1. Manifestation Determination Review (MDR)
*This document should be attached to any formal invitation/letter sent regarding the MDR.
Your attendance is requested at a Manifestation Determination Review. Your involvement is
critical and the input you offer will be valued. Information shared at the MDR is
confidential and will not be shared with those outside of the meeting.
Student Name: _________________________
Date of MDR: _________________________
Time of MDR: _________________________
Location of MDR: _________________________
The following people have been invited to attend in Alphabetical Order and
their Responsibilities:**
General Education Teacher: _________________ /_______________
• Bring current grade/performance/attendance reports.
• Come prepared to discuss overall progress.
Parents/ Guardian: _________________/_______________
• Come prepared to discuss your concerns.
• Come prepared to ask any questions that you may have.
• Provide any other information relevant to behavior (counseling, medication, etc.)
School Administration: _________________/_______________
• Create and send invitation for the MDR.
• Facilitate the meeting.
• Bring current attendance reports.
• Bring copy of discipline notes/ summary.
• Bring copy of suspension records.
• Bring Cumulative File (CA-6O).
• Come prepared to discuss CA-60 findings.
• Come prepared to discuss recommendations for discipline.
• Come prepared to present the overall case.
• MDR Form- Assign someone to complete the form at the meeting.
School Psychologist: ____________________
• Come prepared to discuss current evaluations and recommendations.

2. School Social Worker: ____________________
• Come prepared to discuss overall progress in work with you.
• Come prepared to discuss current evaluations and recommendations.
• Come prepared to discuss information on medication, conversations with outside
counselors, therapist, etc.
Special Education Teacher: ________________/_______________
• Bring current grade/performance/attendance reports.
• Come prepared to discuss overall progress.
• Bring copy of current IEP and Teacher Files.
• Be prepared to complete the MDR Form and send all paperwork.
Student: (If Appropriate) ___________________
• Come prepared to discuss the circumstances that are causing the discipline.
• Come prepared to explain your actions.
• Come prepared to offer insight and input into your current rEP, etc.
Other: _______________ ______________
**Not all areas need to be represented at each MDR. The Group should consist of people
familiar with the student and those able to speak about the student’s progress related to
the IEP, observations from classroom work, home information, etc.
The following items will be discussed:
- Nature of discipline/Summary of Incident — Administration and Student.
- Teacher Input — All teachers can report information in person or in writing.
- Grades and Attendance — Administration and Teachers.
- IEP and Evaluation Information- Teachers, Social Worker, School Psych
- Parent Information- Parent and Student.
Attached you will find a sample copy of the MDR Form. This is the form that we will use to
help guide our meeting and our discussion. Information shared should be relevant and
factual. All information shared will be held in confidence. The MDR becomes part of the
student’s IEP.