CCJS - New Student Move In Form Updated 07/2025

New Student Move In Form

Clinton County Joint Services
Complete this form when a new student enrolls who was in a special education program in a previous school and/or was referred for testing at the time of the move from the previous school. A copy of the current educational evaluation(s) and IEP must be provided to Joint Services with the Move-In IEP.

Fax this form to Joint Services at 765-514-0075 or scan/email to ghamilton@rcsd.k12.in.us.

NOTE: According to Article 7-24-4(a5), a case conference must be held “within ten (10) instructional days of the enrollment date of a student who has been receiving special education in another state or another district within the state.” The school cannot postpone enrollment to arrange a conference.
Student’s Name*
Grade*
Date of Birth*

MonthDayYear
Date
STN*
School*
Language*
Parent Name(s)*
Phone*
Home Address*
Race

White/Caucasian Black AmericanBlack AmericanPacific IslanderEthnicity:American Indian or Alaskan NativeAsianMultiracial
Ethnicity*

HispanicNot Hispanic
Previous School/Corporation*
Anticipated Eligibility Category*
Anticipated Teacher of Record*
Team Members who need IEP access*
Person completing this form*
Educational Consultant/SLP*
The Educational Consultant or SLP (for LSI only students) will review the school records, educational evaluation(s), and current IEP to ensure the student meets Article 7 eligibility criteria prior to the move-in conference.
Date of File Review*

MonthDayYear
Date
Date of Move-In conference*

MonthDayYear
Date
The following records have been attained from the previous school:
Current IEP At the previous school*

YesNo
Education Evaluation Reports*

YesNo
Additional Information*

YesNo
Article 7 eligibility and report requirements are met.*

YesNo
If no, indicate missing pieces:
Should be Empty:

New Student Move In Form

The following records have been attained from the previous school: