District 75 Forms

District 75 Forms & Files





District 75 General Forms

Health Services


 Inclusive Education

Interpreting Services



 Multiple Disabilities

Office of Related & Contractual Services (ORCS)

 Physical Therapy




 Title  Download   Size 
 Permission to Photograph, Film, or Videotape Students  .htm    
Back to Top


Title Download  Size 
Anti Bullying Resources .doc  23K
Bereavement Letter .doc  13K
Bias Harassment 1 .pdf Adobe Acrobat 27K
Bias Harassment 2 .doc  48K
Bias Harassment 3 .doc  49K
Bias Harassment 4 .doc  48K
Bias Harassment 5 .doc  49K
Bias Harassment 6 .doc  49K
Implementing Respect For All .pdf Adobe Acrobat 727K
Child Abuse Phone Listing .pdf Adobe Acrobat 24K
Consent Letter for Practicum Student Service .doc  20K
Counseling Instructions .doc  29K
Counselor Introduction Letter .doc  22K
Counseling progress report template (Annual, Tri, Re-Eval) .pdf Adobe Acrobat 206K
Developmental Disabilities Services Offices (DDSO) .doc  19K
Educational Neglect Policy .pdf Adobe Acrobat 639K
Foster Care Introduction Letter from ACS .pdf Adobe Acrobat 585K
Suicide Prevention Reporting Form .doc  45K
High School Admission Letter .pdf Adobe Acrobat 159K
High School Admission Letter - Spanish .pdf Adobe Acrobat 169K
IEP Crosswalk .ppt  4M
Indirect Counseling Service Report (revised) .doc  92K
Introductory Letter for the Start of the School Year .doc  103K
Short-term Counseling Letter for At-Risk Students .doc  28K
NYC Clinics 3/21/2011 (See Letter to Providers) .pdf Adobe Acrobat 100K
NYC Guide to Suicide Prevention, Services & Resources .pdf Adobe Acrobat 395K
Mobile Crisis Team Directory .pdf Adobe Acrobat 152K
OCGS Daily Log .doc  97K
Reporting Chart .doc  87K
Request for Release of Records .doc  65K
Safety Resource Guide .pdf Adobe Acrobat 131K
Schedule - Counseling (revised) .doc  112K
SESIS IEP Refinement .ppt  1.5M
Sexual Harassment 1 .doc  80K
Sexual Harassment 2 .doc  82K
Sexual Harassment 3 .doc  79K
Sexual Harassment 4 .doc  80K
Sexual Harassment 5 .doc  49K
Sexual Harassment 6 .doc  78K
Social Media Guidelines .pdf Adobe Acrobat 118K
SOPM 08 .pdf Adobe Acrobat 2M
Suicide Hotline Presentation .pdf Adobe Acrobat 81K
The Teen Brain .pdf Adobe Acrobat 2M
Back to Top

Counseling - Child Abuse

Title Download Size 
ACS Interagency Liaisons .pdf Adobe Acrobat 156K
60 Day Case Flow - Safety First .pdf Adobe Acrobat 51K
ACS Borough Email List LDSS-2221A (revised 1/3/13) .pdf Adobe Acrobat 21K
ACS Directory of Borough Commisioners (Revised 5/14/10) .pdf Adobe Acrobat 48K
ACS - CityWide Managerial Roster 3-2009 .pdf Adobe Acrobat 129K
ACS-DOE Case Review Request Form .pdf Adobe Acrobat 71K
Child Abuse Phone Listing .pdf Adobe Acrobat 24K
Child Abuse Prevention Resource Numbers .pdf Adobe Acrobat 48K
Family Assistance Program Brochure .pdf Adobe Acrobat 226K
Quick Guide For Reporting Suspected Child Sexual Abuse .pdf Adobe Acrobat 29K
Suspected Child Abuse or Maltreatment Report LDSS_2221A .doc  188K

Counseling - Chancellor's Regulations

Title Download Size
A-420 Pupil Behavior & Discipline-Corporal Punishment .pdf Adobe Acrobat 221K
A-421 Pupil Behavior and Discipline-Verbal Abuse .pdf Adobe Acrobat 60K
A-740 Pregnant And Parenting Students And Reproductive Health Privacy .pdf Adobe Acrobat 3M
A-750 Reports of Suspected Child Abuse .pdf Adobe Acrobat 1.2M
Highlight of CRA-750 The Blue Card (Note: print on blue card stock) .pdf Adobe Acrobat 162K
A-755 Suicide Prevention/ Intervention .pdf Adobe Acrobat 92K
A-831 Student to Student Sexual Harassment .pdf Adobe Acrobat 530K
Student to Student Biased Based Harassment, Intimidation and/or Bullying .pdf Adobe Acrobat 327K
Back to Top

Counseling - IEP Goals

Title Download Size 
Goals: Academic and Social Emotional .pdf Adobe Acrobat

Counseling - FBA/BIP

Title Download  Size 
ABC Chart .doc  34K
ABC Data Collection Sheet .doc  123K
ABC Checklist/Duration/Latency Intensity Data .pdf  55K
ABC Checklist/Duration/Intensity .doc  241K
ABC Checklist/Duration/Intensity - Notes .doc  45K
Antecedent Strategies 2014 .pdf  416K
Behavior Intervention Planning in SESIS .pdf  75K
Best Practices for Intervention Strategies .pdf 
BIP as Part of the Annual Review .ppt 
BIP Progress Monitoring Form .doc  31K
BIP Summary 2010 Sample Form .doc  48K
Categorizing and Prioritizing Behavior .pdf  81K
Frequency Chart .pdf  16K
Functional Assessment Interview Tool: Parent/Guardian Form .doc  62K
Functional Assessment Interview Tool: Staff Form .doc  74K
Functional Assessment Interview Tool – Student Interview Guide .doc  72K
Functional Behavior Assessment in SESIS .pdf  89K
FBA Summary 2010 Sample Form .doc  44K
Forced Choice Reinforcement Survey .pdf  55.4
Latency Data Recording Sheet .doc  37K 
Latency Definition & Recording .pdf  87K
Latency Recording Sheet .pdf  34K
Measuring Intensity of Behavior .pdf  4K
Problem Beahvior Checklist .pdf  18K
Reinforcer Assessment .pdf  108K
SESIS-BIP Cheat Sheet .pdf  255K
SESIS-FBA Cheat Sheet .pdf  332K
Strategies and Replacement Behaviors .pdf  2.1M


Title Download Size
Committee for Special Education (CSE) Contacts .pdf Adobe Acrobat 22K
Discharge Codes .pdf Adobe Acrobat 27K
District 75 Academic and Behavioral Interventions .pdf Adobe Acrobat 107K
District 75 Administrative Handbook .pdf Adobe Acrobat 901K
District 75 Continuum of Programs and Services .pdf Adobe Acrobat 215K
DOE Office of Special Education Educator Resources .htm web page  
Procedures for Emergencies .doc  80K
The Quality Review: A Reflection .pdf Adobe Acrobat 175K
SIE Categories .pdf Adobe Acrobat 24K
Staffing Ratios Defined (e.g., 6:1:1, 12:1:4) .pdf Adobe Acrobat 21K
Back to Top

Health Services

Title Download Size
Office of School Health Contact Numbers .pdf Adobe Acrobat 27K
Blood-borne Pathogens Training Slide show .ppt  424K
Hazard Communication - Right-to-Know .ppt  242K
Blood-borne Pathogens/Hazard Communications Procedures (see also OOSH) .pdf Adobe Acrobat 43K
Back to Top

Hearing Education Services (HES)

Title Download Size
Hearing Education Services (HES) Brochure .doc  376K
.pdf  227K
HES Audiologists List .doc  28K
.pdf  11K
Audiology Brochure .pdf  229K
Back to Top

Inclusive Education

Inclusive Education - Best Practices

Title Download Size
D75 SETSS Handbook .pdf  284K
Matrix of Program Quality Indicators for Students with Disabilities In Inclusive Schools .doc  33K
Inclusive Environment Checklist .doc  63K
IEP at a glance .doc  35K
Teacher's Inclusion To-Do List .doc  32K
Administrator Guidelines for Developing Inclusive Education .doc  58K
.pdf  56K
SESIS D75 SETSS Recommendation Reference Guide .pdf  53K
Back to Top

Inclusive Education - District 75 Inclusive Programs

Title Download Size 
Choice Form .pdf  71K
Directory of New York City Public High Schools with District 75 SETSS Programs 2013-2014 .pdf  2M
Back to top    

Inclusive Education - General Documents

Title Download Size 
A Day in the Life of Being in Inclusion .pdf  5K
Funding for Students Receiving District 75 SETSS Supports .pdf 


My Positive Experience with Inclusion ,pdf  123K
Shared Instruction - Instructions .pdf  72K
Story Told by Marc Mendez .pdf  55K
To Do List .pdf  45K
What is Inclusion? .pdf  47K
YAI "Progress in Inclusion" Newsletter August 2011 .pdf  673K

Back to Top

Interpreting Services

Title Download Size
Interpreting Services Brochure .pdf  120K
Sign Language Interpreter Request Form .pdf  23K
Sign Language Observation Request Form .pdf  30K
Back to Top    


Title Download Size 
D75 Literacy Units of Study Aligned to CCLS .pdf  904K
Literacy Walkthrough Checklist .xls  37K
Text Complexity Gradient Informational .pdf  102K
Text Complexity Gradient INSTRUCTIONAL STRATEGIES .docx  64K
Text Complexity Gradient for Literary .pdf  110K
Text Complexity Pre-Conventional Gradient .pdf  104K
Back to Top


Title Download Size
Common Core - P-12 Learning Standards in Mathematics .pdf  634K
2009 Impact Mathematics Course 1 .pdf  104K
2009 Impact Mathematics Course 2 .pdf  61K
2009 Impact Mathematics Course 3 .pdf  120K
Information about Everyday Math Online Games .doc  41K
Math in Focus Flowchart .ppt  702K
Math in Focus Overview .ppt  759K
Math Toolkit AIS Summary .doc  195K
Workshop Model .pdf  13K
Back to Top

Multiple Disabilities

Title Download Size
Classroom Practices for Students with Multiple Disabilities .doc  37K
.pdf  24K
Typical 12:1:4 Students .pdf  111K
Back to Top

Multiple Disabilities - Brigance Forms

Title Download Size 
Directions for Assigning Item Codes .pdf  141K
Assessment Considerations Checklist .doc  58K
Back to Top

Office of Related and Contractual Services (ORCS)

Title Download Size
RSA-3 Form - Transportation Reimbursement Voucher Public Transportation, Private Car or Metered Taxi Cab .doc  100K
RSA-3a Form - Transportation Reimbursement Voucher Private Car Services .doc  94K
W-9 Form .pdf  354K
Back to Top

Physical Therapy & Occupational Therapy - Administration




Provider Schedule .doc  77K
Therapist Tuition Reimbursement Instructions .pdf  149K
Therapist Tuition Reimbursment Form .pdf  163K
PD19 .pdf  35K
Resources for PT/OT at Office of School Health .html 
Back to Top

Speech Services

Title Download  Size 
Administrative Timeline .pdf  83K
Assistive Technology Flowchart for Staff .pdf  13K
Caregiver Mealtime Interview .pdf  18K
Classroom Communication Systems .doc  33K
Clinical Record Book Cover Sheet .pdf  20K
Collaborative & Class Trip Lesson Plans .doc  33K
Collaborative Lesson Plan Form .pdf  67K
Communication Boards Support - Generic Comm Wallet 1 .pdf  337K
Communication Boards Support - Generic Comm Wallet 2 .pdf  224K
Communication Dictionary Information Form .doc  33K
Contracted Service Parent Letter .pdf  161K
CSS Communication Profile .pdf  292K
CSS Speech Evaluation Outline .pdf  13K
D75 Administrator & SPED Liaison SESIS Training .pdf  688K
Eating Skills Screening .pdf  118K
End of Year Procedures .pdf  70K
End of Year Summary .pdf  127K
Feeding Consultation .pdf  32K
First-Then .doc  38K
Give Me 20 Main Board (White) .pdf  52K
IEP Driven Device Provider Survey .pdf  29K
IEP Refinements Cheat Sheet .pdf  737K
Interim Service Plan .pdf  1M
Intervention Plan .doc  30K
Intervention Plan 2 .doc  31K
Intervention Plan 3 .doc  30K
Intervention Plan 4 .doc  48K
Introducing Chewables .pdf   26K
Key Questions .pdf  58K
Mandate Modification/Termination Form .doc  41K
Mealtime Plan 2011-2012 .doc  28K
Mealtime Plan Checklist .pdf  75K
Mealtime Plan Form .doc  28K
Mini Supersymbols .pdf  301K
ORCS/IVR FAQs .pdf  187K
Personnel Data Form .pdf  81K
Professional Log .doc  37K
Pro-Ed Speech Speech and Language Development Chart .pdf  106K
Recording a Service in SESIS Job Aid .pdf  69K
Referring Students for Assistive Technology in SESIS .pdf  184K
Related Service Provider Schedule .doc  69K
SESIS Encounter Attendance .pdf  737K
Steps for Creating a Mealtime Plan .pdf  82K
Supervisor Locations & Contact Information 2011-12 .pdf  52K
Task Analysis Worksheet .doc  33K
Tracking Log .pdf  225K
Transmittal Request .doc  33K
Viewing & Editing Your Caseload in SESIS .pdf  28K
Visitation Form .doc  28K
What I Worked On .doc  28K
What We Are Working On .doc  297K
Back to Top

    District 75  |  400 First Avenue, New York, NY 10010  |  (212) 802-1500  |  Contact