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Referral Forms

Referral Process

Tier 1

Do It Yourself (Site Team responsibility)

 

Tier 2

Include data sheets from Tier 1

Request for equipment and/or consult (Consider way to let each district personalize this process)

 

Tier 3

Request for assistance with assessment

Data Sheets from Tier 1 and 2

Request for Follow-up Assistance



Developing the Request for AT Services forms

Tier 2

Needed elements:

Student name/ID

School

School District

Completed by

Case Manager/Contact info

IEP goal(s) related to request

School start times

Data sheets

 

Tier 3

Same info from Tier 2 plus:

Includes an assessment plan (need further discussion about who fills this out; maybe site team, but how to stay within timelines?)

Tier 2 data sheets

Copy of current IEP and evals

Work samples in area of need if applicable




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