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Model Student Information Summary Form and Mandatory Individualized Education Program (IEP) Form

The New York State Education Department (NYSED) has developed a model Student Information Summary Form and mandatory Individualized Education Program (IEP) Form for use with preschool and school-age students with disabilities. 

Student Information Summary Form

The Student Information Summary form is provided only as a model form that could, at a district's discretion, be completed to supplement a student's IEP.  Information on the model Student Information Summary form is important information for the district to document, but is not required by law or regulation to be included in a student’s IEP. School districts may modify the Student Information Summary form to add or replace the suggested fields as they deem appropriate. 

Individualized Education Program Form

The  IEP form is required for use by all local and State educational agencies in New York State, pursuant to section 200.4(d)(2) of the Regulations of the Commissioner of Education.  The State’s mandatory IEP form may be used in its current Word document format, or may be converted to another format, including a computerized format. The General Directions to Use the State’s Mandatory IEP Form provides instructions for the use of this form as Word document and information regarding each section of the State’s IEP form.

For questions regarding IEPs, please contact the Special Education Quality Assurance Office in your region or email