The Kansas State Department of Education, Special Education Services, requires a district developed plan which serves as documentation of local policies, practices, and procedures for Child Find, Screening, General Education Intervention, Referral, Notice and Consent, and Eligibility. As part of the annual LEA Application, sponsoring District USD #333 Concordia and Cooperating Districts USD #108 Washington County, USD #109 Republic County, USD #224 Clifton/Clyde and USD #426 Pike Valley agree to adopt and implement policies which conform to state and federal statutes and regulations regarding special education. These assurances to adopt district policies aligned to federal and state statutes and regulations fulfill the “policy” portion of this requirement. In addition, sponsoring District USD #333 Concordia and Cooperating Districts USD #108 Washington County, USD #109 Republic County, USD #224 Clifton/Clyde and USD #426 Pike Valley adopt the KSDE Special Education Process Handbook requirements regarding “procedures”. Adoption and implementation of practices fulfill the final requirement. The term “practices” refers to how policies and procedures are actually applied.
Documentation of District Practices is the result of collaborative efforts between general and special education staff, principals, superintendents and parents in meeting this requirement. The LCNCK appreciates your continued efforts to ensure compliance with IDEA to meet the needs of students with disabilities.
|General Education Intervention Forms|
Child Find, Screening, General Education Intervention and Referral, Notice and Consent, and Eligibility Procedures
Explanation of District practices regarding child find, screening, general education intervention and referral, notice and consent, and eligibility procedures.
General Education Documentation Form GEI 1 (Print on light blue paper)
Documentation of building level, general interventions is required for students prior to evaluation for special education eligibility. All sections of the blue General Intervention Form must be completed. Include signatures of GEI team members, parent (s) and building principal.
Observation Checklist for Speech/Language Referral Form GEI 2 SL
Documentation for speech or language concerns.
Parent Permission to Participate in Speech Improvement Sessions GEI 4 SL
Permission form for articulation only speech improvement sessions.
General Education Gifted Services Referral Form GEI 5 G
Assessing & Meeting the Needs of High Ability Students Flowchart
Documentation for referral for gifted services.
Parent Questionnaire Gifted Services Referral Form GEI 6 G
Documentation to be completed by parents for gifted referral.
Health Referral Form GEI 7 Health
Documentation to be completed for health concerns.
Occupational Therapy Referral Form GEI 9 OT
Documentation to be completed for motor concerns. Documentation must also be completed for a student currently receiving special education services with a recommendation for OT services.
Physical Therapy Referral Form GEI 10 PT
Documentation to be completed for motor concerns. Documentation must also be completed for a student currently receiving special education services with a recommendation for PT services.
School Psychologist Referral Form GEI 11 Psych
Documentation to be completed only for a student currently receiving special education services for a recommendation for School Psychologist Services.
MAP Placement Guidelines GEI 12 (Screening Students for Instructional Programs)
Measures of Academic Performance (MAP) test scores can help guide placement in appropriate instructional programs for gifted, at-risk/special-needs, and programs for each grade level.
Parent Request for Evaluation Flow Chart GEI 13
Parent request for an evaluation.
Parent/Teacher Interview Academic Concerns Form GEI 14
Documentation for referral for academic services.
Autism Spectrum Disorder Referral Form GEI 17
Documentation to be completed for Autism Spectrum Disorder concerns