SELPA Referral Procedures
device is registered, and that are updated through the account (i.e., Apple Store, Google Play Store, Galaxy Store, etc.), rather than traditional hardware operating system built into a desktop or laptop computing system. • Complete SELPA Low Incidence Pre-Approval Request for Mobile Computing Device form (DM 86B) . Director of special education must sign form DM 86B before the packet is submitted. The SELPA or the LEA will be responsible for purchasing the mobile computing device and educational device applications that meet criteria as educationally appropriate to the child’s functional level. The SELPA will assign the low incidence equipment/ID number, download approved device applications, and coordinate delivery and release of the equipment to the LEA/student. When the LEA purchases the equipment, this will be indicated on the LIE pre- approval request form. NOTE: Entertainment/game applications will not be permitted.
C.
Assessment for Non-Low Incidence Equipment
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. Write Assistive Technology Assessment on the line for “other.”
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 of Information form (DM 63) and obtain the parent/guardian signature. Specify the receiving a gency’s name, if known. If not, leave the field blank.
CAHELP JPA Referral Procedures
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Revised 8/9/2022
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