Eastern Oregon Regional Program Referral Form

Process for Completing the Eastern Oregon Regional Program Referral

Sections A and B:

To request EORP assistance for Student Evaluation and/or Service for students suspected of having one of the five low incidence disabilities, please follow the steps below.

Please indicate the assistance that you are requesting.
1. Check box "A" if you only want help with the evaluation. (excludes Autism)
2. Check box "B" if you want help with the evaluation, and then if the student is found eligible, to enroll the student for service.
3. Check box "B" if the student is already eligible and you would like to enroll the student for services. Be sure to send in a copy of the eligibility statement along with this referral form (attach below).
Once the Eastern Oregon Regional Program Referral has been completed, it must be signed by the Special Education Director or his/her approved designee.

Please note that the specialist assigned to assist you with an evaluation will need to get a copy of the consent form before he/she can begin the assessment. To expedite this process, if you have the signed consent at the time you are submitting the referral, please send a copy of it with the EORP referral. If you will be inviting the specialist to the preplanning meeting where the consent will be signed, please be prepared to provide the specialist with a copy of the consent once the meeting is over (attach below).

When should an EORP specialist be invited to an eligibility meeting?

An eligibility team needs to include "the parent, in accordance with OAR 581-015-2190, and two or more qualified professionals. At least one of whom is knowledgeable and experienced in the evaluation and education of children with the suspected disability." OAR 581-015-2120(1) (a). The resident district should invite the EORP specialist as the professional who is knowledgeable and experienced in the evaluation and education of children with disabilities served by the regional program (hearing impairment, vision impairment, severe orthopedic impairment) unless the district has another professional with the requisite knowledge. This can be an issue of critical importance in ensuring that a student receives a free appropriate public education.

We are requesting the following assistance of Eastern Oregon Regional Program:

Section A

Participation in the evaluation process

I have a copy of

Attach Documentation

Please attach an electronic copy of your documentation.

Section B

To receive help with an evaluation and/or begin services

Student Information

Student District

Attending School Placement

Grade

For children younger than kindergarten age, please use

Student First Name *Required

Student MI

Student Last Name *Required

Student DOB

Student Gender

Student SSID#

Student Address

Please include Street, City, State and Zip

Parent/Guardian 1 Name

Parent/Guardian 1 Phone

Parent/Guardian 2 Name

Parent/Guardian 2 Phone

IEP/IFSP Information

Current IEP/IFSP Date

Case Manager Name

The Case Manager is responsible for providing student file information to the EORP specialist.

Case Manager Email