<p>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.</p><p>Academic  Classroom observation in the subject area of concern (required for LD referrals)</p><p> Work samples</p><p> Copies of all report cards (hard copies required in order to view teacher comments)</p><p> AIMS data/scores of benchmarks, TAKS/STARR, and other assessments (if not available in eCST)</p><p> Attendance records for last 3 years (if not documented on report cards)</p><p>Behavior (if the referral pertains to behavioral difficulties)  Behavioral observations/data (antecedent, consequence, frequency, description of behavior)</p><p> Example of behavior contract with documentation of implementation and efficacy (may be part of eCST documentation)</p><p> Copies of discipline referrals (if not available in eCST)</p><p> Emotional/Behavioral Concerns Evaluation Request (if student is being referred for an ED Evaluation)</p><p>Language  Home Language Survey (hard copy required)</p><p> Special Education/English Language Learner Referral Form (if the referral pertains to an ELL student)</p><p> Language Proficiency Testing (Pre-LAS/LAS-LINKS within one year, if the referral pertains to an ELL student)</p><p>Health  Health/Social History Form (completed by parent)</p><p> 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.</p><p> Medical records/outside evaluations, if relevant eCST Documentation Completed Electronically  Goal plan (goals & interventions)</p><p> Progress monitoring over 6-9 week period (in progress monitoring section)</p><p> Meeting records </p><p> Service tracking records (not a substitute for progress monitoring)</p><p>1-22-2013 Other  CST Pre-referral Information Sheet </p><p> Any previous Special Education History and/or 504 documentation</p><p>Decision after review by evaluation staff:  Referral complete, schedule CST with parent/guardian.  Resubmit to evaluation staff member with requested documentation (see checklist above).</p><p> Consult with ______(e.g. speech/language pathologist, behavior specialist, curriculum specialist) regarding:______.</p><p> Continue Tier II and/or III interventions; monitor progress for ______(length of time), then resubmit with new data.</p><p> Modify Tier II and/or Tier III Interventions Plan (add, delete, or change goals and strategies); implement NEW Action Plan</p><p> Concerns: ______</p><p> Other: ______</p><p>Date folder returned to CST chair: ______Evaluation Staff Signature: ______</p><p>1-22-2013</p>