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Warning Text %XTableStyleMedium9PivotStyleLight16` 192 CompEdMath192 CompEdLanguageArts192 ESL193 E&D$193 SIPU 193 Speech&!  ;!  ;!  ;!  ;!  ;!  ;_ftn1:_ftnref1:Sp4 u3 A@@  WMonth billing Began Last Name First NameDOBGradeTeacher ObservationScoreSchoolVendorCommentsNameDate Date of BirthSvc plan Begins SVC Plan EndsUpdate ReceivedUpdated SVC plan BeginsUpdated SVC plan expiresUpdate receivedInvoice CorrectionsReevalInitialAnnualNotes:6Update received: if the service plan expired mid-year.Update returnedDate Service Completed Invoice # Not approvedSMIDFederal Classification Code#Updated Federal Classification Code%Letter to Parent (in native language) work samplestestsMissing/ rejected Not ApprovedAssessment name Grades 3-12Date 407-1 Received Grades K-2*#Eligibility Documentation Provided "Eligiblity Documentation Provided c *Grades K-2 must include 3 of the 4 eligibility criteria listed below, to district specifications:  Score sheet assessment of English reading level, assessment of academic performance in English, input of teaching staff members responsible for the educational program of the pupil, and any other assessments agreed upon in the consultation REnter students into student management system same as a district-enrolled studentsEvaluation Type:Referral Packet for Initial Last Evaluation Current Evaluation RequestType'Initial evaluation timing requirements:3After parental consent to the initial evaluation is obtained, the evaluation, determination of eligibility for special education and related services, and if eligible, the development and implementation of the service plan for the student must be completed within 90 calendar days [N.J.A.C. 6A:14-3.4(e)]. ;An annual review may not take place within six months of a reevaluation unless the parent requests it in writing and submits a 407-1 form and the district determines conditions warrant it (i.e., concerns over the student s academic performance or a change in the student s behavior), as documented on the 407-1 form:A reevaluation may not be conducted sooner than three years unless conditions warrant or if the student's parent or teacher requests the reevaluation based on concerns over the student's educational performance. However, reevaluation shall not be conducted prior to the expiration of one year from the date the parent is provided written notice of the determination with respect to eligibility in the most recent evaluation or reevaluation, unless the parent and district both agree that a reevaluation prior to the expiration of one year as set forth above is warranted$if the service plan expired mid-yearsEnter on this tab if student requires speech-language evaluation/services only and no other 193 evaluation/servicesMStudent Services Plan w/ parent signature (only if speech services requested)$If the service plan expired mid-year11. Teacher/parent survey, interviews, observationV2. Work samples collected over time with child s name, date and graded with percentage3. Developmental screenings 4. Report cards, tests, projectsComments/Notes Not Approved Work samplesTestsDate 407-1 Sent Back to VendorIf District Did Not Approve:Month Service Can BeginMonth Service Can Begin**Month Billing Began%Month Service or Evaluation Can BeginDetermined Not Eligible for SI Assessment***Other indicatorMonth Service Can Begin****State-approved English language proficiency tests and the corresponding standards for determining limited English proficient may be found at http://www.state.nj.us/education/bilingual/resources/prof_tests.htm.7**Must include at least one other indicator, including: The full Child Study Team, parent and regular education teacher who has knowledge of the student s educational performance must meet within 20 calendar days of the receipt of the student application (407-1 form) to determine whether an evaluation is needed [N.J.A.C. 6A:14-3.3(e)].  - Annual and Reevaluation timing requirements:  .Student Services Plan page w/ parent signatureYOnly one service will be paid with 193 state funds: speech evaluation or speech services. 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