Evesham Township School District Child Study Team (CST) Referral Form
What is a Referral?  

"Referral" means the written request for an initial evaluation to determine whether a student is eligible for” special education and related services (NJAC 6A:14-1.3) . A referral is made when one suspects a student (age 3-21) may have a disability due to physical, sensory, emotional, communication, cognitive or social difficulties.

Who can make a referral?

Referrals to the Child Study Team may come from the school district's instructional, administrative, and other professional staff, parents/guardians and state agencies concerned with the welfare of students.  

What happens once a referral is made?

Within 20 calendar days* of receiving a referral, the school district must hold a meeting to decide whether an evaluation is warranted.
  • School districts must, when appropriate, provide interventions in the general education setting to a student exhibiting academic difficulties, prior to referral for evaluation.
  • General education staff must keep written documentation of the type, frequency, duration and effectiveness of each intervention [6A:14-3.3(b)].
  • A student shall not be determined eligible if the determinant factor is due to a lack of instruction in reading, including the essential components of reading instruction, or mathematics, or if the student is an English language learner (ELL). [6A14-3.5]
*This time frame excludes district Board of Education holidays but does not exclude summer vacation.

For more information, please click here to review the NJDOE's Parental Rights in Special Education (PRISE).
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Email *
Student's last name *
Student's first name *
Referral type *
Current grade level *
Student's date of birth *
Student's address *
Parent/guardian preferred contact (xxx-xxx-xxxx) *
Last name of person making referral *
First name of person making referral *
Relationship to Student *
Current School *
Please note the main areas of academic/behavioral concern and/or areas of suspected disability. ETSD staff must attach documentation supporting the referral.
Has your student been through the Intervention and Referral Services (I&RS) process?
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