Get the free Pre-Referral Checklist

Student name: Referral ChecklistDate: K12 Students Is this Special Education Referral Appropriate for an English Language Learner? This checklist helps school personnel to collect pertinent information

How to fill out pre-referral checklist

How to fill out pre-referral checklist

1. Start by gathering any relevant documentation or information about the student, such as previous assessments or behavior records.
2. Review the pre-referral checklist form to familiarize yourself with the sections and criteria that need to be filled out.
3. Begin by providing basic information about the student, such as their name, grade level, and primary language.
4. Proceed to fill out each section of the checklist, addressing areas such as academic performance, behavior concerns, and any potential learning disabilities or special needs.
5. Use specific examples or observations to support your responses and ensure accuracy.
6. If applicable, include information about any interventions or accommodations that have already been tried or implemented for the student.
7. Once all sections are completed, review the checklist to ensure all necessary information has been provided and that it is clear and concise.
8. Sign and date the checklist to indicate your completion and keep a copy for your records.
9. Submit the pre-referral checklist to the appropriate staff or department who will further evaluate the student's needs and determine next steps.

Who needs pre-referral checklist?

1. A pre-referral checklist is typically needed by educators, school psychologists, or other professionals in the education field who suspect that a student may require additional support or special education services.
2. It is used as an initial step in the referral process and helps to gather information and evaluate a student's needs before determining if a formal evaluation or assessment is necessary.

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What is pre-referral checklist?

The pre-referral checklist is a document used to evaluate a student's needs before referring them for special education services.

Who is required to file pre-referral checklist?

Teachers, school administrators, or other educational professionals may be required to file the pre-referral checklist.

How to fill out pre-referral checklist?

The pre-referral checklist should be completed by providing information about the student's academic performance, behavior, and any interventions that have been tried.

What is the purpose of pre-referral checklist?

The purpose of the pre-referral checklist is to gather information about a student's needs and determine if they require special education services.

What information must be reported on pre-referral checklist?

Information that must be reported on the pre-referral checklist includes the student's name, date of birth, current grade level, disabilities, and any interventions that have been tried.