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Local Education Agency Referral Form Please complete this form for referring a child to early intervention if you prefer to do so in writing. Also, please indicate the feedback that you want to receive
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How to fill out local education agency referral

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How to Fill Out a Local Education Agency Referral:

01
Contact Information: Begin by providing your contact information at the top of the referral form. This includes your name, address, phone number, and email address.
02
Student Information: Fill out all necessary details regarding the student for whom the referral is being made. This may include the student's name, age, grade level, and any relevant identification numbers such as student ID or special education ID.
03
Reason for Referral: Clearly state the reason for the referral. This could involve concerns about the student's academic performance, behavior, social or emotional well-being, or need for special education services. Be specific and provide as much information as possible to help the local education agency understand the situation.
04
Supporting Documentation: Attach any supporting documents that provide additional context or evidence regarding the referral. This might include academic records, assessment results, behavioral incident reports, or notes from conversations with parents, teachers, or other professionals involved with the student.
05
Educational Background: Provide a summary of the student's educational history, including previous schools attended, any previous interventions or accommodations implemented, and outcomes of those efforts.
06
Parent or Guardian Input: It is essential to involve parents or guardians in the referral process. Include a section for their input, concerns, or observations about the student's needs, preferences, or any specific challenges they might have noticed.
07
Signature and Date: Ensure that the referral form includes a section for your signature and the date of submission. This signifies that you have reviewed and completed the referral accurately.

Who Needs a Local Education Agency Referral?

01
Teachers: Teachers who observe persistent academic, behavioral, or emotional challenges in a student may need to complete a referral to seek additional support or interventions.
02
School Counselors: School counselors may identify students who require specialized services or interventions to address social or emotional difficulties that impact their educational progress.
03
Special Education Staff: Special education staff members, including teachers, case managers, or evaluators, may initiate a referral for a student who they believe may benefit from an Individualized Education Program (IEP) or other special education services.
04
School Administrators: Principals or other administrators might involve themselves in the referral process if they become aware of significant concerns related to a student's well-being or academic progress.
In summary, filling out a local education agency referral involves providing accurate student and contact information, clearly stating the reason for the referral, including supporting documentation, summarizing the student's educational background, obtaining parent input, and signing and dating the form. Teachers, school counselors, special education staff, and school administrators may all require a local education agency referral to address various student needs.

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