SELPA - Independent Educational Evaluation (IEE) Review Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Sacramento County SELPA is currently updating our IEE Provider Lists and your name/agency has been provided to the Sacramento County SELPA as a person/agency who may be qualified to conduct an Independent Educational Evaluation (IEE). Please provide the following information so that your qualifications can be reviewed.

Name of Provider/Agency *

Address of Provider/Agency *

City *

County *

State *

Phone Number *

Email Address *

Name of Contact Person
*

Are you a State-Certified NPA *

Yes

Required

What is your IEE Area of Expertise? *

Please provide a brief description of your qualifications. *

What is your Billing Rate for an IEE? *

How many hours does an evaluation usually take? *

Will you be available to observe the student in the classroom and interview parents/staff?
*

Will you be available to attend the IEP meeting after the evaluation is completed?
*

What is your rate for attending an IEP?
*

Will you upload a copy of your CV or Resume to this link: https://drive.google.com/drive/folders/1ozKbadGg6YnZ0LnMTRwDkMW2R7MAGfRe?usp=sharing *

Yes

General Comments

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Sacramento County Office of Education.

Does this form look suspicious? Report

Forms