GEI Forms
| Introduction |
The Kansas State Department of Education, Special Education Services requires documentation of district practices regarding child find, screening, general education interventions (GEI), referral, evaluation and eligibility practices and
procedures. This site includes District Policies, Practices and Procedures for 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.
NOTE: Documentation of building level, general education interventions is required for students prior to evaluation for special education eligibility. The GEI can be carried out through a school-wide approach of providing a multi-tiered system of scientifically, research-based interventions for all children or through an individual child problem solving approach. Regardless of the approach used, the focus is on designing supports for children who need additional assistance in order to be successful in the general education curriculum and environment.
| General Education Intervention Forms |
Child Find, Screening, General Education Intervention and Referral Practices and Procedures Explanation of District practices regarding screening, general education intervention and referral 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
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
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.
Social Worker or School Psychologist Referral Form GEI 11 SW/Psych
Documentation to be completed only for a student currently receiving special education services for a recommendation for Social Work or 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
Evaluation and Eligibility Explanation of District practices regarding eligibility and evaluation.
