"Application Packet for Private Schools or Facilities Providing Special Education Services" - Idaho

Application Packet for Private Schools or Facilities Providing Special Education Services is a legal document that was released by the Idaho Department of Education - a government authority operating within Idaho.

Form Details:

  • Released on March 1, 2017;
  • The latest edition currently provided by the Idaho Department of Education;
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Download "Application Packet for Private Schools or Facilities Providing Special Education Services" - Idaho

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Private School or Facility
Special Education Program Services
APPLICATION PACKET
For Programs Serving Students
With Disabilities
Idaho Department of Education
Special Education
Sheri Ybarra
Superintendent of Public Instruction
P.O. Box 83720
Boise, ID 83720-0027
Private School or Facility
Special Education Program Services
APPLICATION PACKET
For Programs Serving Students
With Disabilities
Idaho Department of Education
Special Education
Sheri Ybarra
Superintendent of Public Instruction
P.O. Box 83720
Boise, ID 83720-0027
Return this application to:
Idaho Department of Education
Special Populations Coordinator
P.O. Box 83720
Boise, ID 83720-0027
(208) 332-6910
PRIVATE SCHOOL OR FACILITY APPLICATION
PACKET FOR INITIAL APPLICATIONS AND
RENEWALS
For Programs Serving Students with Disabilities
GENERAL INFORMATION
Agency Name
Telephone
Address
Fax
City/State/Zip
Email
Chief Administrator
Contact Person
Date Submitted:______________________
Initial Application
Renewal
Note: SDE Special Education approval of a private school or facility does not guarantee
that the private school or facility will be contracted for services by a LEA.
Application Packet for Private Schools or Facilities providing Special Education Services (03/2017)
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ORGANIZATIONAL INFORMATION
Organizational Structure (check all that apply)
Religiously Affiliated
Developmental Center
Residential
Vocational Training Center
Day School
Hospital
Preschool/Child Care
Other (list)
Agency Accreditation (check all that apply)
Idaho Department of Education –
Licensed Rehabilitation Center
Northwest Accreditation Commission
(please name licensing agency)
(NWAC), a division of AdvancED
Disabilities Served
Specific Learning Disability
Cognitive Impairment
Speech Impairment
Language Impairment
Emotional Disturbance
Health Impairment
Orthopedic Impairment
Deafness
Hearing Impairment
Visual Impairment
Deaf/Blindness
Multiple Disability
Developmental Delay (age 3-9 only)
Autism
Traumatic Brain Injury
Number of Students Currently Enrolled by Age
3-5
6-12
13-17
18-21
Total number of
Students with
Disabilities
Total number of
Students with
Disabilities served
through contracts
with LEAs
Total number of
Students enrolled
Total
Application Packet for Private Schools or Facilities providing Special Education Services (03/2017)
3
Related Services (check all that apply)
Speech Therapy
Language Therapy
Occupational Therapy
Physical Therapy
Licensed Psychological Services
Social Work
Behavior Intervention
Recreational Therapy
Medical and/or Health Services
Counseling
Orientation and Mobility Services
Vision Services
Hearing Services
Family Support Services
Vocational/Career Development
Independent Living Skills
Rehabilitation Counseling
Transportation
Education (reading, math, art, etc.)
Assistive Technology Service
Program Information
Briefly describe any program/service characteristics not covered in the application form.
PERSONNEL
1. List all personnel who work with special education students ages 3 through 21 years. At
least one staff member must hold a valid Idaho Exceptional Child Certificate,
endorsement is generalist K-12. Also list all administrative personnel, such as a
principal, special education director or other school administrator, certified in an
administrative area.
Name
Grade/Age Level
Idaho State
Special Education
Certificate or License
Qualifications
Number
(degrees, training, or
experience)
Application Packet for Private Schools or Facilities providing Special Education Services (03/2017)
4
CERTIFICATE OF ASSURANCES
Private Agency/School
(Name)
(Address)
I, ________________________________________, do hereby certify that I am the chief administrator of the above-
named private school or facility and that the information contained in this Application Packet is true and correct. I
further certify that the above-named private school or facility is located at the address given; that said private school
or facility is scheduled to provide special education services throughout the 20__ - 20__ school year from
_________ to ___________; and that said private school or facility meets or will meet, at the time services are
provided, the following assurances:
1. It will maintain its accreditation as a school, or if a facility, its licensing requirements.
2. It has financial safeguards in place to track the revenues and expenditures associated with
contracted placements to ensure the funds are used for the students for whom they are
contracted.
3. It has record retention systems in place that meet applicable government requirements for all
operating, financial, personnel and student records.
4.
It complies with the Individuals with Disabilities Education Act (IDEA) and its implementing regulations.
5.
The program includes instructional and related services of sufficient scope to meet the needs of students
with disabilities as identified on their individualized education programs (IEPs) and will fully implement
each child’s IEP.
6.
It will coordinate with the contracting LEAs to initiate and convene IEP meetings at least annually or more
often at the discretion of the LEA. Changes to IEPs will follow appropriate procedures for IEP revisions or
amendments and in accordance with the contracts with LEAs.
7.
It will coordinate with the contracting LEAs for any needed student reevaluations in accordance with
federal and state law.
8.
It will notify the contracting LEA of the need for any changes in a student’s educational program and will
not make any changes to a program, service or placement unless the contracting LEA consents to the
changes.
9. It will provide the contracted LEAs with all educational records maintained on behalf of a
contracted student.
10. It shall certify to the LEA the daily record of attendance of each contracted student.
11. All private school or facility personnel responsible for providing services to students with disabilities
possess appropriate Idaho State certification or licensure. The private school or facility will provide
notification to contracting public school districts, state agencies, and the Idaho State Department of
Education of any changes in certificated staff or deletion of programs within three (3) business days.
12. All non-certified staff providing services to students with disabilities possess formal training, in-service
training and/or successful experience in working with students with disabilities.
Each certificated and noncertificated employee, substitute staff, interns, student teachers,
13.
and all individuals who have unsupervised contact with students, will have completed
and cleared a criminal history check as required by Idaho Code 33-512(15).
It has a system that cross-checks all contractors or other persons who have irregular
14.
contact with students against the statewide sex offender register, as required by Idaho
Code 363-512(16).
15. It meets the requirements set forth in Section 504 of the 1973 Rehabilitation Act and the Americans with
Disabilities Act of 1990.
16. It accepts all areas of responsibility consistent with those of state and federal regulations concerning
instructional programs, confidentiality requirements, and procedural safeguards.
17. It will maintain liability insurance coverage at all times.
Application Packet for Private Schools or Facilities providing Special Education Services (03/2017)
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