Special Education Referral Checklist

Required Pre-referral Documentation: Review & Feedback from SEES Staff (LSSP or Ed. Diag.) Student: ______DOB: ______ID# ______Grade___ Campus______The SEES staff member must be notified 5 school days prior to scheduling the CST. The following documents must be made available to the SEES staff member 5 school days prior to scheduling the CST either in e-CST or in paper form where applicable.

Academic  Classroom observation in the subject area of concern (required for LD referrals)

 Work samples

 Copies of all report cards (hard copies required in order to view teacher comments)

 AIMS data/scores of benchmarks, TAKS/STARR, and other assessments (if not available in eCST)

 Attendance records for last 3 years (if not documented on report cards)

Behavior (if the referral pertains to behavioral difficulties)  Behavioral observations/data (antecedent, consequence, frequency, description of behavior)

 Example of behavior contract with documentation of implementation and efficacy (may be part of eCST documentation)

 Copies of discipline referrals (if not available in eCST)

 Emotional/Behavioral Concerns Evaluation Request (if student is being referred for an ED Evaluation)

Language  Home Language Survey (hard copy required)

 Special Education/English Language Learner Referral Form (if the referral pertains to an ELL student)

 Language Proficiency Testing (Pre-LAS/LAS-LINKS within one year, if the referral pertains to an ELL student)

Health  Health/Social History Form (completed by parent)

 Vision and Hearing Screening (within one year). Student must have passed both. If failed either or both, follow-up documentation from a medical professional must be obtained.

 Medical records/outside evaluations, if relevant eCST Documentation Completed Electronically  Goal plan (goals & interventions)

 Progress monitoring over 6-9 week period (in progress monitoring section)

 Meeting records

 Service tracking records (not a substitute for progress monitoring)

1-22-2013 Other  CST Pre-referral Information Sheet

 Any previous Special Education History and/or 504 documentation

Decision after review by evaluation staff:  Referral complete, schedule CST with parent/guardian.  Resubmit to evaluation staff member with requested documentation (see checklist above).

 Consult with ______(e.g. speech/language pathologist, behavior specialist, curriculum specialist) regarding:______.

 Continue Tier II and/or III interventions; monitor progress for ______(length of time), then resubmit with new data.

 Modify Tier II and/or Tier III Interventions Plan (add, delete, or change goals and strategies); implement NEW Action Plan

 Concerns: ______

 Other: ______

Date folder returned to CST chair: ______Evaluation Staff Signature: ______

1-22-2013