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Student Info & Key Dates
All fields auto-populated from SEIS/SIS — verify before the meeting.
Student Name / Birthdate — Must match SIS enrollment exactly.
IEP Date — The most recent IEP in effect at the time of the incident.
⚠ Manifestation Date — The date of this MDR meeting. Must occur within 10 school days of the decision to impose a disciplinary change of placement. Missing this deadline is a procedural violation.
School / Grade / SSID / Gender — Pulled from SIS. Verify all fields match current enrollment records.
Parent Demographics — Verify from SIS
Confirm all contact info with the family at the start of the meeting.
Parent/Guardian Name — Verify legal name; changes from marriage or divorce may not be updated in SIS.
Home Address / City / Zip — Critical. Required MDR notices sent to a wrong address = failure to notify under IDEA. Update SIS immediately if the family has moved.
Phone (Home/Work/Cell) / Email — Verify each meeting. Family must be notified of the MDR with reasonable advance notice.
District of Residence / Teacher — Pulled from SIS. Verify teacher is the current assigned Education Specialist or classroom teacher.
Current Educational Setting(s)
Document the student's placement at the time of the incident — not a proposed or future placement.
Include all settings:
• "General education with SAI pull-out 90 min/week in math" • "Resource room — Reading/Math, 150 min/week" • "Special Day Class 4 periods/day, general ed electives 2 periods"
This matters because the team must evaluate whether the placement was appropriate at the time of the behavior. An insufficiently supportive setting is directly relevant to the manifestation determination.
Description of Behavior
Describe the specific behavior that led to this analysis — objectively and in detail.
Include:
• Exactly what the student did (observable, specific — not labels like "aggressive")
• Date, time, and location
• Who was involved
• Sequence of events leading up to the behavior
⚠ Be factual and specific. "Student was disruptive" is insufficient. This description anchors the entire MDR — both causal questions must be evaluated against this exact behavior.
Example: "On 10/15/2024 at 10:20 AM in the main office, student knocked items off the desk and pushed a chair when asked to wait."
Disciplinary Action & Date
Disciplinary Action: Describe exactly what is being imposed — number of suspension days, expulsion recommendation, IAES removal, etc.
Date of Decision: The date the discipline was decided. ⚠ The MDR must occur within 10 school days of this date.
An MDR is required before:
• Any suspension creating a change of placement (10+ cumulative days in a school year)
• Any expulsion proceeding
• Removal to an Interim Alternative Educational Setting (IAES)
Information Considered by the MDR Team
Check everything the team actually reviewed — and describe it specifically:
Teacher observations — List specific observations relevant to the behavior. Document what was observed and when, not just "teacher knows the student."
The Student's IEP — Review the full current IEP. Was the placement appropriate? Were all services being delivered? Were goals addressing relevant skill areas?
Parent information — Document what the parent shared, even informally. Parent input is required to be considered.
Other — FBA results, behavior data, counselor notes, medical records, prior incident reports.
⚠ All items left unchecked or undescribed create due process vulnerability.
Causal Question 1: Direct & Substantial Relationship
"Was the conduct caused by or did it have a direct and substantial relationship to the disability?"
Yes = Manifestation. Discipline may not proceed.
No = Move to Question 2.
Consider:
• Does the disability directly impair the student's ability to control this behavior?
• Does the disability impair understanding of impact or consequences?
• Is this behavior characteristic of the disability (e.g., impulsivity with ADHD, dysregulation with ED)?
⚠ Document reasoning in Comments regardless of answer. A bare Yes or No with no explanation will not withstand scrutiny in a due process hearing.
Causal Question 2: Failure to Implement IEP
"Was the conduct the direct result of the LEA's failure to implement the IEP?"
Yes = Manifestation. Discipline may not proceed. LEA must immediately remedy the failure.
No = If also No on Q1, discipline may proceed.
Honestly evaluate:
• Were all IEP services (SAI minutes, related services) being delivered as written?
• Were accommodations and modifications consistently implemented?
• Were BIP strategies in place at the time of the incident?
⚠ If ANY service was not delivered as written, the answer should be Yes. This is the most consequential — and most honestly answered — question on this form.
Outcome: WAS a Manifestation
Check if the team answered Yes to either Question 1 or Question 2.
⚠ Discipline proceedings may NOT occur.
Required next steps: • FBA must be conducted (unless recently completed) addressing the specific behavior
• BIP must be developed or updated based on FBA findings
• IEP team must reconvene to review placement and services
Exception: If behavior involved weapons, drugs, or serious bodily injury, student may still be moved to an IAES for up to 45 days regardless of manifestation finding.
Outcome: Was NOT a Manifestation
Check only if the team answered No to BOTH Question 1 AND Question 2.
Discipline may proceed only if ALL four conditions are met:
1. Behavior is not a manifestation ✓
2. Student understood the impact and consequences of the behavior
3. Student could control the behavior
4. Services and supports were correct at the time of the incident
⚠ Even during disciplinary proceedings, FAPE must continue. Educational services must not stop — the setting may change but services must be maintained to enable progress toward IEP goals.
Comments & Next Steps
Document the team's full reasoning here — this is your best protection in a dispute.
Include:
• Specific evidence reviewed and how it informed the decision
• All team members present and their roles
• Any disagreements and how they were resolved
• Specific next steps, responsible parties, and timelines
⚠ MDR decisions that are not well-documented are among the most frequently challenged in due process. If the team took time to make a careful, data-based decision, the documentation should reflect that.
Parent: Agrees / Disagrees
Document the parent's response to the MDR outcome.
Agrees — Parent concurs with the team's determination. Note any comments.
Disagrees — ⚠ Critical flag. Document the parent's specific concerns in the Comments field.
A parent who disagrees has the right to:
• Request mediation through the SELPA
• File a state complaint with CDE
• Request a due process hearing
Provide Procedural Safeguards at this meeting and document the date provided (see checkbox below).
Signatures — Required Team Members
All required MDR team members must sign.
Required members:
• LEA Representative — administrator or designee with authority to commit resources
• Parent/Guardian — or documentation of all reasonable attempts to include them
• Special Education Teacher — who knows the student's curriculum and disability
• General Education Teacher — if the student participates in general education
• Other relevant personnel — psychologist, counselor, behavior specialist as appropriate
Parent/Guardian checkbox: Check Parent, Guardian, Surrogate, or Adult Student as applicable.
⚠ Procedural Safeguards must be provided to the parent at or before this meeting. Check Yes and record the date.
El Dorado County Charter SELPAManifestation DeterminationSpecial Education Local Plan Area
