Special Education Department
Ligon Middle School
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Frequently Asked Questions
Teacher Initiated Referral
Test Lab Requests
MTSS/RTI Tier III Referrals
TEACHER INITIATED REFERRAL FORM
Please complete the document and submit.
Teacher's Name
*
First
Last
Student's Name
*
First
Last
Current Grade Level
*
6th Grade
7th Grade
8th Grade
Has the parent been contacted?
*
Yes
No
Please provide your statement of request for referral for the above student
*
Your referral statement may include the following: " I submit a request for referral for evaluations for the above named student for consideration for special education services."
Submit