SELPA Referral Procedures
C.
Timeline for Assessment
An assessment is not required.
D.
Timeline for Services
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 begin services. The ISA will be forwarded to the appropriate NPA for signature. Upon receipt of the signed ISA, the SELPA will forward the referral packet to the appropriate NPA to initiate services. The NPA will not begin services until the agency has a signed ISA for the student.
VIII. NONPUBLIC AGENCY (NPA) - BEHAVIORAL INTERVENTION ASSESSMENT AND SUPPORTS
A.
Pre-referral
Local Educational Agency (LEA) Responsibility
a) Convene an IEP meeting to document the team’s decision to refer the student for a behavioral intervention assessment.
b) Complete the Assessment Plan form (DM 66) and mark the appropriate boxes that correspond to observations/interviews, review of any recent assessment and “other” indicating “Functional Behavioral Assessment.” c) Complete the Authorization for Use and/or Disclosure of Information form (DM 63) upon receipt upon the signed Assessment Plan form (DM 66) and obtain the parent/guardian signature. Specify the agency’s name, if known. If not, leave the field blank.
d) The parent/guardian should initial each applicable statement listed under the Parental Authorization section of form (DM 63).
The parent/guardian should initial each applicable statement listed under the Parental Authorization section of form DM 63.
It is important to remind the parent/guardian to return forms DM 66 and DM 63 to the LEA on the date that it is signed or as soon as possible thereafter.
When the signed Assessment Plan is received by the LEA, it should be date stamped or return date written at the bottom of form DM 66.
CAHELP JPA Referral Procedures
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Revised 8/9/2022
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