Section 5: Nonpublic School Initial Referral Transfer Referral Section 6: Occupational Therapy (OT) Initial Referral Transfer Referral Section 7: Physical Therapy (PT) Initial Referral Transfer Referral Section 8: Residential Placement Initial Referral Transfer Referral Section 9: Special Health Care Services Initial Referral Transfer Referral Section 1: Audiological Assessment Initial
The SELPA Audiological Program provides students with audiological assessment and services that will assist the student to participate and progress in the general education curriculum.
Pre-Referral Local Education Agency (LEA) Responsibility 1. Convene an Individualized Education Program (IEP) meeting to document the team’s decision to refer the student for an Audiological Assessment. 2. Complete the Initial Request for Audiological Evaluations/Services form (D/M 108) and obtain the signatures of the person making the referral and the director of special education. 3. Complete the Assessment Plan form (D/M 66) and obtain the parent/guardian signature. 4. The person making the referral should check the box that corresponds to the type of assessment(s) requested. 5. The parent/guardian should initial each applicable statement listed under the Parental Authorization section of form D/M 66.
Chapter 22 – Supports and Services, Charter SELPA As of 10/17/2019 D/M Charter SELPA Steering Committee Approval
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