SELPA Referral Procedures
a) Complete the Transfer into LEA form (DM 52) and obtain the parent/guardian signature.
b) Complete Interim IEP form (DM 68IP)
c) Complete the Nonpublic School Placement Referral form (DM 134) and obtain the signatures of the person making the referral and the director of special education. Specify the team’s preference for a specific NPS, if applicable. d) Juvenile Hall/Nonpublic School students – If the student’s last placement was a local NPS prior to being moved to a juvenile detention center, complete Interim IEP form (DM 68IP) and Authorization for Use and/or Disclosure of Information form (DM 63) if update is needed, upon the student’s return to the LEA in lieu of preparing a new transfer packet.
2.
Referral Procedures
Forward the following completed documents to the attention of the SELPA school psychologist who coordinates NPS placements.
DM 52 – Transfer into District
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• DM 134 – Nonpublic School Placement Referral
• IEP or IEP Addendum dated within one year of the transfer referral for NPS placement that documents the previous NPS placement
• Psycho-educational evaluation dated within three years of the transfer referral for NPS placement
• If the last triennial was completed with a Triennial Assessment Determination form (DM 119) , include the last full psycho- educational report. • All current assessment reports, including but not limited to, psycho-educational evaluations, functional behavioral assessment, speech assessments, occupational therapy assessments.
Pertinent medical documentation
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• Behavioral intervention plans and behavior data collection
Discipline logs
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Incident reports
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Any additional information
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CAHELP JPA Referral Procedures
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Revised 8/9/2022
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