Isbe 34 41 is a new form that has been released by the state of Illinois. This form is used to report the expulsion of a student from school. This form must be completed within five days of the expulsion. The purpose of this form is to provide information about the incident that led to the expulsion, as well as any disciplinary actions that have been taken against the student. Completing this form correctly is important, as it can help ensure that students are held accountable for their actions.
| Question | Answer |
|---|---|
| Form Name | Form Isbe 34 41 |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | 34 41_deviation_cl ass_age isbe special education classroom size 2013 2014 school year form |
ILLINOIS STATE BOARD OF EDUCATION
Special Education Services Division
100 North First Street,
Springield, Illinois
OR
Telephone:
REQUEST FOR APPROVAL OF SPECIAL EDUCATION CLASS SIZE/AGE RANGE DEVIATION(S)
School Year
INSTRUCTIONS: Complete and submit this form to the above address or
COOPERATIVE/DISTRICT INFORMATION
NAME OF SCHOOL |
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NAME/TITLE OF DISTRICT CONTACT PERSON |
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SCHOOL ADDRESS (Street, City, State, Zip Code) |
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SCHOOL |
GRADES IN BUILDING |
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DISTRICT NAME AND NUMBER |
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NAME OF DIRECTOR OF SPECIAL EDUCATION |
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DISTRICT ADDRESS (Street, City, State, Zip Code) |
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TELEPHONE (Include Area Code) |
FAX (Include Area Code) |
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STAFF INFORMATION |
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NAME OF CLASSROOM TEACHER |
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IEIN OR COPY OF CERTIFICATE FOR CLASSROOM TEACHER |
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NAME OF PARAPROFESSIONAL |
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IEIN OR COPY OF CERTIFICATE FOR PARAPROFESSIONAL |
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PROGRAM INFORMATION |
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PROPOSED DEVIATION |
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Class Size |
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Age Range |
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RATIONALE
The rationale for this deviation must include an explanation of why the deviation is necessary and what the district is doing to correct
Provide the following information regarding this deviation request. Note: Do not type beyond the allotted space provided. Attach additional sheets to this form as necessary.
YES
NO Did you request a deviation for the same class/program previously? If yes, describe the reasons for the resubmission.
•Describe the direct cause for this request.
ISBE |
Page 1 of 4 |
RATIONALE (CONTINUED)
•Describe the proposed class size/age range of classroom.
•Describe the options that were explored prior to this deviation request and why they were determined to be inappropriate.
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Date |
Original Signature of District Superintendent |
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Original Signature of |
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ISBE USE ONLY
Full approval will be withdrawn from approved program deviations if monitoringoftheseprogramsbytheIllinoisStateBoardofEducation
determines that they are: 1) not being implemented as approved; and/or 2) it is determined that adequate/suficient services are not
beingprovidedtothespecialeducationstudentsbasedontheirIEPs.
DATE RECEIVED
DATE DISAPPROVED |
REVIEWER |
POST EVALUATION DUE DATE |
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DATE APPROVED |
REVIEWER |
RECEIPT DATE |
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ISBE |
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ILLINOIS STATE BOARD OF EDUCATION
Special Education Services Division
100 North First Street,
Springield, Illinois
SPECIAL EDUCATION CLASSROOM SCHEDULE*
* Complete one for each program which has one FTE special education teacher.
NAME OF SCHOOL |
SCHOOL YEAR |
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NAME OF TEACHER
TYPE OF SCHOOL
Elementary
Elementary
Middle
Junior High
Senior High
Junior/Senior High
Special Education Center
Other ________________________
CLASS
PERIOD
AGE SPAN BY BIRTHDATE OF OLDEST/
YOUNGEST CHILD
(Age Range Request Only)
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CLASSROOM |
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NUMBER OF STUDENTS |
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PARAPROFESSIONAL |
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(Class Size Request Only) |
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(NOT INDIVIDUAL |
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STUDENT AIDE) |
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EE Code 1 |
EE Code 2 |
EE Code 3 |
Yes |
No |
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ISBE |
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ILLINOIS STATE BOARD OF EDUCATION
Special Education Services Division
100 North First Street,
Springield, Illinois
OR
Telephone:
SPECIAL EDUCATION TEACHER ASSESSMENT OVERVIEW
For conidentiality purposes, this completed form can be submitted directly to the Illinois State Board of Education at the indicated address or
ISBE