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.
|
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.
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 |