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Run: Manifestation Determination Review Documentation Form

Document the team review of whether a student's conduct was a manifestation of their disability before discipline is imposed. Capture incident details, suppo...

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Submission Notice

Review notice

What happens after I submit?

Student and Incident Details

Student ID (required)

Use the internal student identifier if available. Avoid entering unnecessary personal details.

Date of incident (required)

Incident summary (required)

Briefly describe the conduct being reviewed, using observable facts only.

Is discipline currently pending? (required)

Proposed discipline action

Disability and Support Information

Does the student have an IEP? (required)

Does the student have a Section 504 plan? (required)

Supports reviewed by the team (required)

Select the records or supports considered during the review.

Were behavior supports in place at the time of the incident? (required)

Manifestation Determination Questions

Was the conduct caused by, or did it have a direct and substantial relationship to, the student's disability? (required)

Was the conduct the direct result of the school's failure to implement the IEP? (required)

Team rationale (required)

Summarize the facts, records, and discussion that support the team's determination. Avoid unnecessary PII.

Team Determination and Follow-Up

Final determination (required)

May the proposed discipline proceed? (required)

Required follow-up actions (required)

Follow-up notes

Add any deadlines, responsible parties, or implementation notes.

Team Attestation

Meeting date (required)

Recorded by (required)

Enter the name or role of the staff member completing the record.

I confirm this record accurately reflects the team's manifestation determination review. (required)

Yes No N/A

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Email (required)

Your name (optional)

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