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SameGoal includes forms for Special Education.


Includes Special Education forms published by the Arizona Department of Education, as well as many additional forms that while not published by the state, are commonly used.

Determination of Eligibility

Form NameLink
Child with Autism (A)Link
Child with Developmental Delay (DD)Link
Child with Emotional Disability (ED)Link
Child with Hearing Impairment (HI)Link
Child with Multiple Disabilities (MD)Link
Child with Multiple Disabilities with Severe Sensory Impairment (MDSSI)Link
Child with Mild Intellectual Disability (MIID)Link
Child with Moderate Intellectual Disability (MOID)Link
Non-Eligible Child for Special EducationLink
Child with Other Health Impairment (OHI)Link
Child with Orthopedic Impairment (OI)Link
Child with Preschool Severe Delay (PSD)Link
Child with Specific Learning Disability (SLD)Link
Child with Severe Intellectual Disability (SID)Link
Speech/Language Impairment (SLI)Link
Child with Traumatic Brain Injury (TBI)Link
Child with Visual Impairment (VI)Link

Additional Forms

Form NameLink
Revocation of Consent for Special Education and Related ServicesLink
Individualized Education Program (IEP)Link
Individualized Education Program (IEP) AddendumNA
Progress Report (automatically generated)NA
Student At-Risk Referral FormNA
Child Find Referral FormNA
General Education Referral FormNA
Teacher Referral FormNA
Referral-Parent InfoNA
Evaluation PlanNA
Student Screening ReportNA
Letter of Concerns from Screening to ParentsNA
Parent Consent to Claim Medicaid ReimbursementNA
Child Study Team Intervention PlanNA