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This document provides instructions for conducting an interview aimed at assessing children and adolescents who are experiencing significant difficulties and facilitates their referral to appropriate
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How to fill out interview for assessment referral

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How to fill out Interview for Assessment & Referral for Specialized Services

01
Gather necessary personal information of the individual being assessed.
02
Prepare any relevant documentation required for the assessment process.
03
Schedule the interview at a convenient time for the individual.
04
Introduce yourself and explain the purpose of the interview.
05
Ask questions about the individual's background and current situation.
06
Assess the specific needs of the individual related to specialized services.
07
Record all responses accurately for future reference.
08
Discuss potential referrals to appropriate specialized services based on the assessment.
09
Provide the individual with information on next steps and available resources.
10
Thank the individual for their time and conclude the interview.

Who needs Interview for Assessment & Referral for Specialized Services?

01
Individuals who require specialized services in areas such as mental health, developmental disabilities, or other specific needs.
02
Families or caregivers of individuals seeking support and resources.
03
Professionals or organizations looking to facilitate access to specialized services for individuals in need.
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A copy of the written request should go to the Building Principal and Director of Special Services. The document should include the reason for the referral and details describing academic or behavioral concerns. Once the request is made, the team will determine if an evaluation is warranted.
In NYC, the special education preschool and school age children are coordinated by the Department of Education (DOE). To seek an evaluation for your child, email a letter to your local Committee on Preschool Special Education (CPSE). Find your district and CPSE by visiting the page “Find a School Tool” at schoolsearch.
Clearly articulate what occurred that necessitates a skilled therapy evaluation and intervention. If therapy is sought for a decline in function, specify what tasks the patient is currently unable to perform that they could do independently before the referral. Finally, consider including a timeline.
Model Letter I am writing to request that my son/daughter, (child's name), be evaluated for special education services. I am worried that (child's name) is not doing well in school and believe he/she may need special services in order to learn. (Child's name) is in the ( _ ) grade at (name of school).
(1) Within 60 school days of the receipt of consent to evaluate for a student not previously identified as having a disability, or within 60 school days of the referral for review of the student with a disability, the board of education shall arrange for appropriate special programs and services, except that if such
The referral is the starting point of the special education process. A referral is simply a request for an evaluation. This referral can be made by the parent or guardian, the classroom teacher, any member of the school district (public or private).
Each letter you write should include the following basic information: Put the date on your letter. Give your child's full name and the name of your child's main teacher or current class placement. Say what you want, rather than what you don't want. Give your address and a daytime phone number where you can be reached.
"People with disabilities" or "individuals who use wheelchairs" places people first. Some folks may also prefer "disabled person" or "D/deaf student" or "autistic individual." Treat disability identity as you would any other name or pronoun - just ask the person what they prefer to be called!

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The Interview for Assessment & Referral for Specialized Services is a process used to evaluate an individual's needs and determine the appropriate specialized services they may require.
Individuals seeking specialized services or their representatives are required to file the Interview for Assessment & Referral for Specialized Services.
To fill out the Interview for Assessment & Referral for Specialized Services, you need to provide personal information, describe the individual's needs, and indicate any previous services received.
The purpose of the Interview for Assessment & Referral for Specialized Services is to comprehensively assess an individual’s needs and facilitate access to appropriate services.
Essential information to report includes the individual's demographic details, specific needs, any prior assessments, and relevant medical or psychological history.
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