Academy of Innovation
(Formally Ava White Academy)
REFERRAL FORM
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What type of Current Special Education services are being provided at this time?
Does your child have any Special Considerations that we should know about?
Does your child currently take any medications?
Yes
No
If yes, please list the medications here:
Has your child had a Psychological Evaluation in the past three (3) years?
Yes
No
If yes, could we have a copy to look over?
Yes
No
Does your child have a current IEP (Individualized Education Plan)?
Yes
No
If yes, could we have a copy to look over?
Yes
No
Please list any additional testing that has been completed for your student.
Is it possible for us to get a copy of this testing?
Yes
No
If it's determined that your child will need to be tested by our staff, please list days and times that are convenient for you.
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