Referral Procedures Forward the following completed and signed documents to the attention of the Program Manager for Resolution Support Services at the SELPA. • Cover letter requesting a Functional Behavioral Assessment (FBA) (Note: the director and the NPA determine the maximum number of hours needed to conduct assessment). Please indicate which NPA the LEA is selecting to complete the FBA. • D/M 66 Assessment Plan form • D/M 63 Authorization for Use and/or Disclosure of Information form • IEP or IEP Addendum dated within one year referring the student for a behavioral intervention assessment and behavioral intervention supports • Psycho-educational evaluation dated within three years of the referral for a behavioral intervention assessment and behavioral intervention supports • Other assessments (private evaluations, Occupational Therapy (OT), Physical Therapy (PT), etc.) • Incident reports • Discipline reports Timeline for Assessment Within five business days of receipt of the completed referral packet, the Program Manager for Resolution Support Services at the SELPA will develop an Individual Service Agreement (ISA) for the NPA to conduct the assessment. The SELPA will forward the ISA to the appropriate NPA for signature. Upon receipt of the signed ISA, the SELPA will forward the referral packet to the appropriate NPA to conduct the assessment. The assessment must occur within 60 calendar days from the date the Assessment Plan was received by the LEA. Timeline for Services Upon completion of the assessment, a report will be sent to the director of special education by either the NPA that conducted the assessment or the Program Manager for Resolution Support Services at the SELPA with a request to schedule an IEP meeting. The director of special education will reconvene the IEP team to review the report findings and recommendations of the assessment and determine whether or not behavioral intervention supports services are warranted. If the IEP team agrees that services are not needed, it will be documented in the IEP notes.
Chapter 22 – Supports and Services, Charter SELPA As of 10/17/2019 D/M Charter SELPA Steering Committee Approval
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