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Educational Needs Form

This form is to be submitted ONE PER STUDENT and only needs to be completed if your child has educational needs. Please reach out to Dr. Katy Schierding should you have any questions, katy.schierding@icdschool.org.

Does your child need any special arrangements resulting from physical conditions such as visual impairments, hearing Impairments, medical conditions, or other physical disabilities?*
Answer Required
In order to understand your child’s educational needs, we need to know if your child has ever been evaluated due to learning difficulties by a public school district, a private agency, or a private practice professional. Examples of agencies and individuals who perform educational evaluations include your local public school district, the Archdiocesan Department of Special Education, and private practice physicians and psychologists. Has your child ever been evaluated?*
Answer Required

Evaluating Agency Location:

State
Answer Required
The evaluation determined that my child has:
Please check all that apply.
Answer Required
Does ICD School have a copy of the evaluation report that includes the existing diagnosis? (If NO, please submit a copy of the evaluation report to the ICD Resource Coordinator at katy.schierding@icdschool.org).*
Answer Required
Does your child receive services from the public school district?*
Answer Required
Is your child scheduled to receive services for 2019-2020 school year? *
Answer Required

If your child’s services have been terminated, please provide ICD's resource department with a copy of current IEP or letter from district stating your child has been staffed out of the service.

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