Please note: Be sure to attach all current evaluations, reports, prescriptions, etc. for any Related Services. An Intake Conference will not be scheduled or a placement decision made without complete referral material on files.

The following records should be included with this Referral Form:

· *Current IEP

· * Recent Social History

· *Recent Psychological Evaluation

· *Health and Immunization Records

· *Other Educational, Diagnostic or Anecdotal Records

· * Academic Achievement Data

· *Transcripts (as appropriate)

· *Disciplinary Records

· * Related Service Evaluations, Prescriptions, etc.

· *Behavior Intervention Plan