Special Ed & Support Services – Notification or Request Form | Alternative Education | Kern County Superintendent of Schools

Subject*

Notification
Request

Your Name*

First Last

Your Email*

Site Submitting:*

Aeries ID, (Type NA if unavailable):*

Student's First & Last Name*

Student's Date of Birth:*

Individualized Education Plan*

Student has IEP
Student suspected of having an disability
Section 504 (may include medical health plan)
Medical Health Plan ONLY (DOES NOT HAVE IEP or SECTION 504)
Assessment in progress at enrolling district

Notification Action*

Request Action*

Student has been released from Court School

Date of Release*

Assigned Probation Officer*

Probation Officer Phone Number*

Student expected to enroll at:*

Student is expecting to be released from Court School

Expected Release Date*

Pre-Release Meeting Date*

Assigned Probation Officer*

Probation Officer Phone Number*

Student has been transferred to Court School

First date expected to be in class*

Court School Transferring To*

Assigned Probation Officer*

Probation Officer Phone Number*

Please note: Max 10 MB (of combined attachments) only per each web form submission

Attach File

Max. file size: 50 MB.

Attach Court Intake, Transcripts, copy of IEP, copy of Section 504 Plan, etc.

Attach File

Max. file size: 50 MB.

Attach Court Intake, Transcripts, copy of IEP, copy of Section 504 Plan, etc.

Attach File

Max. file size: 50 MB.

Attach Court Intake, Transcripts, copy of IEP, copy of Section 504 Plan, etc.

Attach File

Max. file size: 50 MB.

Attach Court Intake, Transcripts, copy of IEP, copy of Section 504 Plan, etc.

Student has enrolled in Court School

First date expected to be in class*

Court School enrolled at*

Assigned Probation Officer*

Probation Officer Phone Number*

Please note: Max 10 MB (of combined attachments) only per each web form submission

Attach File

Max. file size: 50 MB.

Attach Court Intake, Transcripts, copy of IEP, copy of Section 504 Plan, etc.

Attach File

Max. file size: 50 MB.

Attach Court Intake, Transcripts, copy of IEP, copy of Section 504 Plan, etc.

Attach File

Max. file size: 50 MB.

Attach Court Intake, Transcripts, copy of IEP, copy of Section 504 Plan, etc.

Attach File

Max. file size: 50 MB.

Attach Court Intake, Transcripts, copy of IEP, copy of Section 504 Plan, etc.

Student has enrolled in Community School

Date Enrolled*

Community School Enrolled At*

Was an interim IEP meeting held?*

Yes
No

Attach File*

Max. file size: 50 MB.

Required documents: Interim IEP, Emergency Card, Meeting Notice. Put all 3 documents in 1 PDF file.

Reason for Post Notification*

Additional notes or comments

Student has been placed "to" dormant

Date of dormant status*

Attach File*

Max. file size: 50 MB.

Attach dormant letter sent to parents

Student has been removed "from" dormant status

Date expected to be in class*

Student has been transferred to Independent Study/Safety Security (SS1) from Classroom

Date of Transfer*

Assigned Probation Officer*

Probation Officer Phone Number*

Student has been transferred to Classroom from Independent Study / Safety Security (SS1)

Date of Transfer*

Assigned Probation Officer*

Probation Officer Phone Number*

Student is enrolled with Valley Oaks Charter School

Date enrollment document was completed*

Enrollment Date*

Assigned general education resource teacher*

First & Last name

Please note: Max 10 MB (of combined attachments) only per each web form submission

Attach File*

Max. file size: 50 MB.

Attach: Parent Request for Enrollment packet , Questionnaire, and signed Request for Release of School Records along with any IEP, Assessments, or reports provided by parent.
Put all documents in 1 PDF file.

Attach File

Max. file size: 50 MB.

Additional Documents (if needed)

Comments, Concerns and/or questions to Special Education & Support Services

Student is dropped from Valley Oaks Charter School

Drop Date*

Drop Reason*

Student is requesting enrollment with Community School

Date of Referral*

Attach File

Max. file size: 50 MB.

Attach Community School referral, copy of IEP, copy of Section 504 Plan, transcripts, etc.

Attach File

Max. file size: 50 MB.

Attach Community School referral, copy of IEP, copy of Section 504 Plan, transcripts, etc.

Attach File

Max. file size: 50 MB.

Attach Community School referral, copy of IEP, copy of Section 504 Plan, transcripts, etc.

Attach File

Max. file size: 50 MB.

Attach Community School referral, copy of IEP, copy of Section 504 Plan, transcripts, etc.

Comments, Concerns and/or questions to Special Education & Support Services

Student is requesting enrollment with Valley Oaks Charter School

Date enrollment documents were completed*

Status*

Pending
Lottery

Attach File*

Max. file size: 50 MB.

Attach: Parent Request for Enrollment packet , Questionnaire, and signed Request for Release of School Records along with any IEP, Assessments, or reports provided by parent.
Put all documents in 1 PDF file.

Comments, Concerns and/or questions to Special Education & Support Services

Student is enrolled with Valley Oaks Charter School

Date enrollment documents were completed*

Expected Start Date*

Assigned General Education Resource Teacher*

First and Last name

Please note: Max 10 MB (of combined attachments) only per each web form submission

Attach File*

Max. file size: 50 MB.

Attach: Parent Request for Enrollment packet , Questionnaire, and signed Request for Release of School Records along with any IEP, Assessments, or reports provided by parent.
Put all documents in 1 PDF file.

Attach File

Max. file size: 50 MB.

Additional Documents (if needed)

Comments, Concerns and/or questions to Special Education & Support Services

Student is requesting transfer to another Community Site

Date of Request*

Reason for Transfer Request*

Student is requesting drop from Community School

Date of Request*

Expected Drop Date*

Reason*

Student is requesting drop in order to return to District of Residence

Date of Drop*

District of Residence*

Student is Graduating

Expected Date of Graduation*

Last date student is expected to be on campus*

Student is graduating with:*

Diploma
Diploma with excemption
Certificate

Student is requesting change from Classroom to Independent Study

Date of Request*

Reason for Transfer Request*

Student is requesting change from independent study to classroom

Date of Request*

Reason for Transfer Request*

Revocation of Consent - no longer wants to have IEP or Section 504 Plan implemented

Date parent made initial request*

Request Made To*

Parent / Guardian Name*

Parent / Guardian's Current 'Full' Address*

Street, City and Zip is needed

Home Phone Number*

Alternate Phone Number

Currently Enrolled*

Yes
No

Request for evaluation to see if student qualifies for IEP or Section 504 Plan

***NOTE: School site staff does not accept any written communication regarding requests. Inform requestor that Special Education and Support Staff will meet with them and receive all information directly from them***

Date of Request*

Request Initated by (Title Only)*

i.e. parent, probation, social worker, lawyer, etc.

Request Initated by (First & Last Name)*

i.e. Mary Smith

Requestors Primary Contact Number*

Request Made to (Title Only)*

i.e. parent, probation, social worker, lawyer, etc.

Request Made to (First & Last Name)*

i.e. Mary Smith

Parent / Guardian's Name*

First & Last

Parent / Guardian's Current 'Full' Address*

Street, City and Zip is needed

Home Phone Number*

Alternate Phone Number

Currently Enrolled*

Yes
No

If you have any of the following, attach them to this request (using the "Drop Files here" box below. Options include, but are not limited to: Community School referral, copy of assessment reports, SST documents, parents written request for assessment, Parent Request for Enrollment packet , Questionnaire, and signed Request for Release of School Records along with any IEP, Assessments, or reports provided by parent.

Request for evaluation to see if student qualifies for IEP or Section 504 Plan - uploaded files

Drop files here or

Max. file size: 50 MB.

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Special Ed & Support Services – Notification or Request Form

Student has been released from Court School

Student is expecting to be released from Court School

Student has been transferred to Court School

Student has enrolled in Court School

Student has enrolled in Community School

Student has been placed "to" dormant

Student has been removed "from" dormant status

Student has been transferred to Independent Study/Safety Security (SS1) from Classroom

Student has been transferred to Classroom from Independent Study / Safety Security (SS1)

Student is enrolled with Valley Oaks Charter School

Student is dropped from Valley Oaks Charter School

Student is requesting enrollment with Community School

Student is requesting enrollment with Valley Oaks Charter School

Student is enrolled with Valley Oaks Charter School

Student is requesting transfer to another Community Site

Student is requesting drop from Community School

Student is requesting drop in order to return to District of Residence

Student is Graduating

Student is requesting change from Classroom to Independent Study

Student is requesting change from independent study to classroom

Revocation of Consent - no longer wants to have IEP or Section 504 Plan implemented

Request for evaluation to see if student qualifies for IEP or Section 504 Plan