Special Education Forms | Wyoming Department of Education

Administrative Assistant
Ashley Provencio
(307) 777-3530
ashley.provencio@wyo.gov

E-1 Referral Form Special Education, (PDF, MS Word, Spanish)
E-2 Prior Written Notice and Consent for Evaluation, (PDF, MS Word, Spanish)
E-3 Evaluation Report and Eligibility for Determination, (PDF, MS Word, Spanish)
E-A Documentation of Eligibility – Autism, (PDF, MS Word, Spanish)
E-CD Documentation of Eligibility – Cognitive Disability, (PDF, MS Word, Spanish)
E-DB Documentation of Eligibility – Deaf-blindness, (PDF, MS Word, Spanish)
E-DD Documentation of Eligibility – Developmental Delay, (PDF, MS Word, Spanish)
E-ED Documentation of Eligibility – Emotional Disability, (PDF, MS Word, Spanish)
E-HI Documentation of Eligibility – Hearing Impairment Including Deafness, (PDF, MS Word, Spanish)
E-MD Documentation of Eligibility – Multiple Disabilities, (PDF, MS Word, Spanish)
E-OHI Documentation of Eligibility – Other Health Impaired, (PDF, MS Word, Spanish)
E-OI Documentation of Eligibility – Orthopedic Impairment, (PDF, MS Word, Spanish)
E-SL Documentation of Eligibility – Speech or Language Impairment, (PDF, MS Word, Spanish)
E-SLD Documentation of Eligibility – Specific Learning Disability, (PDF, MS Word, Spanish)
E-TBI Documentation of Eligibility – Traumatic Brain Injury, (PDF, MS Word, Spanish)
E-VI Documentation of Eligibility – Visual Impairment Including Blindness, (PDF, MS Word, Spanish)

I-1 Consent to Invite Transition Agencies, (PDF, MS Word, Spanish)
I-2 Excusal of an IEP Team Member, (PDF, MS Word, Spanish)
I-3 Prior Notice and Consent for Initial Services, (PDF, MS Word, Spanish)
I-4 Individualized Education Program, (PDF, MS Word, Spanish)
I-4a Measurable Goal Page IEP, (PDF, MS Word, Spanish)
I-4b Supplementary Services Page, (PDF, MS Word, Spanish)
I-5 IEP Amendment, (PDF, MS Word, Spanish)
I-6 Summary of Performance, (PDF, MS Word, Spanish)
I-7 Revocation of Consent for Special Education and Related Services, (PDF, MS Word, Spanish)