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Referral Information

School districts and charter schools interested in requesting services should complete the appropriate referral form below.  

Use this form when requesting evaluations, services or placement for a specific student:

School Age Student Service Referral

Use this form when requesting services that are not specific to students, such as Safe Crisis Management training, programmatic consultation, or special education coaching:

School Age Non-Student Service Referral

More Information

All referral requests should be emailed to
or faxed to 717-732-8425.