Manifestation Determination Review Documentation Form

Documents the team review of whether a student's conduct was a manifestation of their disability before discipline is imposed, including incident context, IEP/behavior supports reviewed, team determination, and follow-up actions.

Submission Notice

• Review notice
• What happens after I submit?

Student and Incident Details

• Student ID
  Use the internal student identifier if available. Avoid entering unnecessary personal details.
• Date of incident
• Incident summary
  Briefly describe the conduct being reviewed, using observable facts only.
• Is discipline currently pending?
• Proposed discipline action

Disability and Support Information

• Does the student have an IEP?
• Does the student have a Section 504 plan?
• Supports reviewed by the team
  Select the records or supports considered during the review.
• Were behavior supports in place at the time of the incident?

Manifestation Determination Questions

• Was the conduct caused by, or did it have a direct and substantial relationship to, the student's disability?
• Was the conduct the direct result of the school's failure to implement the IEP?
• Team rationale
  Summarize the facts, records, and discussion that support the team's determination. Avoid unnecessary PII.

Team Determination and Follow-Up

• Final determination
• May the proposed discipline proceed?
• Required follow-up actions
• Follow-up notes
  Add any deadlines, responsible parties, or implementation notes.

Team Attestation

• Meeting date
• Recorded by
  Enter the name or role of the staff member completing the record.
• I confirm this record accurately reflects the team's manifestation determination review.