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Alternative Education
Special Ed & Support Services – Notification or Request Form
Special Ed & Support Services – Notification or Request Form
Subject
*
Notification
Request
Your Name
*
First
Last
Your Email
*
Site Submitting:
*
Bridges Academy
Central School
CEO
CLC
CLC Tech
EKCS
Jamison
LICS
NKCS
Redwood
WKCS
VOCS-Bakersfield
VOCS-KRV
VOCS-Taft
VOCS-Tehachapi
VOCS-Frasier Park
Aeries ID, (Type NA if unavailable):
*
Student's First & Last Name
*
Student's Date of Birth:
*
MM slash DD slash YYYY
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
*
student recommended for drop base on step policy
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 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 has been suspended
Request Action
*
Request for enrollment at non-residential Court 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
Request records to see if student receives SE services
Request records to see if student has a Section 504
Request for ERMHS screening review
Request for Manifestation Determination - Attendance
Request for Manifestation Determination - Behavior
Student has been released from Court School
Date of Release
*
MM slash DD slash YYYY
Assigned Probation Officer
*
Probation Officer Phone Number
*
Student expected to enroll at:
*
District
Community
Court
Unknown
Student is expecting to be released from Court School
Expected Release Date
*
MM slash DD slash YYYY
Pre-Release Meeting Date
*
MM slash DD slash YYYY
Assigned Probation Officer
*
Probation Officer Phone Number
*
Student has been transferred to Court School
First date expected to be in class
*
MM slash DD slash YYYY
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
*
MM slash DD slash YYYY
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
*
MM slash DD slash YYYY
Community School Enrolled At
*
Auburn
Blanton Academy
Blanton Elementary
CLC 34th
CLC Tech
EKCS
LICS
NKCS
Ridgecrest
Sillect
WKCS
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
*
MM slash DD slash YYYY
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
*
MM slash DD slash YYYY
Student has been transferred to Independent Study/Safety Security (SS1) from Classroom
Date of Transfer
*
MM slash DD slash YYYY
Assigned Probation Officer
*
Probation Officer Phone Number
*
Student has been transferred to Classroom from Independent Study / Safety Security (SS1)
Date of Transfer
*
MM slash DD slash YYYY
Assigned Probation Officer
*
Probation Officer Phone Number
*
Student is enrolled with Valley Oaks Charter School
Date enrollment document was completed
*
MM slash DD slash YYYY
Enrollment Date
*
MM slash DD slash YYYY
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
*
MM slash DD slash YYYY
Drop Reason
*
Student is requesting enrollment with Community School
Date of Referral
*
MM slash DD slash YYYY
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
*
MM slash DD slash YYYY
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
*
MM slash DD slash YYYY
Expected Start Date
*
MM slash DD slash YYYY
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
*
MM slash DD slash YYYY
Reason for Transfer Request
*
Student is requesting drop from Community School
Date of Request
*
MM slash DD slash YYYY
Expected Drop Date
*
MM slash DD slash YYYY
Reason
*
Student is requesting drop in order to return to District of Residence
Date of Drop
*
MM slash DD slash YYYY
District of Residence
*
Student is Graduating
Expected Date of Graduation
*
MM slash DD slash YYYY
Last date student is expected to be on campus
*
MM slash DD slash YYYY
Student is graduating with:
*
Diploma
Diploma with excemption
Certificate
Student is requesting change from Classroom to Independent Study
Date of Request
*
MM slash DD slash YYYY
Reason for Transfer Request
*
Student is requesting change from independent study to classroom
Date of Request
*
MM slash DD slash YYYY
Reason for Transfer Request
*
Revocation of Consent - no longer wants to have IEP or Section 504 Plan implemented
Date parent made initial request
*
MM slash DD slash YYYY
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
*
MM slash DD slash YYYY
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
Select files
Max. file size: 50 MB.
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