Application Instructions for State Aid Reimbursement of Tuition Costs - 2014-15 School Year
New York State Approved Out-of-State Private Residential Program Placement Application - 2014-15 School YearWord (176 KB- includes instructions, application, assurance, referral chart and student profile)
For an application seeking State reimbursement of tuition costs for a student in an approved out-of-State residential school, the committee on special education (CSE) must submit the following documentation to the New York State Education Department (NYSED) for review and approval against the criteria established for approval of State reimbursement pursuant to section 200.6(j) of the Regulations of the Commissioner of Education.
- CSE cover letter that describes the reasons for submitting the application and the steps the CSE took to ensure that the screening and referral process was completed
- Application checklist
- A proposed plan and timetable for enabling the student to return to a less restrictive environment or a statement of reasons why such a plan is currently not appropriate
- Statement of Assurance
- Certification by the CSE that the student is of school age; has a disability or combination of disabilities; has a current individualized education program (IEP); and that the nature or severity of the student’s disability is such that appropriate public facilities for instruction are not available.
- For each student recommended for initial placement in residential care, certification that:
- when a student was first determined at risk of residential placement, the district sought parental consent (or consent of the student if age 18 or older) to invite county or State agency representatives to the CSE meeting to make recommendations concerning the appropriateness of residential placement and other programs and placement alternatives. For students in a foster care placement, the local social services district was notified when the student was determined to be at risk of residential placement.
- upon receipt of parental (or student) consent, other agency representative(s) were invited to the CSE meeting (see http://www.oms.nysed.gov/stac/guide_DCERT/pdf).
- Documentation that no appropriate public or private facilities for instruction are available within New York State (NYS) (8 NYCRR section 200.6(j)). The listing of approved in-State private schools appropriate to the student’s disability can be obtained at http://www.p12.nysed.gov/specialed/privateschools/home.html. Include copies of all acceptance or rejection letters.
- Student profile
- Signed STAC-1 (summer, if applicable, and school year; see http://www.oms.nysed.gov/stac/forms/stac-1_form_for_schoolage.pdf to access STAC-1 form)
Note: School districts must complete and submit an application for State reimbursement of tuition costs consistent with these procedures and timelines. Failure to do so may result in a denial of State reimbursement of tuition costs. Failure to submit a timely application will result in State reimbursement as of the date the application for reimbursement is received by NYSED. Regardless of the State’s determination regarding approval of State aid reimbursement, the Board of Education of the sending school district is responsible for a timely placement of the student.
New York State Approved Out-of-State Private Residential Program Placement Application Checklist - 2014-15 School Year
For NYSED Office Use Only
Date Received: ___________
New York State Approved Out-of-State Private Residential Program Placement Application Checklist - 2014-15 School Year - Word (176 KB- includes instruction, application, assurance, referral chart and student profile)
Check the boxes below to indicate that the application is complete and all required documentation is submitted at the time of submission.
For students turning 21 during July or August 2014
For students returning in-State:
(Please Type or Print)
Student Name: DOB: / /
Current Educational Placement:_______________________________________
CSE Recommended Residential Placement:
Start Date: / /
Date of CSE Meeting: / / Disability Classification:
STAC # (Continuing Students Only):
CSE Chairperson: Email:
Phone Number: ( ) Fax #: ( )
With consent of parent, has the CSE made a referral for eligibility to the?
Office for People With Developmental Disabilities (OPWDD) __ Yes __ No __ N/A
Office of Mental Health (OMH)? __Yes __No __ N/A
If yes, date of referral If No or N/A, reason:
Proposed Plan and Timetable for LRE
Instructions: Describe the school district's proposed plan and timetable for enabling the student to return to an LRE or a statement of reasons why such a plan is currently not appropriate. Provide description below or separately.
1 OMH and OPWDD have specific eligibility criteria for supports and services. Before referring a student to OMH or OPWDD for an individual eligibility review, please review OMH and OPWDD guidance on eligibility and the referral process at www.omh.ny.gov/omhweb/childservice/community_support.html and www.opwdd.ny.gov/opwdd_services_supports/eligibility.