Haddonfield Child Study Team Referral Form

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What is a Referral?

A referral is “the written request for an initial evaluation to determine whether a student is eligible for” (NJAC 6A:14-1.3) special education and related services. A referral is made when one suspects a student (age 3-21) may have a disability which may require special education services.

Who can make a Referral?

Referrals to the Child Study Team may come from a parent/guardian, school administrator, school staff member, a school committee such as I&RS (Intervention and Referral Services), or state agencies concerned with the welfare of the student.

What happens once a referral is made?

You will be contacted to schedule a meeting with the Child Study Team.

For more information, please visit this link to review NJDOE's Parental Rights in Special Education (PRISE).

Email *

Student's Last Name *

Student's First Name *

I confirm that I am eligible to make this referral *

Yes - I am a Teacher/Administrator/I&RS Interventionist or School Staff Member

Yes - I am the parent or Legal Guardian

Required

I confirm that the student is officially registered in the district. Please contact your home school secretary to ensure the student is in Genesis before proceeding.

*NOTE: If student is transferring to the district with an IEP or an ISP - DO NOT USE this form - instead, please return to the school registrar and submit all documents to registration.

YES

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