Evaluation Process for a Special Education

Paraprofessional Support Request

Staff member completing this form:

Date: Building:

Directions:
1. When staff consider the addition of paraprofessional support, it is important to review this need with the principal who may/may not give permission for the
evaluation process.
2. If the principal approves evaluating the request, then complete the questions under Step I and forward to the district’s Special Services Coordinator (SSC).
The SSC will complete the paraprofessional evaluation process.

Step I. IEP Manager Information - Describe the need for additional paraprofessional services using the following format: 
A. Request is for: Program Para - works in a program with several students
Student name(s): __________________________________________
Comments: _______________________________________________
Child-Specific Para (1:1) – works only with one student
Student name: _____________________________________________
Comments: ________________________________________________
B. Needs in: Social / behavior Academics
Adaptive functioning (self-help) Other (describe):

C. Describe the need: ___________________________________________________________________________________________

___________________________________________________________________________________________________________
E. Hours/days needed:
F. What behaviors/skills will be increased/decreased with the addition of paraprofessional support?

G. Review and comment whether professional staff can solve the problem:

H. Are there students who have paraprofessional support, who are becoming more independent so that some para time can be freed up?

Yes No
If so, who are these students? _____________________________________________________

 
 

Step II. Special Services Coordinator Review

Yes No a. Program is following best practices.

Yes No b. All other paraprofessionals in program are utilized according to approved program guidelines (attach a list of current paraprofessionals
along with their duties/daily schedule if needed).
Yes No c. All less intrusive interventions and adaptations have been implemented (e.g., assistive technology, accommodations/modifications).

Suggestions to try before approval of additional staff: ______________________________________________________________________________

________________________________________________________________________________________________________________________

Yes No d. Special Services Coordinator has observed the student.

Yes No e. Special Services Coordinator and teacher have filled out Intensive Needs Checklist.
Yes No g. Criteria for additional position is met.

* Please attach any other supportive data from observations, interviews, etc.

Step III. Special Services Coordinator will:

A. Review with Case Manager.
Date: _____________
C. Review with Principal.
Date: _____________

Step IV. Principal will:

A. Review and secure decision of the Superintendent.
Date: _____________

B. Follow district hiring procedures.

C. Name of person recommended to Board for hire:
D. Send copy of this form to Special Services Coordinator.

Signatures
 
Case manager: 
 
Special Services Coordinator: 
 
Principal: 
 

 
 

Intensive Needs Checklist

 
 
Yes No Are there safety needs related to self and/or others? If yes, please describe:
_____________________________________________________________________________________________________________
Yes No Does the student require continual teacher prompts during instruction?
If yes, is there a difference between academic instruction vs. specials? Yes No

Yes No Does the student require continual teacher prompts during independent seatwork?
Yes No Does the student require continual teacher prompts during transitions, unstructured time (e.g., lunch, recess, hallway)?
Yes No Does the student require assistance with organizational tasks?
Yes No Does the student require assistance with any of the following functional skills?
Yes No Toileting
Yes No Mobility
Yes No Feeding
Yes No Dressing
Yes No Following basic safety rules
Yes No Communication
Yes No Does the student have medical needs that require the monitoring or assistance of a paraprofessional? If so, what level of certification or
training is needed to meet medical needs? _________________________________

Do the student’s peers include the student in classroom activities?

Is the student receptive to peer tutoring and support?

Is the student currently receiving specialized small or individualized group instruction in specific academic areas? If so, what is the current student to teacher ratio?