Kentucky Department of Education

This page contains downloads to special education forms commonly used by local school districts to document eligibility for special education.  Included is the Consent to Evaluate/Reevaluate and each of the Eligibility Determination forms specific to the suspected disability. 

Revisions to the forms in the SIS occur based on feedback the Division of Learning Services receives from Director’s of Special Education, State Stakeholder Groups, KDE Interpretation of Law, and Legal Decisions.  In addition, the Division of Learning Services, Diverse Learners Branch make revisions to the state mandated forms based on on-site and desk audit monitoring. 

State approved forms used for special education due process including the Individual Education Program (IEP), referral and others can be found by clicking on this link:

Special Education Forms - Due Process

These forms will be included in the state's student information system (SIS) Summer 2011.  The forms below exist in two formats; a Microsoft Word file and an Adobe Acrobat or PDF file.  The Word version is an electronic form that can be downloaded and completed directly from the Word program electronically.  The Adobe Acrobat version is intended to be printed out and completed manually.

The advantage to the Word version is that once completed it can be saved as a file and uploaded to the SIS at the child level.  This option is not available in the Adobe Acrobat version unless the manually completed form is scanned and an electronic file created by that scan.

If you have questions about the content of these forms and the process for uploading files to the SIS, please contact either Windy Newton or Chris Thacker at (502) 564-4970.

Consent to Evaluate/Reevaluate 2011-2012
Autism Eligibility Determination Form 2011-2012
Deaf-Blindness Eligibility Determination Form 2011-2012
Developmental Delay Eligibility Determination Form 2011-2012
Emotional-Behavioral Disability Eligibility Determination Form 2011-2012
Functional Mental Disability Eligibility Determination Form 2011-2012
Hearing Impairment Eligibility Determination Form 2011-2012
Mild Mental Disability Eligibility Determination Form 2011-2012
Multiple Disabilities Eligibility Determination Form 2011-2012 NOTE:  Eligibility Documentation forms for each underlying disability should also be completed.
Orthopedic Impairment Eligibility Determination Form 2011-2012
Other Health Impairment Eligibility Determination Form 2011-2012
Specific Learning Disability Eligibility Determination Form 2011-2012 Revised October 20, 2011
Speech or Language Impairment Eligibility Determination Form 2011-2012
Traumatic Brain Injury Eligibility Determination Form 2011-2012
Visual Impairment Eligibility Determination Form 2011-2012