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TESA Intake Folder (RED Hanging Folders)

1. New Student Info Sheet and Main File Checklist (on green) Case manager fills out
2. District 917 Intake Case manager fills out
3. Meeting Summary Ask for someone to take notes. This should be transferred into Sped
forms by case manager after the meeting--once we have Sped Forms access to student.
4. IEP Meeting Attendance Consent of Excused Absence Case manager prepares--excuse
general education teacher and any others unable to attend.
5. TESA Parent Info Give to parent to return with Health Forms
6. Ethnicity Form Parent fills out at meeting
7. Name on Diploma (on colored paper) Parent fills out at meeting
8. Consent to Release Private Data (3) Fill out as needed for outside providers DURING
meeting
9. Referral for Services within District 917 Case manager fills out and attach
eval./documentation and give to Don for signature (after meeting)
10. Are Your Kids Ready? (MN Immunization Law) Give to family or request immunizations
from family/home district if they have them.
11. PT Referral Give to parent to get physician’s signature
12. Annual Health Ltr to Parents/Guardian (plus half sheet with web info) Give to parents to
return prior to student start date.
13. Student Emergency Contact Form Give to parents to return prior to student start date.
14. Annual Health Information Form Give to parents to return prior to student start date.
15. Authorization and Request for Admin of Meds (2) Give to parents to return prior to
student start date. Remind parent to send in medication, only need physician’s
signature if it is a prescription medication.
16. Medication Profile Joan may fill this out if needed
17. Third Party Billing (IEP Health Related Services) Give to parent to fill out/sign AT
MEETING. This form needs to go to Lynda Hurt ASAP. If parent refuses, we need
documentation/letter from parent expressing they refuse.
18. Student/Parent Agreement Give with student handbook for students starting within
current school year.
19. Application for Enrollment in Secondary Tech Center plus Special Needs Data Sheet
Provide to parents if applicable--assist with filling out.
20. Pamphlet for Secondary Provide to parents if applicable
21. Transportation Numbers Provide to parents
22. Lunch Application – NEW application on July 1st Provide to parents if applicable for
current school year.
23. Special Diet Statement Provide to parents if applicable--parents need to get physician’s
signature.
24. Notice of Procedural Safeguards Provide to parents at start of meeting with Excusal
Form.
25. TESA Calendar Provide to parents

* A handbook is also given at intake meeting.

* Transportation plans are now completed in Sped Forms when complete students IEP.

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