Santa Barbara County
Special Education Local Plan Area ……….A Joint Powers Agency
Request for Consideration of SBCSELPA Funded Non-Mental Health Nonpublic School (NPS) Placement
To be completed by the referring Local Education Agency LEA Special Education Administrator/designee and forwarded
to the SBCSELPA Director for consideration of an NPS placement in order for the SBCSELPA Director to determine if
the NPS placement (residential or nonresidential) meets the criteria for being funded out of SBCSELPA shared funding.
Directions: The referring Local Education Agency (LEA) Special Education Administrator/Designee completes all of the
following steps:
Note: It is recommended that the referring LEA Special Education Administrator/designee contact the SBCSELPA
Director as soon as possible to notify him/her of the potential for a student NPS placement and possible forthcoming
request for access to SBCELPA funding.
Step 1: Please indicate below the reason why the request for consideration of an NPS placement is being made:
 Parent / Guardian request for an NPS placement
Within 15 days of the receipt of the request, the referring LEA Special Education Administrator/designee must either:
1) send the parents a Prior Written Notice (PWN) denying the request for an NPS placement.
or
2) send the parent/guardian a PWN by and proposed Assessment Plan to assess the need for an NPS placement.
 IEP team recommended an assessment to determine if an NPS placement is potentially needed
Within 15 days of the request, the referring LEA Special Education Administrator/designee must send the
parent/guardian a PWN by and proposed Assessment Plan to assess the need for an NPS placement.
 Other (describe)___________________________________________________________________
If residential placement is being requested, the LEA School Psychologist shall conduct an assessment to determine if there
is a Need for Out of Home Placement and current social/emotional assessment.
Step 2:
Student is eligible for special education services:
yes
no
Is student Medi-Cal eligible:
yes
no
Student’s primary disability:
secondary disability:
unknown
(if applicable)
Step 3:
IEP team has ruled out the continuum of least restrictive environments:
yes
no
Please List
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Step 4:
Attach the follow documents to the request for consideration and forward to the SBCSELPA Director:
o Cover letter with referral request and brief history of the case to include developmental, health, and
educational history, including history of previous educational and behavioral interventions and the results
of these interventions, including information/input from the current classroom teacher
o Current IEP, including any behavior intervention plans
o Current psycho-educational evaluation (intellectual functioning, language, adaptive behavior, academic
skills, social/emotional functioning, and psycho-motor development)
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Santa Barbara County
Special Education Local Plan Area ……….A Joint Powers Agency
o An assessment for need for out of home placement (if potential SBCSELPA funding is being request for
o
o
o
o
o
o
residential services
If student is a Tri-Counties Regional Center (TCRC) client, an assurance that TCRC has been notified of
the potential placement and whether or not TCRC has determined if they will potentially co-fund an outof-home NPS placement (the parent/guardian must make this request to TCRC if they feel they cannot
safely maintain the child at home)
Current academic assessment reports (public/private) not included in psychologist’s report
Related service assessment reports (if applicable)
Copy of any suspensions or expulsion records and behavior emergency reports
Current observation data
Any other relevant documents
Date Sent
Next Steps
Once the SBCSELPA Director receives a copy of the assessment report, and prior to an IEP meeting being convened,
the SBCSELPA will notify the district of residence special education administrator if a potential nonpublic school
placement of the recommended student meets the criteria for SBCELPA shared funding and at what level.
Within 60 days of the signed Assessment Plan, the referring LEA schedules an IEP meeting to review the assessment
data and to discuss placement options, to include potential placement in a nonpublic school / residential treatment
center. The SBCSELPA Mental Health Specialist and Director must participate in this IEP meeting if it has been
determined that a potential placement would meet the criteria for SBCELPA funding.
Note: Final recommendations for NPS placement are made by the IEP team, not SBCSELPA.
If the IEP team recommends a NPS placement (residential or non residential) and the parent consents to the
SBCSELPA seeking a mutually-agreeable placement, SBCSELPA will begin the referral process and seek an
appropriate placement for the student. Once a suitable placement is found, the parent and district will be notified to
hold an IEP to offer a final NPS placement. The staff from the tentative NPS placement will be invited to participate
in the IEP meeting. SBCSELPA will arrange and fund (in part as appropriate) a transport of the student to the new
NPS placement (this may be the parent or a transport company).
The SBCSELPA will schedule a follow-up thirty (30) day IEP if deemed needed to review and update behavior plan,
services and goals.
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