1. Office of Special Education February 2013 Educable Child

2. School District Application Required Documents Payments/Reimbursements Reminders February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 2

3. Section 1: Information Pertaining to Student  Fill in ALL blanks  Date of eligibility matches date on IEP form  Date of IEP matches date on IEP form  Circle the child’s disability – (only one) February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 3

4. Section 2: Information Pertaining To Public School District to which warrant Should Be Mailed.  Indicate where the reimbursement is to be mailed February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 4

5. 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) February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 5

6. 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 February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 6

7. 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 7

8. 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? ____________________________________ --------------------------- --------------------------------------- InstitutionAnticipated Date of Entrance Millcreek, Cares, and Crossings are not State- funded institutions. February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 8

9. 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 February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 9

10. 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 March 2012 Office of Instructional Enhancement and Internal Operations/Office of Special Education 10

11. 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 February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 11

12. Required Forms  A 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) February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 12

13. Individualized Education Program (IEP):  To be completed on the school district’s form  Agency representative is school district personnel  Meeting 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 February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 13

14. 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 February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 14

15. 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 March 2012 Office of Instructional Enhancement and Internal Operations/Office of Special Education 15

16. Determination of Eligibility  The Determination of Eligibility (DER) should be on the school district’s form  The date eligibility was determined is indicated  The eligibility is clearly marked  Submit a copy of the current Evaluation Report (ER) February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 16

17. 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 February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 17

18.  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. February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 18

19.  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. February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 19

20. Reminders  Date enrolled on reimbursement should be the same date on the application  No 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 March 2012 Office of Instructional Enhancement and Internal Operations/Office of Special Education 20

21.  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. March 2012 Office of Instructional Enhancement and Internal Operations/Office of Special Education 21

22. Barbara Quarles bmquarles@mde.k12.ms.us Kimberly Peyton kpeyton@mde.k12.ms.us http://www.mde.k12.ms.us/special-education/special-education-grants- and-funding/special-education-educable-child 601-359-3498 February 2013 Office of Instructional Enhancement and Internal Operations/Office of Special Education 22