1. LEA / School Information
- District / LEA
- [District Name]
- School(s)
- [School Name(s)]
- NCES ID(s)
- [NCES ID(s)]
- Special Ed Director
- [Name & Email]
- IDEA Part B Allocation
- [$XX,XXX]
- Students with IEPs
- [Number — from OSEP child count]
- Disability Categories
- [Primary categories served — e.g., SLD, SLI, ASD, OHI]
2. Maintenance of Effort (MOE) Verification
| Fiscal Year | Total SpEd Expenditure (State + Local) | Per-Pupil SpEd Expenditure |
|---|---|---|
| Prior Year ([FY]) | [$X,XXX,XXX] | [$X,XXX] |
| Current Year ([FY]) | [$X,XXX,XXX] | [$X,XXX] |
MOE Status: [Current year expenditure ≥ prior year → Compliant / Not Compliant]
3. Item / Service Description
Describe the materials, services, or assistive technology to be purchased with IDEA Part B funds.
| Item / Service | Type | Qty | Unit Cost | Total |
|---|---|---|---|---|
| [Item 1] | [Material / AT / Service] | [#] | [$] | [$] |
| [Item 2] | [Material / AT / Service] | [#] | [$] | [$] |
| Total Requested | [$] | |||
4. Needs Assessment
Describe the specific needs of students with disabilities that this purchase addresses, supported by IEP data and assessment results.
Write 3-5 sentences grounded in student data. Reference IEP goals, assessment results, and current resource gaps.
[e.g., "Of the [XX] students with IEPs at [School Name], [XX%] have mathematics-related goals targeting number sense and operations. The most recent progress monitoring data shows that [XX%] of these students are not making adequate progress toward annual goals. Current classroom resources include only [X] sets of manipulatives shared across [X] special education classrooms, requiring teachers to improvise with non-standards-aligned materials. Occupational therapy assessments indicate [XX%] of students with SLD benefit from multi-sensory instructional approaches."]
5. IEP Alignment & Educational Purpose
Connection to IEP Goals
[Describe how this purchase directly supports specific IEP goals for the target student population. Example: "Multi-sensory math manipulatives (base-ten blocks, fraction tiles, geometric solids) support IEP goals related to number sense, operations, and geometric reasoning for students with Specific Learning Disabilities in mathematics."]
Multi-Sensory Instructional Approach
[Explain the multi-sensory methodology. Example: "These materials provide tactile, visual, and kinesthetic learning pathways aligned to the Concrete-Representational-Abstract (CRA) instructional framework recommended by the National Council of Teachers of Mathematics for students with learning differences."]
Least Restrictive Environment (LRE)
[Describe how this purchase supports LRE goals. Example: "Classroom-based manipulative kits enable students with IEPs to participate in general education math instruction with appropriate supports, reducing pull-out time and increasing inclusion."]
6. ESSA Evidence Tier — Intervention Selection
IDEA Part B encourages the use of evidence-based practices for students with disabilities. Document the evidence base for this intervention.
| Tier | Standard | Requirement |
|---|---|---|
| Tier 1 — Strong | At least 1 well-designed experimental study | Statistically significant positive effects |
| Tier 2 — Moderate | At least 1 well-designed quasi-experimental study | Statistically significant positive effects |
| Tier 3 — Promising | At least 1 correlational study with statistical controls | Positive effects with controls for selection bias |
| Tier 4 — Demonstrates Rationale | Well-defined logic model based on research | Ongoing effort to examine effects |
Evidence Citation
Cite research supporting multi-sensory or manipulative-based instruction for students with disabilities.
[e.g., "IES Practice Guide: 'Assisting Students Struggling with Mathematics' (2009, updated 2021) recommends systematic use of concrete manipulatives (Recommendation 3, Strong Evidence). The National Center on Intensive Intervention rates CRA methodology as having strong evidence for students with mathematics learning disabilities. Bouck & Park (2018) meta-analysis found significant positive effects of virtual and concrete manipulatives for students with learning disabilities (d = 0.77)."]
7. Data-Driven Decision Making
Demonstrate how IEP goal data and assessment results informed the selection of this intervention.
| Data Source | Finding | Implication for Purchase |
|---|---|---|
| [IEP Goal Progress Monitoring] | [XX% of students not meeting math goals] | [Need for multi-sensory math materials] |
| [State Assessment — SpEd subgroup] | [Math proficiency at XX% vs. XX% statewide] | [Gap requires targeted instructional tools] |
| [Teacher/Staff Survey] | [XX% report insufficient materials] | [Current resources inadequate for CRA] |
| [OT/Related Services Assessment] | [XX% benefit from tactile approaches] | [Multi-sensory materials match student needs] |
8. SMART Goals & Measurable Objectives
Define goals using the SMART framework: Specific, Measurable, Achievable, Relevant, Time-bound.
Write 2-3 SMART goals specific to students with IEPs.
[Goal 1: "By May 2027, 70% of students with mathematics-related IEP goals will demonstrate measurable progress as documented in quarterly IEP progress reports, compared to 45% baseline."]
[Goal 2: "By January 2027, inclusion rates for math instruction will increase from [X%] to [X%] as students participate more fully with manipulative-based supports in general education settings."]
[Goal 3: "By May 2027, 85% of special education teachers will implement multi-sensory materials in at least 3 lessons per week, as documented by observation logs."]
9. Eligible Use Categories
- Supplementary Aids & Services (Sec. 602(33)): Materials and supports provided in general education classes to enable children with disabilities to be educated alongside nondisabled peers
- Assistive Technology Devices (Sec. 602(1)): Any item that increases, maintains, or improves functional capabilities of a child with a disability
- Special Education (Sec. 602(29)): Specially designed instruction to meet the unique needs of a child with a disability, including instruction in the classroom and in other settings
- Related Services (Sec. 602(26)): Transportation and developmental, corrective, and other supportive services required to assist a child with a disability to benefit from special education
10. Target Population & Impact
| Metric | Value |
|---|---|
| Students with IEPs served | [Number] |
| Primary disability categories | [SLD, SLI, ASD, OHI, etc.] |
| Grade levels | [K-2, 3-5, etc.] |
| Service delivery model | [Inclusion / Resource Room / Both] |
| Total purchase cost | [$X,XXX] |
| Per-Student Cost | [Total / Students Served] |
11. Budget Narrative
Provide a prose justification explaining why each line item is necessary and how it specifically serves students with disabilities.
Connect each expenditure to IEP requirements and student needs.
[e.g., "The proposed purchase of [X] multi-sensory math kits at [$X,XXX] each directly supports [XX] students with IEP goals in mathematics across grades [X-X]. These kits were selected because they include tactile, visual, and kinesthetic components aligned to the CRA instructional framework recommended by the National Council of Teachers of Mathematics for students with learning differences. The per-student cost of $[X.XX] is cost-effective compared to specialized assistive technology alternatives ($200-$500/student) while serving a broader population. Pricing was validated against [X] vendor quotes."]
12. Implementation & Progress Monitoring
| Phase | Timeline | Action | Monitoring |
|---|---|---|---|
| Procurement | [Month] | Purchase, delivery, inventory | Order confirmation |
| Staff Training | [Month] | SpEd and gen-ed teacher PD on materials | Sign-in sheets, feedback |
| IEP Integration | [Month] | Update IEP goal progress monitoring tools | IEP team review |
| Quarterly Review | [Quarterly] | IEP progress data collection | Progress reports |
| Annual Evaluation | [Month] | Outcome analysis — IEP goal mastery rates | Annual IEP review data |
13. Evaluation Plan
| Component | Details |
|---|---|
| Evaluation Methodology | [IEP progress monitoring data + classroom observation + state SpEd subgroup data] |
| Baseline Data | [Current IEP goal mastery rate, inclusion %, assessment scores as of [date]] |
| Target Outcomes | [From SMART goals above] |
| Assessment Instruments | [IEP progress reports, CBM probes, observation rubric, state assessment SpEd subgroup] |
| Data Collection Schedule | [Quarterly IEP progress reports | Annual IEP review | State assessment annually] |
| Responsible Staff | [SpEd Director, case managers, school psychologist] |
| Reporting Cadence | [Quarterly to SpEd Director; annually to OSEP coordinator] |
14. Logic Model
| Inputs | Activities | Outputs | Short-Term Outcomes | Long-Term Outcomes | ||||
|---|---|---|---|---|---|---|---|---|
| [IDEA funds, multi-sensory kits, SpEd PD, teacher time] | → | [Teacher training on CRA, daily use in SpEd/inclusion settings, IEP goal monitoring] | → | [# SpEd teachers trained, # students with IEPs served, # lessons per week] | → | [Increased IEP goal progress, higher inclusion rates, teacher confidence with multi-sensory methods] | → | [Improved SpEd math proficiency, narrowed achievement gap, sustained inclusive practices] |
15. Sustainability Plan
Describe how the program continues after initial IDEA funding and how instructional capacity is maintained.
[e.g., "Multi-sensory manipulative kits have a 5+ year useful life with no consumable components. Year 1 professional development builds lasting instructional capacity — trained special education teachers mentor new staff through the district's SpEd induction program. The IEP process ensures continued use: as students' IEP goals reference manipulative-based instruction, materials become embedded in service delivery. Replacement kits can be funded through the district's annual IDEA Part B flow-through allocation."]