Procedure – Category 5000 (Students) AR 5005.4 – SELPA Referral Procedures
and the director of special education. Specify the team’s preference for a specific NPS, if applicable. 4. Juvenile Hall/NPS students – If the student’s last placement was a local NPS prior to being moved to a juvenile detention center, complete Interim IEP form (DM 68IP) and Authorization for Use and/or Disclosure of Information form (DM 63) if update is needed, upon the student’s return to the LEA in lieu of preparing a new transfer packet.
B. Referral Procedures Forward the following completed documents to the attention of the SELPA school psychologist who coordinates NPS placements. • DM 52 – Transfer into LEA • DM 134 – Nonpublic School Placement Referral
• IEP or IEP Addendum dated within one year of the transfer referral for NPA placement that documents the previous NPS placement. • Psycho-educational evaluation dated within three years of the transfer referral for NPS placement. • If the last triennial was completed with a Triennial Assessment Determination form (DM 119), include the last full psycho- educational report. • All current assessment reports, including but not limited to, psycho-educational evaluations, functional behavioral assessment, speech assessments, occupational therapy assessments. • Pertinent medical documentation • Behavioral intervention plans and behavior data collection
• Discipline logs • Incident reports • Any additional information.
C. Timeline for Services
AR 5005.4 – SELPA Referral Procedures Desert Mountain Charter Special Education Local Plan Area (DMCS) (rev. 8/9/22)
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