfeasible to do so. 

The ARC considered evaluations and information provided by the 

parents.

The ARC considered current classroom-based, local or state 

assessments and classroom observations; and observations from

teachers and related service providers. 

 The ARC conducted a full and individual evaluation prior to implementing 

special education services. 

Evaluations and information provided by the parents; 

Minimum of two classroom-based observations by teachers and related services providers;

One or more of the following:

Current classroom-based assessment data

Local assessment data

State assessment data 

Current progress monitoring of IEP goals to determine whether the child’s educational performance

continues to be significantly and consistently below the level of similar age peers. (Adverse Effect) 

Notifies the parent(s) of the reasons the ARC is not conducting a reevaluation; AND 

Informs parent(s) of their right to request an assessment.