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GEI Forms

Introduction

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.

Speech Misarticulation Form GEI 3 SL
Rating of Speech Intelligibility in the Classroom
Documentation for articulation only 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.

Adaptive Physical Education Referral Form  GEI 8 APE
Documentation to be completed only for a student currently receiving special education services with a recommendation for APE services.

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.

DIBELS Benchmark goals GEI 15 (Screening Students for Instructional Programs)
Dynamic Indicators of Basic Early Literacy Skills can help guide placement in appropriate instruction programs for gifted, at-risk/special-needs, and programs for grade levels K-6.

DIBELS Benchmark GEI 16 (Screening Students for Instructional Programs)
Dynamic Indicators of Basic Early Literacy Skills can help guide placement in appropriate instruction programs for gifted, at-risk/special-needs, and programs for grade levels K-12.

Autism Spectrum Disorder Referral Form
GEI 17
Documentation to be completed for Autism Spectrum Disorder concerns

Autism Interdisciplinary Assessment Flowchart
GEI 18

 

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LCNCK219 W 7th StreetConcordia, KS  66901

785.243.3294

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