SELPA Forms

Please click on the link(s) for the forms/packet:

INTER DISTRICT TRANSFER FORMS

SELPA GUIDELINES

MEMORANDUM OF AGREEMENT (MOA) (For IEP team-referral transfers)

ACTUAL COST CALCULATION FORM

AVERAGE COST CALCULATION FORM

REGIONAL ESY COST CALCULATION FORM

LOW INCIDENCE FORMS

Low Incidence Request Checklist

Low Incidence Equipment / Materials Requisition Form

Home Use of Low Incidence Equipment

Return/Transfer of Low Incidence Equipment

NON PUBLIC AGENCY (NPA) ASSESSMENT REQUESTS

Beginning 2020-2021, in partnership with the Santa Clara County SELPAs I, II, III, IV, and VII and the South East Consortium SELPA, the SCCOE has served as the central entity for contracting with NPAs so that districts do not have to establish multiple contracts with agencies. The partnership establishes master contracts with multiple NPAs that provide special education related services. The partnership negotiates and establishes competitive and reasonable rates with NPAs. Districts can then “piggy-back” on the SCCOE-SELPA-NPA master contract to access NPAs that provide special education related services based on the district’s needs.  

A list of preferred providers can be found HERE

Note: The NPA Master Contract is similar to the NPS Master Contract that each District has in place with each NPS serving students from its District; however, the NPA Master contract is maintained through SCCOE

SELPA ITINERANT SERVICES REFERRALS

Itinerant Vision Services

Itinerant DHOH Services

HIPAA Privacy Authorization Form

SELPA PROGRAM ADMINISTRATOR SUPPORT REFERRALS

SELPA Program Administrator Classroom Consultation Request

Behavior-Related Resources and Forms

Functional Behavioral Assessment (FBA) and Behavior Intervention Plan (BIP) Resource Guide

      –FBA and BIP Blank Forms

Special Circumstance Instructional Assistance Assessment (SCIA) Resource Guide (Word Fillable)

Behavioral Emergency Intervention Report (BEIR)