Special Education

Student Referral Chart

Student Name:


Student Referral Chart

The information required in this section must be completed by the CSE and submitted with the out-of-State residential initial or reapplication.

A.    List all NYSED approved in-State private schools to which the CSE referred a student and the results of those referrals.  Attach the letters from the private schools that confirm acceptance or rejection of the student.  Rejection letters should state the reason for rejection based on the individual educational needs of the student.  For reapplications, letters within six months of the date of receipt of application are acceptable.  Duplicate this page as needed.

Name of School to which Referral Packet was Sent Date of CSE Meeting Date Referred to School Date of Screening/ Interview Date of Response from School Response
(check one)
Date of Acceptance/ Rejection Reason(s) for Rejection, if applicable 2
Accepted Rejected

B.    If the CSE has determined that the private school(s) that accepted the student is unable to meet the student’s IEP needs, the CSE must provide a statement justifying its actions.  Such rejections must be based on sound educational reasons consistent with the IEP.  This information becomes part of the official CSE record.  _____________________________________________________________________


2 While the CSE must consider the concerns of the parents in the placement process, the district must take responsibility to secure an appropriate placement for the student in the least restrictive environment even in the instance where a parent does not cooperate with the referral and placement process.  In such cases, the cover letter submitted with the application must document the CSE’s efforts in the referral process.  The district must take other steps to ensure the referral process is completed, which may include arranging for the in-State school to evaluate the student at his/her current placement and/or notifying the parent that the district will arrange the student’s transportation to the in-State school for evaluation.
Last Updated: March 31, 2014