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12/09 RELATED SERVICES CHECKLIST PHYSICAL THERAPY SERVICES Students Name: CRITERIA FOR ELIGIBILITY student is classified and eligible for special educational services AND there is documented evidence
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How to fill out related services checklist

01
To fill out the related services checklist, follow these steps:
02
Start by reviewing the list of related services provided on the checklist.
03
For each related service, determine if your child requires that service. If your child does require the service, mark it as 'Yes'. If not, mark it as 'No'.
04
Make sure to carefully consider whether your child needs any additional related services that may not be listed on the checklist. If so, write them down in the 'Other' section.
05
Once you have completed marking all the relevant services, review your responses to ensure accuracy.
06
Sign and date the checklist to indicate that you have reviewed and completed it.
07
Submit the checklist to the appropriate educational or healthcare professional who requires it.
08
Keep a copy of the completed checklist for your records.

Who needs related services checklist?

01
The related services checklist is typically needed by parents or guardians of children who may require additional services or support in an educational or healthcare setting.
02
It is often used in the special education process to determine the need for and provision of related services such as speech therapy, occupational therapy, counseling, and more.
03
If a child has an Individualized Education Program (IEP) or Section 504 Plan, the related services checklist may be required to assess their eligibility and develop appropriate goals and strategies.
04
In some cases, healthcare professionals may also use a related services checklist to evaluate and determine the need for specific therapies or interventions.
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The related services checklist is a document that outlines the necessary services that a student with disabilities may require to succeed in school.
School administrators, special education coordinators, or individuals responsible for coordinating services for students with disabilities are required to file the related services checklist.
The related services checklist can be filled out by documenting the specific services that a student with disabilities needs, along with the frequency and duration of each service.
The purpose of the related services checklist is to ensure that students with disabilities receive the necessary services and support to help them succeed academically.
The related services checklist must include information on the specific services needed, the frequency of services, the duration of services, and any additional notes or accommodations.
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