Special Education Referral Process Chamberlain School District

  1. Document referral in writing using referral form.
  2. Notify Building Administrator
  3. Give referral to Special Education Director
  4. Possible members of Informal Review Team
  5. referring teacher,
  6. one other regular education teacher who has knowledge of the student or the appropriate grade level curriculum,
  7. special education director,
  8. building administrator (if possible),
  9. special education teacher,
  10. related service personnel as necessary
  11. Parent
  12. Data necessary for Informal Review
  13. Review current levels of student
  14. Grades
  15. Standardized Test Scores and CBM
  16. Academic Strengths and Weaknesses
  17. Behavior
  18. Attendance
  19. Health Issues
  20. Vision/Hearing
  21. Review previous and current interventions
  22. Assist with plan for further information if necessary
  23. Design intervention plan
  24. Director will assign or document information.
  25. Informal Review Team(IRT) will determine necessity for evaluation
  26. Evaluation not necessary
  27. Director will send prior notice to parents
  28. Evaluation necessary
  29. (IRT) will determine suspected disability and types of evaluation
  30. Complete prior notice/permission for evaluation (Director)

ChamberlainSchool District

Special Needs Referral Form

Please complete this form and return to (Valerie Johnson ).

Student: / DOB: / Grade: / Date:
Parent: / Teacher:
Address: / Referring Person:
Title:
Phone: / Administrator’s Initial:

Does the student receive Title I services: Yes No

Have the student’s parents been contacted? Yes No

Dates and outcome: ______

______

Is/Are the student’s current teacher/teachers Highly Qualified? Yes No

Medical Concerns: (Has the child been diagnosed with a medical condition, such as vision or hearing loss? Is the child on medication?):

Health Concerns:

Hearing (specify concerns)______

Vision(specify concerns)______

Fine Motor (specify concerns)______

Gross Motor (specify concerns)______

Speech/Language Concerns:

Articulation-Student substitutes one sound for another, omits a sound, or distorts a sound in his/her conversational speech.

Language-Student’s word usage is inappropriate, does not seem to understand what is said, responds inappropriately to what is said, uses incorrect sentence structure, or is unable to share thoughts and ideas clearly.

Fluency-Student blocks: cannot get words out, has jerky, unrhythmic speech, or repeats sounds, syllables, words, or phrases.

Hearing-Student has difficulty following verbal directions, doesn’t seem to listen to classroom discussions or to directions, often confuses different words with similar words, complains of frequent earaches, or is unusually attentive to speaker’s face.

Voice-Student’s voice is chronically hoarse, harsh, or strident.

Math Calculation Concerns:

Counting ObjectsRegrouping in Addition-CarryingMultiplication/Division FactsDecimals

Arithmetic ReadinessFractions – add/su/mult/divDivision Operations Subtraction Facts

Addition Facts Multiplication OperationsRegrouping in Subraction-Consumer Math

Math Reasoning Concerns:

Problems involving timeMoney ValuesWord Problems w/more than one function% Problems

Measurement ProblemsFractional partsApplying appropriate Concepts to Solve ProblemsEstimation

Problems w/o Paper/PencilInterpreting Data on Charts/maps/Graphs

Basic Reading Skills Concerns:

Identify LettersReversalsSilent lettersAdditon of Letter Sounds in Words

Word AttackSight WordsReading ReadinessOmission of Letter Sounds in Words

Consonant SoundsSyllabicationVowel SoundsDipthongs-Vowels in Combination

Reading Comprehenion Concerns:

Main ideaCause and EffectInference or Information Implied by not Stated

Sequence of EventsDetails Stated in MaterialVocabulary/Meaning of Words or Phrases in Selection

Reading Fluency Concerns:

Words per minuteVoice InflectionOral Reading FluencyRetellAccuracy

Written Expression Concerns:

Incorrect Pencil GraspReversalsPunctuation/CapitalizationLegibilitySpelling

SpellingUpper/Lower Case lettersSentence Structure – complete thoughts

AbbreviationsOrganization of paragraphs

Listening Comprehension Concerns:

Auditory Attention SpanAuditory memorySequence of EventsAnswers Questions inappropriately

Auditory DiscriminationReceptive vocabularyUnderstanding DirectionsNeeds Directions repeated

Oral Expression Concerns:

Expressive vocabularyGrammarPragmatics (Social communication)Reasoning/Problem Solving

AntonymsSynonymsSyntax (Sentence Structure)Analogies

Behavior/Emotional Problem Areas (Extreme or Excessive)

Independent ActivityGroup ActivityPeer RelationshipsWithdrawn/Moody

Attention SpanUnder ActivePassive/ShyVerbally/Aggressing

Home RelationshipsOveractiveDisruptiveUnresponsive

Mood SwingsMotivationPhysically AggressiveNon-compliant

Teacher RelationshipsOther (specify)______

MUST comment on areas checked above and include frequency and duration: ______

Initial Evaluation Process

  1. (IRT) determines need for evaluation
  2. What disabilities are being considered
  3. What evaluations are necessary
  4. Permission is completed
  5. Contact parents for input about evaluation (special education director)
  6. Complete prior notice for consent to evaluate (special education director)
  7. Evaluations must be completed within 25 school days of the date the permission is received
  8. Eligibility must be determined within 30 calendar days of the last date allowed for evaluation.

Re-evaluation Process

At least 2 months prior to eligibility date (If annual IEP falls before eligibility move up evaluation to avoid duplicate meetings.)

  1. Staff to determine necessary evaluation.
  2. Notify parents and gather input into evaluation.
  3. Complete prior notice/permission ( include parent’s rights booklet)
  4. If permission is not received within one week, resend permission indicating date evaluation will begin.
  5. Notify all individuals of date received for permission and when evaluation must be completed.

IEP Process

  1. Start planning approximately two months before IEP is due
  2. Be sure to check dates. (Evaluation or Eligibility date is the date the team meets and determines eligibility. Re-evaluation date is three year’s after that date.)
  3. Use IEP Process sheet to assist
  4. Send meeting notice to parent at least 5 days before the meeting.
  5. Schedule first meeting date at least two weeks prior to due date (probably closer to three) now to allow for rescheduling if necessary.

ESY Process

  1. Complete ESY form as soon as possible at the beginning of the school year and determine which students you will need to gather data for regression and recoupment
  2. Must have at least three data collection periods to determine eligibility
  3. Copies of ESY forms should be given to Valerie no later than March 15. If there are students you are unsure about complete the form, turn it in and attach a note about your concerns.
  4. Let Valerie know if you are interested in teaching ESY