Discuss/list any concerns the school has over Service Start How position Consultation Initials/signature State Program with Link services provided this year or requested changes for Provider Date for will be filled dates to Guidance next year Services in the event or of a District and Product nonpublic Delivery absence or designees: leave Chapter 192 Chapter 193 NA Examination/ Classification Chapter 193 NA Supplementary instruction Chapter 193 NA Speech Correction Additional 192/193 Topics Discussed During Consultation, if relevant District Designee Nonpublic School (The designees from the district and nonpublic school should initial next to each topic to indicate that it has been Initials/signature Designee discussed) Initials/signature If applicable, discuss the time, place and format of services If desired, discuss the assessments the school will use to determine eligibility for compensatory education under Chapter 192 services (district approval is required).
State Program with Link to Guidance Discuss/list any concerns the school has over services provided this year or requested changes for next year Service Provider Start Date for Services or Product Delivery How position will be filled in the event of a absence or leave Consultation dates Initials/signature District and nonpublic designees: Chapter 192 Chapter 193 Examination/ Classification NA Chapter 193 Supplementary instruction NA Chapter 193 Speech Correction NA Additional 192/193 Topics Discussed During Consultation, if relevant (The designees from the district and nonpublic school should initial next to each topic to indicate that it has been discussed) District Designee Initials/signature Nonpublic School Designee Initials/signature If applicable, discuss the time, place and format of services If desired, discuss the assessments the school will use to determine eligibility for compensatory education under Chapter 192 services (district approval is required).
ConsolidatedConsultationForm.docx