Monsignor Farrell

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Class of 2027

Special Education Survey

Please complete the form regarding any special educational and/or physical considerations that your son may require.

It is the policy of Monsignor Farrell High School to only grant extended time for midterm, final, and/or Regents exams if indicated by an IEP or 504.

Student's First Name *

Student's Last Name *

1. Has your son ever been evaluated by a special education committee or specialist?

Yes

2. If you answered "yes" to question #1, has he ever been classified with a learning or physical disability?

Skip this question if you answered "no" to question #1

Yes (physical)

Yes (learning)

Yes (physical & learning)

2a. If you answered "yes" to question #2, please explain the classification(s):

3. Does your son have a current Individual Education Profile (IEP)?

Yes

3a. If you answered "yes" to question #3, please describe what his IEP entails:

*A copy of the IEP must be mailed/emailed to......

4. Does your son currently have any 504 Accommodations that we should be aware of so we may address his academic program needs for freshman year?

This may include scheduling, setting, testing, use of aids, etc.

Yes

4a. If you answered "yes" to question #4, please explain:

5. Please include any other information that you would like us to know about your son and any special educational and/or physical accommodations that he may require:

Name of the Person Completing this Form:

First Name *

Last Name *

Email *

Relationship to Student

Father

Mother

Step Father

Step Mother

Guardian

By checking yes below, I attest that the information that I provided in this form is accurate.

Yes