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Referral Process IEP


NOCAC Head Start will refer a child to the Local Education Agency (LEA) if warranted as a presented by developmental, speech/language, social/emotional, vison and/ or hearing screenings.


  1. If the child receives two or more concerning scores on their screenings, the teacher will inform the family of the referral process. The parent/guardian will be asked to sign the Child service Plan Referral form (CSPR).
  2. If the family agrees to have the child evaluated by an outside agency, the teacher will complete the Release of information from (ROI) for the parent/guardian to sign.
  3. The Classroom Coach & Mentor (CCM), Disability Services Coordinator (DSC) and the teaching team will develop a Child Service Plan (CSP) to meets the child’s needs. This will be implemented during the LEA evaluation process.
  4. The teacher will give the signed CSPR and ROI to the DSC.
  5. The DSC will gather the required documents required for referral submission:
    1. ROI
    2. CSPR
    3. ASQ Summary
    4. DECA Summary
    5. CSP
    6. Birth Certificate
    7. Hearing/Vision Screening
    8. Physical
  6. The DSC will then scan these documents into the computer as one file. This file will be labeled with the child’s name and age.
  7. The File will then be Sent Via email to the LEA
  8. The submission of referral will be documented in ChildPlus by the DSC under the disability/ Concerns tab.
  9. If a child is deemed eligible for services and receives an IEP, please follow the IEP Procedure.

Forms and Additional Guidance:

This policy complies with the following

Head Start Program Performance Standard:   1302.33 (3,4, 5) 1302.60
ODJFS Child Care Manual:    
CACFP Regulation:    
Caring for Our Children:    
Other Sources:    


Effective Date:   8/7/17 Reviewed Date:   6/9/2022
Approved By Policy Council:     Revision Approved By Policy Council:    
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