Referral Forms for Districts

These forms are for our member districts, NOT FOR CASE EMPLOYEES. For employee forms, go to Staff Resources.

Executive Functioning Referral Form

Feeding and Swallowing Team Referral Form

Selective Mutism Referral Form

Acceptance of Existing IEP Form

Districts Served by CASE Itinerant Services

Functional Hearing Assessment Referral Form

Hearing Educational Screening Form ONLY

Acceptance of Existing IEP Form

Vision Functioning Assessment Referral Form

Request for Orientation and Mobility Services Form

OT Physician’s Referral Form (English and Spanish)

OT & PT Combined Physician’s Referral Form (English and Spanish)

Intro Letter Template for the Above (English and Spanish)

Physical Therapy Physician’s Referral Form (English and Spanish)

OT & PT Combined Physician’s Referral Form (English and Spanish)

Intro Letter Template for the Above (English and Spanish)

Equipment Lending Agreement

Request for Individual Student Form

Request for Classroom Form

Assistive Technology (AT) Services Request Form

Student Use of Assistive Technology Device Agreement

Student Use of Assistive Technology Device Agreement (Spanish)

Student Use of Assistive Technology Trial Device Agreement

Equipment Lending Agreement

AT Collaboration Process Forms

AT Collaboration Procedures for Coalition Liaisons

Student Background Information Form [Infinitec COAL FY27]

Request for Services Collaboration Form [Infinitec COAL FY27]

Classroom Coaching Information [AT Collabs]

Classroom Coaching Request Form [Infinitec COAL FY27]

Community Based Instruction Guidance

Community Based Instruction Year Plan

Community Trip Request Form

Procedural Book

Transportation Request

Community Trip Request

Request for Staff Development – NOT FOR CASE EMPLOYEES. For employee forms, go to Staff Resources.

Authorization for Release / Exchange of Information Form – English

Autorización para la divulgación / intercambio de información – Español

Glenbard Parents as Teachers Intake Form