<p> EDINBURG CONSOLIDATED INDEPENDENT SCHOOL DISTRICT</p><p>RESPONSE TO INTERVENTION PROCESS REFERRAL TO TIER IV FOR CONSIDERATION OF A SPECIAL EDUCATION FULL AND INDIVIDUAL INITIAL EVALUATION RTI-3.8</p><p>Student: DOB: ID#: Gr: Campus: ______</p><p>Date: </p><p>The Edinburg CISD RtI core team of (campus) is recommending that a full and individual initial evaluation may be needed to determine if , ID# , DOB may be qualified student with a disability under the Individuals with Disabilities Education Act (IDEA) and additionally, if qualified, to determine the types of programs and services needed to appropriately serve this student.</p><p>The campus RtI coordinator/case manager will contact the District RtI Coordinator and/or Special Education to review student data from the RtI process. Once approved, a campus representative must complete the Special Education Referral Packet. All data previously collected by the RtI core team and the completed referral packet shall be submitted to the Director of Special Education along with the written permission of the parent, guardian or adult student prior to the initiation of evaluation activities. At the time referral is provided to parent, a campus administrator or representative of Special Education must also provide the parent, guardian or adult student with a copy of the publication entitled An Explanation of Rights and Procedural Safeguards of a Parent with a Child with Disabilities in School and the Guide to the Admission, Review and Dismissal Process. A signed and dated receipt from the parent, guardian or adult student indicating their receipt of the above-mentioned publications must be obtained for RtI campus records and Special Education. The RtI Case Manager shall retain copies of the original referral, the student’s most current intervention plan, and behavior intervention plan, if appropriate. RtI services shall continue during the evaluation process.</p><p>REMINDER: A referral to Special Education should be initiated after an appropriate period of interventions with written documentation of minimal or no progress. In addition, the RtI core team must suspect that the student may have a disability (one of 13 eligibility categories) and is in need of special education and related aids or services. </p><p>RTI CORE TEAM MEMBERS CONCURRING:</p><p>______Campus Principal/Designee RtI Case Manager Regular Education Instructor</p><p>**The purpose of this form is to provide a vehicle for communication and documentation between the Edinburg CISD RtI core team and the Special Education Department of Edinburg Consolidated Independent School District.</p><p>9-2010 4-12 TEAM</p>