Data Collection Form

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Student / Parent Section

Evaluation/IEP tab

Enrollments

Summary

The Data Collection form helps districts with data integrity for their special education data. Dates are important to stay in compliance and the Data Collection form pulls dates from the forms.

A few reminders when using the Data Collection form.

1. The DC form collects information from what was discussed at the IEP/Evaluation meeting by way of the IEP/Evaluation forms in the event.
2. The DC form should be created LAST, so that it can accurately collect data from the other forms in the event. 
3. The DC form should be used in every event where dates are added to forms.
4. For districts who send WISEdata from SEEDS, the DC form will pull data from forms, and then push that data to the student's Evaluation tab. This reduces the risk of error, and creates more accurate SEPA data. 

Student / Parent Section

The information in this section comes from the Student Detail View. This information should be verified to ensure the accuracy of the data on the Student Detailed View. If there are changes, please notify the person who updates your district’s information in SEEDS. 

I. Evaluation/IEP tab

EVALUATION INITIATION DATE & OUTCOME OF EVALUATION INFORMATION

This section is to collect data for information regarding evaluations. 

Evaluation Type: Initial Evaluation Initiated

1. (A-1 Referral) Signed Date:
   The actual date signed by the LEA.
2. (A-3 Notice and Consent Regarding Need to Conduct Additional Assessments)
   Sent Date: The date the A-3 was sent. (This date will prefill from the A-3 form date)
3. (A-3 Notice and Consent Regarding Need to Conduct Additional Assessments)
   Signed Date: The actual date the parent signed for consent.
4. (A-3 Notice and Consent Regarding Need to Conduct Additional Assessments)
   Received Date: The date in which the consent is received in the district.
5. (A-3 Notice and Consent Regarding Need to Conduct Additional Assessments)
   Refused Consent Date: The date in which the consent was refused.
6. (A-4 Notice That No Additional Tests Needed for Evaluation)
   Sent Date: The date the A-4 was sent. (This date prefills from the A-4 Form Date)
7. (A-6 IEP Team Evaluation Report including Eligibility Determination) Meeting Date:
   (This date prefills from the A-6 meeting date)
8. (I-4 Parent Consent for Placement) Date:
   The date the I-4 was signed for consent or rejection of placement. (This date prefills from the I-4 Date)
9. Parent Consent for Placement? Select Yes/No if the parent signed consent for placement.

1. Impairment? Documents if the team decided the student has an impairment or not.
2. Need for Special Education:
   Yes, Enroll - The team determined the student has a need for special education and needs to be enrolled on a class and/or itinerant list
   Yes, Do Not Enroll - The team determined the student has a need for special education but does not need to be enrolled on a class and/or itinerant list
   No - The team determined the student does not have a need for special education
   

Evaluation Type: Re-evaluation Initiated
Additional field for this option is (A-2 Notice of Receipt of Referral or Notice of Re-evaluation) Date: The date the A-2 was sent. (This will prefill from the A-2 form date)

Evaluation Type: Re-evaluation Not Needed

Additional field for this option is (A-2S Notice of Agreement 3 Yr Re-eval Not Needed) Date: The date in which the parent was contacted to determine no evaluation was needed. (This will prefill from the A-2S form date) 

N/A: There was not an evaluation included in the meeting/event.

IEP INFORMATION ONLY 

The IEP Information Only section collects dates from IEP or Service Plan meetings.

1. Meeting Type: Annual IEP
2. Annual Meeting Date: The date the meeting was held.
3. Implementation Date: The implementation is the date in which the IEP will be implemented.
4. Ending Date: Is the last day of the IEP
5. Meeting Type: Review/Revise IEP 
   Date fields: Meeting Date, Implementation Date, Ending Date
6. Meeting Type: Service Plan
   Date fields: Service Plan Meeting Date, Implementation Date, Ending Date
7. Meeting Type: IEP Meeting Not Held, Changes Made
   Date fields: Meeting Date, Implementation Date, Ending Date
8. N/A: There was not an IEP type meeting included in this meeting/event.

IMPAIRMENT INFORMATION

1. Select the Primary Disability for the student
2. Select Secondary Impairment(s) for the student
3. Select the Related Service(s) for the student
4. Select the Program of Adaptive Physical Education for the student if appropriate
5. Select if the student has a Shortened Day. 
6. Select if the student received Medicaid Services. 

ENVIRONMENTAL CODES

SEEDS will give the Educational Environment (EE) code options according to the student's age. The Educational Environment calculator helps to determine the correct code for the student. 

If the student is 3-6 years old and the Data Collection form will give an option for the Preschool Educational Environmental Codes available for students of that age.

The green question mark is a link to DPI's Educational Environment page.

1. Time in special education calculator: Possible Minutes School is in Session in a Week:
2. Time in special education calculator: Total Minutes in Special Education Per Week:
3. Time in special education calculator: Total Minutes in Related Services Per Week:
4. The green Calculate link will calculate the % of the child's time is spent in General Education
5. The drop-down has the EE code options offered.
6. If the child needs multiple codes during the year, this option will populate additional fields about the different codes. 

II Enrollments

Classlist Information

1. Teacher Name / Service Provider: The name of the teacher or service provider needs to be entered. (If Related Services is checked on the IEP, the service will prefill.)
2. Service Level: Determines if the services are new, continued, dropped or an eval only
3. Service Date - Implementation: List the IEP Implementation Date (not meeting date) in this column
4. Current Amount and Frequency for Services: The amount and frequency, as documented on the I-3 will prefill here. 
5. Service Date - Exited Date: Date of the last day the student received services or was dismissed from the classroom
6. Add Another: is used to create another row of fields for additional services.

1. Select WISEdata Exit Reason if the student is physically moving out of the district, max age, graduation or has died.
2. The green question mark is a link to DPI's Exit Reasons page
3. If Exit Reason is TC, enter the continuing district here: Enter the name of the district the student is continuing in
4. Check this box is the student is going to Return to General Ed
5. Add the date the student was dismissed from special education
6. Check this box if the consent was revoked by the parents or adult student
7. Comments: Any information that needs to be documented for further understanding.
8. If Early Childhood Placement: Check the appropriate box if the student attends Early Childhood.
   
   

   CHILD INFORMATION:

9. Birth to 3 Referral – Check this box is the student is a Birth to 3 Referral. The Birth to 3 report pulls student’s who have this box checked.
10. Private School Child receiving special education – Name of Private School – Check this box if the student is attending a Private School. Please fill in the Name of the Private School
11. The Child is placed under Open Enrollment Provision – District of Residence – Check this box is the student is attending the District under “Open Enrollment”, please also list the District of Residence.

III Summary

1. Review Process - Select the name of the person from the dropdown who will receive an email that the event is ready to process. NOTE: The person completing the form needs to have names and emails listed in the Toolbox - Contacts in SEEDS.
2. Name of the person reviewing this Data Collection Form
3. Date the form was reviewed
4. Add necessary notes intended for the staff updating the information in SEEDS.
5. Date the information was updated in SEEDS and the initials of the staff who updated it
6. Check off the data which was updated. NOTE: This information is updated manually by district staff. 
7. Add necessary notes
8. Update Student Detail View - selecting this checkbox will update the information from the GREEN highlighted fields on this Data Collection form to the fields on the Student Detail View.

When the green question mark is clicked, it lists the fields which are updated.