Special Programs Arkansas

Referral Information Profile

This profile is designed to collect and convey referrals for services and support information.

The Referral Information Profile is crucial for guiding decisions about further evaluations or the development of an Individualized Education Program (IEP) for students who qualify for special education services. Additionally, it ensures that all pertinent information is considered when planning interventions or accommodations.

The form consists of nine fields in total. The first four fields are mandatory and establish the workflow from the Referral Profile to the creation of the Evaluation or Reevaluation Notice.

Section and Fields in the Referral Information Profile

Referral Information

Field Name

Description

Data Flow

Source

Student

Name of the student for whom the meeting has been called.

In

NA

Date of Referral

The date on which this evaluation or referral was proposed.

Out

NA

Type of Referral

Type of evaluations for which the student has been referred.

The drop-down shows the following options.

  1. (none)

  2. First Steps

  3. Initial Evaluation

  4. Initial Expedited Evaluation

  5. Initials following a lack of progress in response to interventions

  6. Move-in Review

  7. Reevaluation Review

Out

NA

Name of Person(s) Referring Child

The person(s) who have recommended the evaluation or referral.

Out

NA

Date of Notice of Evaluation

The date when the notice of evaluation was sent to the Parent or Guardian.

Out


Parent Response to Evaluate

Response given by the Parent or Guardian about giving consent for this evaluation or referral.

Out

NA

Parent Consent to Evaluate

The date on which this consent response was given.

Note: A Parent or Guardian has the authority and the privilege to give consent.

  • They can give consent and later withdraw it.

  • They can initially deny and later agree.

In either case, the system will always consider the latest consent status and the date it was given.

Out

NA

Additional Information

List all other details regarding the case that might need to be captured.

Out

NA

Evaluation Timelines

Field Name

Description

Data Flow

Source

Initial Evaluation Due Date

The last date by which the initial evaluation must be completed under state timelines.

Out

NA

Initial Evaluation Date

The actual date the student’s initial evaluation was completed.

Out

NA

Timely - Met 60-Day Evaluation

Marks whether the evaluation was completed within the required 60-day timeline.



Untimely - Did Not Meet 60-Day Evaluation

Marks if the evaluation exceeded the 60-day timeline.



Reason Evaluation Exceeded 60-Day Timeline

Reason for any delay beyond the 60-day evaluation period.



Eligibility Timelines

Field Name

Description

Data Flow

Source

Initial Eligibility Due Date

Date by which the eligibility determination must be completed following evaluation.

Out

NA

Initial Eligibility Determined Date

Actual date, when the eligibility determination was finalized.

Out

NA

Initial Eligibility Outcome

Result of the eligibility determination (e.g., Eligible, Not Eligible).



Timely - Met 30-Day Eligibility

Indicates eligibility was determined within the 30-day requirement.



Untimely - Did Not Meet 30-Day Eligibility

Indicates the 30-day requirement was not met.



Reason Eligibility Exceeded 30-Day Timeline

Reason for exceeding the 30-day eligibility determination timeline.



Early Childhood Elig. Determ. Due Date

Date by which eligibility must be determined for early childhood students.



Early Childhood Elig. Determ. Exceeds 3rd Bday

Marks if eligibility determination extended beyond the student’s 3rd birthday.



Reason EDD Exceeded 3rd Birthday

Reason for delay past the student’s 3rd birthday.



Placement Decision

Field Name

Description

Data Flow

Source

Date of Decision

Date when the placement decision was made.

Out

NA

Reason for Completion

Indicates why the referral process was completed or closed.



3rd Birthday Temp IEP

Marks whether a temporary IEP was created for a child transitioning on their 3rd birthday.



SPED Placement

Specifies if the student was placed in a Special Education program.



Early Intervening Services

Indicates whether early intervening services were provided prior to SPED placement.



Parent Response to Initial Placement

Records the parent’s response to the proposed initial placement.



Parent Consent to Place:

Date when the parent consent for placement was received.



Early Childhood

Field Name

Description

Data Flow

Source

Transitioning from Part C

Indicates whether the child is transitioning from IDEA Part C (Early Intervention services for ages 0–2) to Part B (Preschool Special Education services for ages 3–5).

Out

NA

Part C & B Concurrent

Marks if the child is concurrently receiving services under both Part C and Part B programs.



File Attachments

Field Name

Description

Data Flow

Source

File Attachments

Allows users to upload and store relevant referral documents or supporting files.

Out

NA