Procedure – Category 5000 (Students) AR 5005.4 – SELPA Referral Procedures
• If services are not deemed appropriate, the referral will be closed. • If services are deemed appropriate, a clinician will be assigned, and services will begin. The DMCC provides a monthly report to the directors of special education. The report includes a list of students who are currently served by the DMCC as well as an update for each referral that is in process.
6.0
Nonpublic Agency (NPA) – Behavioral Intervention Assessment Only A. Pre-referral LEA Responsibility:
1. Convene an IEP meeting to document the team’s decision to refer the student for a behavioral intervention assessment. 2. Complete the Assessment Plan form (DM 66) and mark the appropriate boxes that correspond to observations/interviews, review of any recent assessment, and “other” indicating “Functional Behavioral Assessment.” 3. Complete the Authorization for Use and/or Disclosure of Information form (DM 63) upon receipt of the Assessment Plan form (DM 66) and obtain the parent/guardian signature. Specify the agency’s name, if known. If not, leave the field blank. The parent/guardian should initial each applicable statement listed under the Parental Authorization section of form DM 66. It is important to remind the parent/guardian to return forms DM 66 and DM 63 to the LEA on the date that it is signed or as soon as possible thereafter. When the signed Assessment Plan is received by the LEA, it should be date stamped or return date written at the bottom of form DM 66. 4. Identify the NPA assessor to complete the assessment within the 60-day timeline.
B. Referral Procedures
AR 5005.4 – SELPA Referral Procedures Desert Mountain Charter Special Education Local Plan Area (DMCS) (rev. 8/9/22)
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