Special Education Discharge Form
Document the transition of a student out of special education services. Please complete all sections accurately.
Student Information
Student Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
School/Program Name
*
Grade Level
Discharge Details
Type of Discharge
*
Please Select
Graduated
Aged Out
Transferred to General Education
Moved to Another Program
Parent/Guardian Request
Other
Discharge Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Discharge
*
Current Educational Supports at Discharge
Summary of Progress
Remaining Needs or Concerns
Follow-up and Recommendations
Acknowledgment
Signature of Parent/Guardian or Authorized Representative
*
Submit Discharge Form
Submit Discharge Form
Should be Empty: