New Special Education Enrollee Form

New Special Education Enrollee Form

Please complete this form at the time of a student's enrollment in order to initiate the transfer of electronic special education records in PSSP. Thank you!
Your Name
Student's Full Name (First, Middle, Last)
STN Number
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Race/Ethnicity (check all that apply)
Corporation Student is Entering
School Student is Entering
Grade
Move-in Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Name(s)
Custody

Other
Phone Number
Address
Was this student most recently ___?
Most Recent School Corporation
Most Recent School
City
State
Attach most recent IEP from previous school

Cancelof
Attach most recent evaluation from previous school

Cancelof
If most recent IEP and evaluation are not attached above, has a records request been made to the previous school?
Your Name
Your Email
example@example.com
Should be Empty: