Macomb Intermediate School District Therapy Pre-Referral Form
This file is a pre-referral form designed for students needing assessment for physical therapy. It outlines the eligibility criteria and information required for referral. Educators and parents can use this to identify students who may have gross motor difficulties impacting their educational performance.
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How do I fill this out?
To fill out this form, start by entering the student's details at the top of the form. Next, provide specific information on the student's educational concerns and any strategies that have been implemented. Finally, ensure the necessary signatures are filled out before submission.
How to fill out the Macomb Intermediate School District Therapy Pre-Referral Form?
1
Enter the student's personal information in the designated fields.
2
Identify the primary educational or academic concerns that the student faces.
3
List any strategies or accommodations that have been tried.
4
Provide observations that support the concerns raised.
5
Obtain the required signatures from the parent and the physical therapist.
Who needs the Macomb Intermediate School District Therapy Pre-Referral Form?
1
Teachers who suspect a student may require physical therapy services due to gross motor difficulties.
2
Parents who want to advocate for their child's needs in the educational setting.
3
School administrators requiring documentation for referrals to therapy services.
4
Physical therapists needing insights into a student's motor skills issues.
5
Special education professionals assessing a student's eligibility for support services.
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What are the instructions for submitting this form?
To submit the Therapy Pre-Referral Form, ensure all sections are completed and signed by both the parent and the physical therapist. You can fax the completed form to (586) 412-8419 or email it directly to the school district office. Alternatively, the form may be submitted in person at the Macomb Intermediate School District office located at Maple Lane, 37623 Garfield, Suite 110, Clinton Twp., MI 48036.
What are the important dates for this form in 2024 and 2025?
While specific important dates may vary, be sure to check for submission deadlines each school year to ensure timely referrals. Generally, forms need to be filled and submitted before the end-of-term evaluations. Always consult with your school's administration for precise timelines relevant to your district.
What is the purpose of this form?
The purpose of the Therapy Pre-Referral Form is to facilitate early identification of students who may have gross motor difficulties impacting their educational progress. It enables teachers and staff to systematically assess and document concerns regarding a student’s ability to participate in physical activities within the curriculum. By utilizing this form, proper interventions and support can be initiated in a timely manner.
Tell me about this form and its components and fields line-by-line.
- 1. Student: The name of the student being referred.
- 2. District: The school district the student belongs to.
- 3. Eligibility: Indicates the eligibility status for therapy.
- 4. Date: The date the form is filled out.
- 5. School: The school the student attends.
- 6. Grade: The current grade of the student.
- 7. Referring Individual/Teacher: The name of the individual initiating the referral.
- 8. Birthdate: The birthdate of the student.
What happens if I fail to submit this form?
Failing to submit this form may delay the assessment process for the student in question. Consequently, necessary services such as physical therapy could be postponed, potentially impacting the student's academic performance. It is crucial to ensure timely submission to avoid these complications.
- Delayed Services: Without timely submission, necessary support services may be postponed for the student.
- Impact on Academic Performance: Delay in assessment could hinder the student’s academic and social integration.
How do I know when to use this form?
- 1. Identifying Motor Skills Issues: To document concerns about a student's motor skills and physical participation.
- 2. Requesting Support Services: Used to initiate a request for physical therapy assessment.
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