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 links may be helpful:

Resources

Information & Support

For Parents and Patients

Medical Home to School Summary Form (PDF Document 40 KB)
Sample form for communication between health care providers and schools about health concerns that impact a student's education.

Schools Information Release Form (PDF Document 49 KB)
Sample form for schools that approves the exchange of information between the student’s nurse and school professionals as it relates to the diagnosis/condition listed. Intended for use as a consent form to accompany the above Medical Home to School Summary Form when providers request evaluations or services from the school.

Accommodating Children with Special Dietary Needs in the School Nutrition Programs (PDF Document 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. The site includes a sample Eating and Feeding Evaluation form to be completed by the child's parent and physician and a sample Information Card for use by school food service staff in preparing meals for the child. From the U.S. Department of Agriculture Food and Nutrition Service.

Medication Administration Form (Utah) (Word Document 40 KB)
Sample form to be completed by the parent and medical provider to administer medications to students; gives a good example of a school medication form. From the Utah Schools for the Deaf and Blind.

Building Your Care Notebook (AAP)
The American Academy of Pediatrics provides a central place with links to several forms from many states. For families that are new to making care notebooks, we suggest you pick one form and try filling it out before downloading other forms.

P.R.O. Filer Personal Portfolio & Filing System (PDF Document 160 KB)
Provides file dividers for the documents at the link above. Published by the Institute on Community Integration. See the companion Personal Portfolio Manual. For more tools, see the All Means All School-to-Work web site at http://ici.umn.edu/all/.

Personal Portfolio Manual (PDF Document 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. See the companion P.R.O. Filer Personal Portfolio & Filing System.

Authors & Reviewers

Last update/revision: January 2019
Current Authors and Reviewers:
Author: Alfred N. Romeo, RN, PhD
Reviewer: Shena McAuliffe, MFA