SELPA Referral Procedures
This referral handbook was developed by the California Association of Health and Education Linked Professions (CAHELP), a Joint Powers Authority (JPA), to assist participating local educational agencies (LEAs) in the Desert/Mountain Special Education Local Plan Area (SELPA) and the Desert/Mountain Charter SELPA (hereinafter referred to as “SELPA”) in the referral processes for special education and related services and behavioral health programs.
I.
AUDIOLOGICAL ASSESSMENT
A.
Initial Referral
The SELPA Audiological Program provides students with audiological assessment and services that will assist the students to participate and progress in the general education curriculum.
1.
Pre-referral
Local Educational Agency (LEA) Responsibility)
a) Convene an Individualized Education Program (IEP) meeting to document the team’s decision to refer the student for an audiological assessment. b) Complete the Initial Request for Audiological Evaluations/Services form (DM 108) and obtain the signatures of the person making the referral and the director of special education.
c) Complete the Assessment Plan form (DM 66) and obtain the parent/guardian signature.
The person making the referral should check the box that corresponds to the type of assessment(s) requested.
The parent/guardian should initial each applicable statement listed under the Parental Authorization section of form DM 66.
LEAs are encouraged to have assessment plans signed close to the date of their LEA audiology evaluation date and within the required 60-day assessment time frame. d) Complete the Authorization for Use and/or Disclosure of Information form (DM 63) and obtain the parent/guardian signature. Specify the receiving agency’s name as the SELPA/Pacific Hearing Services. The disclosing agency will vary depending on whether it is a physician, medical center, or audiologist.
CAHELP JPA Referral Procedures
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Revised 8/9/2022
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