SELPA Referral Procedures
Low incidence disability is defined in California Education Code § 56026.5 as a severe disabling condition with an expected incidence rate of less than one percent of the total statewide enrollment in kindergarten through grade 12. For purposes of this definition, severe disabling conditions are hearing impairments, vision impairments, and severe orthopedic impairments, or any combination thereof. For purposes of this definition, vision impairments do not include disabilities within the function of vision specified in Section 56338.
1.
Pre-referral
Local Educational Agency (LEA) Responsibility
a) Convene an IEP meeting to document the team’s decision to refer the student for an Assistive Technology (AT) Assessment.
b) Complete the Assistive Technology Assessment Referral form (DM 127) 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. d) Complete the Authorization for Use and/or Disclosure form (DM 63) and obtain the parent/guardian signature. Specify the receiving agency’s name, if known. If not, leave the field blank.
2.
Referral Procedures
Forward the following completed documents to the attention of the Program Manager for Resolution Support Services at the SELPA.
• DM 127 – Assistive Technology Assessment Referral
DM 66 – Assessment Plan
•
• DM 63 – Authorization for Use and/or Disclosure of Information
• IEP or IEP Addendum dated within one year of the referral for an Assistive Technology Assessment
• Psycho-educational evaluation dated within three years of the referral for an Assistive Technology Assessment.
CAHELP JPA Referral Procedures
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Revised 8/9/2022
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