GUIDELINES FOR WEBS PROGRAM
If a Student is being considered for the WEBS Program placement:
1.
2.
3.
4.
IEP Team fills out the eligibility form
School Psychologist contacts the WEBS Administrator
Review eligibility form and fill out with staff and WEBS administrator
During the IEP team meeting formalize WEBS placement, the Certification of
Eligibility, the Transition Plan, and Acquiring School Academic/Health Records.
FOR MOVE-IN STUDENTS WITH ACTIVE PLACEMENT IN A SELF CONTAINED
PROGRAM:
1. School Psychologist, Building principal will notify Director and/or WEBS
Administrator
2. IEP meeting is held to initiate the placement.
WEBS
CERTIFICATION OF ELIGIBILITY
Student’s Name_____________________________________
School: ______________________________________________ Date: _____________________
Met
Not Determined
Not Met
1. Student Criteria:
1.1 Normal Intelligence
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1.4 Substantial evidence that the student’s pattern ______
of behavior in school during school hours is
unmanageable to the degree that maintaining
the current placement is likely to result in injury
to self or others or a significant disruption to
the learning process.
Please Describe: ______________________________________
____________________________________________________________
______________________________________________________________
_______
1.2 Student has an ED Exceptionality
If so explain:
___________________________________
___________________________________
___________________________________
1.3 Utilization of local options to the maximum
extent appropriate before placement
Please describe:
______________________________________________
______________________________________________
______________________________________________
1.5 FBA and BIP appropriate to the severity of the
Problem behavior(s) has been completed and
Implemented with a reasonable amount of time
Allowed for interventions to be effective.
Please Describe: _____________________________________
________________________________________________________
_________________________________________________________
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Met
Not Determined
Not Met
2.Initial Placement Criteria
2.1 The student has been in the Special Education
Classroom for a minimum of 50% of each
School day, for a minimum of 45 School days.
Describe:
________
2.2 The following supplementary aids and services _________
have been implemented in an effort to meet the
behavioral needs of the student.
a. ____ One-on-One Paraprofessional support
b. ____ In-School Counseling
c. ____ Psychiatric/Medical referral
d. ____ Additional Resource Room support
Please Describe:
_________
2.3 Has the student been allowed to attend for a
shortened School day? If yes, when and
how long?
___________
2.4 Has a Functional Behavior Analysis and
Behavior Plan been reviewed/revised
at least twice?
Please list Dates of last revision.
_________
2.5 Is the Functional Behavior Intervention
Plan Appropriate in regards to severity
of the behavior and does it
Adequately target defined problem areas?
Please Describe:
_________
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3. BUILDING TEAM/ADMINISTRATION RESPONSIBILITIES
3.1 The WEBS administrator was notified of the possibility of a student transfer at
least 20 days before the transfer.
3.2 The WEBS administrator was invited to visit the sending school and observe the
student in his/her current setting. Please list date:
Referral Team Meeting:
By signing this document below, you are agreeing as an IEP team, that this student should be
accepted for entry into the WEBS K-12 Program.
Name
Role
Date
________________________________ Parent/Guardian
_________
________________________________ Special Education Teacher
_________
________________________________ School Counselor
_________
________________________________ School Administrator
_________
________________________________ School Psychologist
_________
________________________________ School Social Worker
_________
________________________________ General Education Teacher
_________
_________________________________ WEBS Administrator
_________
_________________________________ WEBS Special Education Teacher
_________
_________________________________ Other
_________
_________________________________ Other
_________
Student’s parents have given permission for this referral?
Yes _____No _____