5. It is important to remind the parent/guardian to return forms D/M 66 and D/M 63 to the LEA on the date that it is signed or as soon as possible thereafter. 6. When the signed Assessment Plan is received by the LEA, it should be date stamped or return date written at the bottom of form D/M 66. 7. The LEA identifies the Nonpublic Agency (NPA) assessor to complete the assessment within the 60-day timeline. 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 • Psycho-educational evaluation dated within three years of the referral for a behavioral intervention assessment • Other assessments (private evaluations, Occupational Therapy (OT), Physical Therapy (PT), etc.) • Behavior plans (original and revised versions) • Incident reports • Discipline reports/log 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 ISA will be circulated for required signatures by the SELPA and the NPA provider. 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. Upon completion of the assessment, the NPA will send the written report to the director of special education for the LEA and the Program Manager for Resolution Support Services at the SELPA.
Chapter 5 – Supports and Services, Desert/Mountain SELPA As of 10/18/19 D/M SELPA Steering Committee Approval
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