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Special Education Data Collection Form

Description of measure:

In order to evaluate the effectiveness of MiBLSi as Multi-Tiered Systems of Support (MTSS), participating MiBLSi schools are asked to complete the Special Education Data Collection Form. This form is intended to record new referrals to special education (not track existing students receiving special education services). Student names are not used in collecting this information and should remain confidential.

Benefits of collecting and using the MiBLSi Special Education Data Collection Form:

The benefits of collecting and using the Special Education Data Collection Form allows schools to track the percentage of the total student count referred for special education services and the percentage of the student count that qualified for special education services.  At the individual building level, schools can use this data as part of their school improvement plan and to assist in determining if implementation of MTSS has decreased the number of students referred and determined eligible for special education services.

 

Measurement tool:

MiBLSi Special Education Data Collection Form 2011-12

MiBLSi Special Education Data Collection Form 2012-13

MiBLSi Special Education Data Collection Electronic Form 2011-12
MiBLSi Special Education Data Collection Electronic Form 2012-13
SAMPLE: MiBLSi Special Education Data Collection Form

When the information is due:

At the end of the school year.  See measurement schedule.

Estimated time involved in collecting information:

The tracking form takes approximately 1 minute to complete per referral.

How to collect and submit information:

The MiBLSi school team should complete the Special Education Data Collection Form, and please submit a copy to:

Candi Gajdos- Drake
Ottawa Area ISD
13565 Port Sheldon Street
Holland, MI  49424
Email: cdrake@miblsimtss.org
Phone: (616) 796-1485
Fax: (616) 738-8946

Frequently Asked Questions:

Q: Should we include ALL students who are currently receiving special education services on the form?
A: No, only include NEW referrals for the current school year.

Q: Should we include referrals for speech and language concerns, articulation in particular?
A: Yes, ALL initial referrals for special education should be included on the form.

Q: Should we include students who are new to our school this year if they had an IEP in another state?
A: No, this form is intended to capture data on NEW referrals only and does not need to include students who had an IEP in another state (or district), even if another evaluation is being conducted this year.

Q: Should we include students whose eligibility area has changed at the point of re-evaluation (e.g. student was previously eligible under speech and language, and after re-evaluation, is now eligible under autism spectrum disorder)
A: No, only new, initial referrals should be included on the form.

Q: We are concerned about releasing information about individual students' eligibility for free/reduced price lunch or we are having difficulty finding the information. Do we have to include it on the form?
A: The form requires that schools use a random code, rather than individual student names, on the Special Education Data Collection Form. This means that MiBLSi staff will never be able to identify individual students based on the data submitted. If your school is still concerned about releasing this information, or if you are having a very hard time finding the information, you may submit your form without free/reduced lunch information. Although there are advantages to schools collecting and analyzing special education data, including demographic characteristics of the students referred, MiBLSi's priority is to analyze aggregate data based on the overall numbers in the summary table.

If you have questions regarding the completion of the special education referral tracking form, please contact:

 

Jennifer Rollenhagen
MiBLSi Measurement and Evaluation Specialist
West Shore ESD
Hart Office
844 Griswold St.
Hart, MI  49420
231.873.5651
jrollenhagen@wsesd.org