Procedure – Category 5000 (Students) AR 5005.4 – SELPA Referral Procedures
• Behavioral intervention plans and behavior data collection • Discipline logs • If the last triennial was completed with a Triennial Assessment Determination form (DM 119), include the last psycho-educational report. • Any additional information. C. Timeline for Services Within ten business days of receipt of the completed referral packet, the SELPA school psychologist who coordinates NPS placements will review the packet for completion and forward it to the LEA’s NPS of choice. The NPS will contact the parent/guardian and placement will be made within ten business days. The NPS will work directly with the LEA to schedule an IEP within 30 days of the student’s placement at the school. The placement should be listed on an IEP or IEP Addendum including the NPS, start date, duration, and frequency. The IEP or IEP Addendum should be forwarded to the SELPA school psychologist who coordinates NPS placements. Within five business days of receipt of the Addendum to the IEP, the SELPA school psychologist will develop a Master Contract with the NPS if one does not currently exist and an ISA. The ISA will be forwarded to the appropriate NPS for signature. The SELPA will enter the NPS placement into the IEP system.
9.2
Transfer Referral A. Pre-referral
LEA Responsibility: 1. Complete the Transfer into LEA form (DM 52) and obtain the parent/guardian signature. 2. Complete Interim IEP form (DM 68IP). 3. Complete the Nonpublic School Placement Referral form (DM 134) and obtain the signatures of the person making the referral
AR 5005.4 – SELPA Referral Procedures Desert Mountain Charter Special Education Local Plan Area (DMCS) (rev. 8/9/22)
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