OUTREACH REQUEST FOR SERVICES DOWNLOADABLE FORM

REQUEST FOR SERVICES, Adobe Acrobat File (.PDF)
or
REQUEST FOR SERVICES, Microsoft WORD File (.doc)

When completing the Request for Services document, you may wish to check every service that may be applicable during the academic year to avoid the need for completing additional paperwork should your student(s) need additional services. Please return all information requested on the enclosed Request Checklist to NCECBVI.

Please have the guardian complete the Notice and Consent for Evaluation (describes the services we offer), the signed Permission for Release of Confidential Information Form, and the Developmental History Form (parents); have each service provider complete the Student Information Worksheet; have the primary teacher complete the Developmental History Form (teacher); and return with any previous evaluations and the latest IEP. Any evaluations completed by NCECBVI staff are already in our files.

Once you return the completed package, one of our consultants will contact you to schedule the evaluation. Please call if you have any questions. Thank you for your interest in our services.  We look forward to serving you, your students, and your school district.

RENEWAL FORM FOR CONTINUING SERVICES (Short Form)

REQUEST FOR SERVICES RENEWAL, Adobe Acrobat File (.PDF)
or
REQUEST FOR SERVICES RENEWAL, Microsoft WORD File (.doc)

If your student has been seen by outreach staff during the past 3 years you may use the shortened form for requesting services for the current year.

LOW VISION CLINIC FORMS

Parental Rights in Special Education,
Nebraska Department of Education