IST Initial Referral 2018-2019
Requirements:

* Two parent contacts via email, letter, phone (Five failed attempts to communicate over a two-week period, please refer to school principal) with the exception of a Related Service Concern which requires only one parent contact prior to initial referral. Please be sure to make the parent aware that you are referring their child to IST.

* Two interventions in area of concern with the exception of a stand-alone Truancy Concern, Related Service Concern or a Gifted referral.

* Please review student data on Performance Tracker

* If a parent makes a request (verbally or written) for an evaluation, a meeting will be held within 10 school days. You will be responsible to present student performance data and I/E intervention strategies at the meeting.

Email address *
Student Name *
Your answer
Date of Referral (Today's Date) *
MM
/
DD
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YYYY
Current Grade Level *
Required
Teacher Name *
Your answer
Student DOB (MM/DD/YY) *
Your answer
Parent/Guardian Contact 1 (include date and summary of communication) *
Your answer
Parent/Guardian Contact 2 (include date and summary of communication)
Your answer
Student Strength 1 *
Your answer
Student Strength 2 *
Your answer
Student Strength 3 *
Your answer
Please check any services that the student is currently receiving:
Check if the student has:
Parent made a request for Evaluation (Date request was made)
MM
/
DD
/
YYYY
Parent made a request for a 504 Service Agreement (Date request was made)
MM
/
DD
/
YYYY
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