InterMountain ESD

Eastern Oregon Regional Inclusive Services Referral

*Only to be completed by Case Managers*

We (the school district) are requesting the assistance of Eastern Oregon Regional Inclusive Services with the following:

Please check all that apply: *Required

IFSP / IEP Information

Does student have a current IFSP / IEP?

If yes, please attach the following required documents:

Student Information

School District Information

If you have any questions, please contact the following people:

Tonya Smith
Director of Regional Inclusive Services

Patty Jo Lathrop
Administrative Assistant