Procedure – Category 5000 (Students) AR 5005.4 – SELPA Referral Procedures
• DM 52 – Transfer into LEA • DM 63 – Authorization for Use and/or Disclosure of Information • IEP or IEP Addendum dated within one year that documents the previous residential placement. • Psycho-educational evaluation dated within three years of the referral for residential placement. • Forward the Interim Placement packet form (DM 68IP). • Any additional information in support of the referral. C. Timeline for Services The new LEA of residence will schedule an IEP team meeting within 30 days of the transfer to document the new placement. The placement should be listed on an IEP or IEP Addendum including the NPS, residential placement, start date, duration, and frequency. The IEP or IEP Addendum should be forwarded to the SELPA school psychologist who coordinates RTC placements.
13.0 Special Health Care Services
13.1 Initial Referral Special health care services are available for students who have special health care needs. A. Pre-referral LEA Responsibility; 1. Convene an IEP meeting to document the team’s decision to refer the student for special health care services.
2. Complete the Special Health Care Services Referral form (DM 148) and obtain the signatures of the person making the referral and the director of special education. 3. Complete the Authorization for Use and/or Disclosure of Information form (DM 63) and obtain the parent/guardian
AR 5005.4 – SELPA Referral Procedures Desert Mountain Charter Special Education Local Plan Area (DMCS) (rev. 8/9/22)
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