Office of Special Education February 2013 Educable Child.

Office of Special Education

February 2013Educable Child

Agenda

• School District Application• Required Documents• Payments/Reimbursements• Reminders

February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 2

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• Section 1: Information Pertaining to StudentFill in ALL blanksDate of eligibility

matches date on IEP form

Date of IEP matches date on IEP form

Circle the child’s disability – (only one)

• SCHOOL DISTRICT APPLICATION

February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education

MISSISSIPPI DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION

EDUCABLE CHILD PROGRAM P.O. BOX 771, SUITE 301

JACKSON, MS 39205 PUBLIC SCHOOL DISTRICT APPLICATION for financial assistance when placing a student with a disability in a private school/facility (YELLOW FORM)

SESSION 20______ - 20______

Section 1, 2 and 3 must be completed by Public School District

Application MUST BE COMPLETE (Please Type or Print)

1. INFORMATION PERTAINING TO STUDENT Name _____________________________________________________________________________________________ (Last) (First) (Middle) Date of Birth____________________________________________Age__________Sex__________Race______________ (Month) (Day) (Year) The above-named student resides in the___________________________________________________________

(Name of Public School District)

At this time placement in this district is not in accordance with the best educational practices and the district recommends placement at______________________________________________________________________

(Name of Private School) MSIS # _____________________________ DATE OF ELIGIBILITY: ________________ DATE OF IEP _______________________ IEP REVISION DATE __________ TYPE OF DISABILITY (Circle the Child’s Disability)

2. INFORMATION PERTAINING TO PUBLIC SCHOOL DISTRICT TO WHICH WARRANT SHOULD BE

MAILED Name of School District__________________________________________________________________ Address_______________________________________________________________________________ (Street, Route and/or Box No.) City_________________________________ State_______________________ Zip_________________ Phone_______________________________

1. Intellectual Disability 2. Specific Learning Disability 8. Other Health Impairment 3. Language/Speech Impaired 9. Multiple Disabilities 4. Hearing Impaired 10. Autism 5. Visually Impaired 11. Developmentally Delayed 6. Deaf-Blind 12. Traumatic Brain Injury 7. Emotional Disability 13. Orthopedic Impairment

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• Section 2: Information Pertaining To Public School District to which warrant Should Be Mailed.

Indicate where the reimbursement is to be mailed

• SCHOOL DISTRICT APPLCIATION


MISSISSIPPI DEPARTMENT OF EDUCATION OFFICE OF SPECIAL EDUCATION

EDUCABLE CHILD PROGRAM P.O. BOX 771, SUITE 301

JACKSON, MS 39205 PUBLIC SCHOOL DISTRICT APPLICATION for financial assistance when placing a student with a disability in a private school/facility (YELLOW FORM)

SESSION 20______ - 20______

Section 1, 2 and 3 must be completed by Public School District

Application MUST BE COMPLETE (Please Type or Print)

1. INFORMATION PERTAINING TO STUDENT Name _____________________________________________________________________________________________ (Last) (First) (Middle) Date of Birth____________________________________________Age__________Sex__________Race______________ (Month) (Day) (Year) The above-named student resides in the___________________________________________________________

(Name of Public School District)

At this time placement in this district is not in accordance with the best educational practices and the district recommends placement at______________________________________________________________________

(Name of Private School) MSIS # _____________________________ DATE OF ELIGIBILITY: ________________ DATE OF IEP _______________________ IEP REVISION DATE __________ TYPE OF DISABILITY (Circle the Child’s Disability)

2. INFORMATION PERTAINING TO PUBLIC SCHOOL DISTRICT TO WHICH WARRANT SHOULD BE

MAILED Name of School District__________________________________________________________________ Address_______________________________________________________________________________ (Street, Route and/or Box No.) City_________________________________ State_______________________ Zip_________________ Phone_______________________________

1. Intellectual Disability 2. Specific Learning Disability 8. Other Health Impairment 3. Language/Speech Impaired 9. Multiple Disabilities 4. Hearing Impaired 10. Autism 5. Visually Impaired 11. Developmentally Delayed 6. Deaf-Blind 12. Traumatic Brain Injury 7. Emotional Disability 13. Orthopedic Impairment

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• Section 3: Certification of Public School District

Indicate the name of the student

Indicate source of financial assistance and amount

Have Superintendent sign and date (blue ink is preferred to indicate original copies)

• SCHOOL DISTRICT APPLICATION


3. CERTIFICATION OF PUBLIC SCHOOL DISTRICT Application for financial assistance, as provided by Senate Bill 2620, Regular Session 1978, is hereby

made for _____________________________________________________________________________. (Name of Student) The educational options have been discussed with the student’s parent(s) and written parental permission for placement at the school named in Section 4 is on file in this school district. Other financial assistance provided for this child’s tuition is as follows [Name the various sources of payment (i.e., SSI, welfare, insurance, scholarships) as well as the amount of financial assistance from each source]: SOURCE(S) _____________________________________ AMOUNT(S) __________________________ If financial assistance is made available, I hereby agree to: a) Furnish the State Department of Education or its authorized agent such information as it may request

concerning the attendance of the student for whom financial assistance is requested; b) Return such funds if the student fails to attend and to notify the State Department of Education immediately of the date the student discontinues attendance; c) Notify promptly the school and the State Department of Education of any change in my address or of

the student for whom financial assistance is granted by submitting a written that statement. I hereby certify that financial assistance is requested for the sole purpose of paying tuition at a private school/facility providing educational service to this child with a disability. I understand that if financial assistance is sought, obtained or expended for any purpose other than that set forth in the statute and in the regulations of the State Department of Education, I shall be liable as provided by Senate Bill 2620, regular Session 1978 (Educable Child Program). The information submitted in this application is true and correct to the best of my knowledge and belief. I am aware that only claims for assistance with the approved signature and address below will be honored. ______________________________ ___________________________________________

(Date) (District Superintendent’s Signature) 4. INFORMATION PERTAINING TO PRIVATE SCHOOL/FACILITY (To be completed by private

School/Facility) Name of School_________________________________________________________________________ Address____________________________________________ _________________ _______ _______ (Street, Route and/or Box No.) (City/Town) (State) (Zip)

I, being the Duly Authorized Official of the above-named school, certify that the above-named student has been accepted and is in actual attendance in the school session from:

__________________ - ______________________ School Program: _________________________ (Date services began) (Date school session ends) (Total number of session days)

Tuition cost for this period of time $__________.

I certify that the above-named school is a private school/facility meeting all requirements of the Mississippi Department of Education in which the institution is located to provide educational services for children with disabilities. I understand that both an eligibility ruling and meeting to develop an Individualized Educational Program for this student must have taken place before any financial assistance may be obtained. This student’s Determination of Eligibility Report, Assessment Team Report and Individualized Education Program are attached.

________Psychiatric Day Treatment ________Intermediate Care Facility for the Mentally Retarded (ICF-MR) ________Psychiatric Residential Treatment Facility (PRTF) _________________________ _________________________________________ (Date) (Signature and Title of Private School Official)

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• Section 4: Information Pertaining To Private School/Facility

Completed by the private school/facility

Date services began is date of enrollment

Date session ends is last day of school (remember Ed Child only reimburses for 180 days)

Indicate type of placement Sign and dated by the Private

School Official

• SCHOOL DISTRICT APPLCIATION


3. CERTIFICATION OF PUBLIC SCHOOL DISTRICT Application for financial assistance, as provided by Senate Bill 2620, Regular Session 1978, is hereby

made for _____________________________________________________________________________. (Name of Student) The educational options have been discussed with the student’s parent(s) and written parental permission for placement at the school named in Section 4 is on file in this school district. Other financial assistance provided for this child’s tuition is as follows [Name the various sources of payment (i.e., SSI, welfare, insurance, scholarships) as well as the amount of financial assistance from each source]: SOURCE(S) _____________________________________ AMOUNT(S) __________________________ If financial assistance is made available, I hereby agree to: a) Furnish the State Department of Education or its authorized agent such information as it may request

concerning the attendance of the student for whom financial assistance is requested; b) Return such funds if the student fails to attend and to notify the State Department of Education immediately of the date the student discontinues attendance; c) Notify promptly the school and the State Department of Education of any change in my address or of

the student for whom financial assistance is granted by submitting a written that statement. I hereby certify that financial assistance is requested for the sole purpose of paying tuition at a private school/facility providing educational service to this child with a disability. I understand that if financial assistance is sought, obtained or expended for any purpose other than that set forth in the statute and in the regulations of the State Department of Education, I shall be liable as provided by Senate Bill 2620, regular Session 1978 (Educable Child Program). The information submitted in this application is true and correct to the best of my knowledge and belief. I am aware that only claims for assistance with the approved signature and address below will be honored. ______________________________ ___________________________________________

(Date) (District Superintendent’s Signature) 4. INFORMATION PERTAINING TO PRIVATE SCHOOL/FACILITY (To be completed by private

School/Facility) Name of School_________________________________________________________________________ Address____________________________________________ _________________ _______ _______ (Street, Route and/or Box No.) (City/Town) (State) (Zip)

I, being the Duly Authorized Official of the above-named school, certify that the above-named student has been accepted and is in actual attendance in the school session from:

__________________ - ______________________ School Program: _________________________ (Date services began) (Date school session ends) (Total number of session days)

Tuition cost for this period of time $__________.

I certify that the above-named school is a private school/facility meeting all requirements of the Mississippi Department of Education in which the institution is located to provide educational services for children with disabilities. I understand that both an eligibility ruling and meeting to develop an Individualized Educational Program for this student must have taken place before any financial assistance may be obtained. This student’s Determination of Eligibility Report, Assessment Team Report and Individualized Education Program are attached.

________Psychiatric Day Treatment ________Intermediate Care Facility for the Mentally Retarded (ICF-MR) ________Psychiatric Residential Treatment Facility (PRTF) _________________________ _________________________________________ (Date) (Signature and Title of Private School Official)

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• Justification for Placement

• Name of Child _______________________________

Date of Birth _______________

• 1.SPECIFIC reasons that the above-named student

cannot be provided a FAPE in an existing or a

• modified program in the

___________________________________________• School District are:

______________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________________

• Note: Please attach pertinent documentation such as psychological recommendation reports or letters.

• Justification For Placement All seven (7) items must be

completed

March 2012 Office of Instructional Enhancement and Internal Operations/Office of Special Education

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2. The following State-funded institutions (i.e., East MS or MS State Hospital, Hudspeth, Ellisville, North or South MS Regional Centers) have been contacted to determine if placement would be appropriate: ___________________________________________

Name of Institution Contact Person Date

_______________________________________________

Results

_______________________________________________

Name of Institution Contact Person Date

_______________________________________________

Results

Has the child been placed on a waiting list? ____________________________________

--------------------------- ---------------------------------------

Institution Anticipated Date of Entrance

• Millcreek, Cares, and Crossings are not State-funded institutions.


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3. The following nearby districts have been contacted to determine if the student could be enrolled there:

______________________________________________

District Contacted Contact Person Date Date

_______________________________________________

Results

_______________________________________________

District Contacted Contact Person Date

_______________________________________________

Results

• Indicate what districts have been contacted, name of person contacted, and date


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4. The following funding sources (such as SSI and Medicaid) have been explored to assist with funding:

__________________________________________________________________

5. The District is aware that if it does make an out-of-district placement consistent with State regulations, the district must pay $8000 of the total cost of the placement. The remainder of the total cost will be paid from Part B set-aside funds, as available. If State monies are not sufficient to fund all applications, there will be a ratable reduction for all recipients.

• Indicate what funding sources have been considered


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6. Did the IEP Committee address other options when determining placement? Please explain.

a. Modification of existing programs_____________________________________________________________________

b. Additional support aids and services

______________________________________________________________________________

c. Other options explored

______________________________________________________________________________

7. Did the IEP Committee consider the Least

Restrictive Environment for this child, i.e., the student being educated with students having no disabilities to the maximum extent appropriate and the participation in nonacademic and extracurricular services and activities? Please explain.

• Explain what has been considered before placing a student in a facility


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School District Applications

• Required FormsA current Individualized Educational Program

(IEP) developed in accordance with regulations

A copy of the current Evaluation Report (ER)A copy of the child’s current Determination of

Eligibility Report (DER)


Individualized Education Program

• Individualized Education Program (IEP):To be completed on the school district’s form Agency representative is school district

personnelMeeting date and projected date of revision

are listed Required IEP members and titles are listed

(please ensure these are legible)Name of school is the school the student

would attend if not placed at the private facility


Individualized Education Program

• Adopted IEPs will not be accepted

IEPs should reflect the related services and goals that will be provided at the student’s current placement

If the student is 14 years old or older, the transition plan must be addressed

If a student is receiving related services, goals/objectives must be included on the IEP


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Individual Education Program

• Beginning/Ending dates of services addressed in the IEP must be for the current school year

The beginning date of services should be the date the student enrolled or school started and the ending date should be the last day of school


Eligibility/Evaluation

• Determination of Eligibility The Determination of Eligibility (DER) should

be on the school district’s formThe date eligibility was determined is

indicatedThe eligibility is clearly markedSubmit a copy of the current Evaluation

Report (ER)


Payments/Reimbursements

•PAYMENT/REIMBURSEMENT PROCESS

When submitting reimbursement forms make sure you use the school district form

Do not combine pay periods on the reimbursement form

Submit pay periods in a timely manner on designated due dates

Do not wait until the end of the school year or until you have expended your $8,000.00


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If a student application was submitted and returned for additional information, you must go back and request payment after the student has been approved.

A list of approved students will be faxed prior to each pay period. Do not list non-approved students on the reimbursement form.

Submit an invoice and an attendance report for each student with the reimbursement form.


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A payment spreadsheet listing the students with the amount paid will be faxed to the Special Education Director approximately 2 weeks after the reimbursement due date.

The spreadsheet must be reviewed for discrepancies. Discrepancies are to be reported to MDE/OSE within 5

business days after receipt of the fax. If you received a listing for approved students for

payment and did not receive a payment spreadsheet, you must notify MDE/OSE by the last day of the pay period month.


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Reminders

• RemindersDate enrolled on reimbursement should be the same

date on the applicationNo drop form is required when changing placement

(example: moving from Day Treatment to Residential Treatment Facility)

A drop form is required when the student drops or has a break in enrollment (Seven (7) school days)

It is the responsibility of the district that places the student in a facility to ensure related services are provided


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Reminders

It is the district ‘s responsibility to ensure that all documents are current.

It is the district’s responsibility to ensure all reimbursements made are correct.

If the student changes district, the new district is responsible for the first $8000.00. The money does not follow the student.


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Educable Child

Barbara Quarles

[email protected]

Kimberly Peyton

[email protected]

http://www.mde.k12.ms.us/special-education/special-education-grants-and-funding/special-education-educable-child

601-359-3498


mailto:[email protected]

mailto:[email protected]



Office of Special Education February 2013 Educable Child.

Documents

Transcript of Office of Special Education February 2013 Educable Child.