Pre-Referral Local Education Agency (LEA) Responsibility
1. Complete the Transfer into LEA form (D/M 52) and obtain the parent/guardian signature. 2. Confirm the student’s current residential placement and educational services through a review of current Individualized Education Program (IEP). 3. Complete the Authorization for Use and/or Disclosure of Information form (D/M 63) and obtain the parent/guardian signature. Specify the receiving agency as the Desert/Mountain Children’s Center (DMCC). Referral Procedures Upon confirmation of prior placement, forward the following completed documents to the attention of the Nonpublic School Coordinator at the SELPA. • D/M 52 Transfer into LEA form • D/M 63 Authorization for Use and/or Disclosure of Information form • 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 • Any additional information in support of the referral 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 Nonpublic School Coordinator at the SELPA. Section 9: Special Health Care Services Initial Referral Special health care services are available for students who have special health care needs.
Pre-Referral Local Education Agency (LEA) Responsibility
Chapter 22 – Supports and Services, Charter SELPA As of 10/17/2019 D/M Charter SELPA Steering Committee Approval
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