Section and Fields in the Referral Conference Decision form

The following table outlines the details of all the fields required to build a Student Profile.

Field name	Description	Is the field editable?	Is the field mandatory?	Data flow (From Profile)	Data flow (To Profile)	Data Source and Field Name
Student Name	Name of the student for whom the meeting has been called.	No.	Yes	Student Information	None	Populated from Student Information. Captured through the {StudentName} field.
ID	Student ID as per the Student Information System records.	No.	Yes	Student Information	None	Populated from Student Profile. Captured through the {StudentID} field.
Date of Birth	DOB of the student as per the Student Information System records.	No.	Yes	Student Information	None	Populated from Student Information Profile. Captured through the {BirthDate} field.
Age	Age of the student as of the date.	No.	Yes	None	None	Captured through the {AgeAsofReferral} field.
Grade	The academic grade the student is enrolled in or would be enrolled in.	No.	Yes	Student Information	None	Populated from Student Profile. Captured through the {Grade} field.
School	The name of the School the student is enrolled in or would be enrolled in.	No.	Yes	Student Information	None	Populated from Student Profile. Captured through the {School} field.

Meeting & Decision Schedule Information

The following table outlines the required fields for scheduling the case conference.

Field Name	Description	Is the field editable?	Is the field mandatory?	Data flow (From Profile)	Data flow (To Profile)	Data Source and Field Name
Referral Date	The date on which the Referral Meeting is scheduled.	Yes	Yes	Yes	N.A.	The {ReferralDate} field is pulled from the Referral Document regardless of whether it is finalized or not.
Referral Conference Decision Date	The date on which the Referral Decision was made. This date flows from the Referral document, Referral Date.	Yes	Yes	Yes	N.A.	Captured through the {RefDecisionDate} field.
Referral Decision	Select one of the following options: Comprehensive Evaluation No Evaluation Needed Specialized Evaluation Other (specify)	Yes	Yes	N.A	N.A.	Captured through the {ReferralDecision} and {ReferralDecisionOther} fields.

Field Name

Description

Is the field editable?

Is the field mandatory?

Data flow (From Profile)

Data flow (To Profile)

Data Source and Field Name

Referral Date

The date on which the Referral Meeting is scheduled.

Yes

N.A.

The {ReferralDate} field is pulled from the Referral Document regardless of whether it is finalized or not.

Referral Conference Decision Date

The date on which the Referral Decision was made. This date flows from the Referral document, Referral Date.

Yes

N.A.

Captured through the {RefDecisionDate} field.

Referral Decision

Select one of the following options:

Comprehensive Evaluation
No Evaluation Needed
Specialized Evaluation
Other (specify)

Yes

N.A

N.A.

Captured through the {ReferralDecision} and {ReferralDecisionOther} fields.

Parent rights under IDEA

The document titled “Information for Parents Regarding Consent”—issued by the Arkansas Department of Education Special Education Services—explains parents’ rights and agency duties around consent in the context of evaluations, special education services, and re-evaluations under the Individuals with Disabilities Education Act (IDEA) for children ages 3-21.

This section has an acknowledgement statement, which requires a signature by at least one of the parents or Guardians.

This section captures the name of the signer, the signature, and the date on which the acknowledgement was signed.

Presenting the rights to the parents

Field Name	Description	Is the field editable?	Is the field mandatory?	Data flow (From Profile)	Data flow (To Profile)	Data Source and Field Name
Method used to present rights	Select one or more of the following options: In person By Mail E-mail	Yes	Yes	N.A	N.A.	Based on the method used to present the document, one of the following fields captures the details. {ProvidedInPerson} {ProvidedByMail} {ProvidedEmail}

Field Name

Description

Is the field editable?

Is the field mandatory?

Data flow (From Profile)

Data flow (To Profile)

Data Source and Field Name

Method used to present rights

Select one or more of the following options:

In person
By Mail
E-mail

Yes

N.A

N.A.

Based on the method used to present the document, one of the following fields captures the details.

{ProvidedInPerson}
{ProvidedByMail}
{ProvidedEmail}

For each participant, their Signature and Date of signing are recorded in this section.

Referral Committee Member List

The following individuals are required to attend and sign their attendance for the meeting.

Field Name	Description	Is the field editable?	Is the field mandatory?	Data flow (From Profile)	Data flow (To Profile)	Data Source and Field Name
Parents or Guardian	You can add multiple entries under the heading ‘Parents or Guardians’. To add an additional entry, click the icon and a new row will appear. The script pulls the Name and captures the Signature and the Date of signature.	No	Yes	Student Contacts	N.A.	Populated from Student Profile and Receives Mail should be checked, referenced through Student Name Captured through the {ParentList} field.
Teacher	The script pulls the Name and captures the Signature and the Date of the signature.	Yes	Yes	Staff Profile	N.A.	Populated from the Staff Profile using the Lookup or Non-lookup feature. Captured through the {TeacherLK} field.
Principal or Designee	The script pulls the Name and captures the Signature and the Date of the signature.	Yes	Yes	Staff Profile	N.A.	Populated from the Staff Profile using the Lookup or Non-lookup feature. Captured through the {PrincipalOrDesigneeLK} field.
Others	You can add multiple entries under the heading ‘Others’. To add an additional entry, click the icon and a new row will appear. The script pulls the Name and captures the Signature and the Date of signature.	Yes	No	Staff Profile	N.A.	Populated from the Staff Profile using the Lookup or Non-lookup feature. Captured through the {OtherPart} field.

You can also rearrange the hierarchy of the people on the ‘Others’ in the Referral Committee list in any order.

To move a disability upwards in the list, use the icon.
Likewise, to move a disability downwards in the list, use the icon.

You can also delete any disability from the list by clicking the icon.

For each participant, their Signature and Date of signing are recorded in this section.

Field Name	Description	Is the field editable?	Is the field mandatory?	Data flow (From Profile)	Data flow (To Profile)	Data Source and Field Name
Public Agency Representative	Use the lookup or Non-lookup feature to search for the name. This name can be modified later	Yes	Yes	N.A.	N.A.	Captured through the {AgencyRepSign} field.
Date	When the “Will sign paper copy” checkbox is checked, the user cannot enter a date. The date value can only be edited via the digital signature process.	Conditional	No	N.A.	N.A.	Captured through the {AgencyESignDate} field.

Field Name

Description

Is the field editable?

Is the field mandatory?

Data flow (From Profile)

Data flow (To Profile)

Data Source and Field Name

Public Agency Representative

Use the lookup or Non-lookup feature to search for the name. This name can be modified later

Yes

N.A.

Captured through the {AgencyRepSign} field.

Date

When the “Will sign paper copy” checkbox is checked, the user cannot enter a date.

The date value can only be edited via the digital signature process.

Conditional

N.A.

Captured through the {AgencyESignDate} field.