Forms for Education
The forms listed on this page are intended to be samples that can be adapted for states and Local Education Authorities (LEAs), usually school districts or charter schools.
Along with the forms in the Resources section below, the following pages in the Medical Home Portal may be helpful:
Resources
Information & Support
For Parents and Patients
Medical Home to School Summary Form (
40 KB)
Sample form for communication between health care providers and schools about health concerns that impact a student's education.
Medical Home - School Information Release Form ( 49 KB)
Sample form for a child's parent/guardian to authorize two-way communication between the health care provider and school team.
Accommodating Children with Special Dietary Needs in the School Nutrition Programs ( 849 KB)
Gives a useful guide for nutrition accommodations, including information about modifying school meals for students with disabilities
and other dietary requirements such as food allergies.
School Contacts Page 1 (Care Notebook) ( 66 KB)
A place to list the school district, special education coordinator, 504 Accommodation Plan coordinator, district nurse for
the school, care provider, and school/preschool. This is part of the Care Notebook Contacts Section.
School Contacts Page 2 (Care Notebook) ( 62 KB)
A form to list the school principal/administrator, classroom teacher, resource instructor, aide/assistant/intervener, special
education director, special education teacher, therapists, and other contacts. This is part of the Care Notebook Contacts
Section.
Personal Portfolio Manual ( 151 KB)
P.R.O. filer - Personal Portfolio and Filing System (2000) gives a helpful guide to organizing documents for youth and young
adults with disabilities. Published by the Institute on Community Integration.