About this Form
Form number: 336-13
Last revised: February 2017
Form 272-10 - Documentation of Interventions
Form 272-9 - Teacher Referral
Form 336-22 - Eligibility Screening Parent Interview/Questionnaire
Form 336-21 - Classroom Observation
Form 336-20 - Educational History
Instructions: The parents/guardians of a Private/Parochial school student seeking evaluation by Montgomery County Public Schools (MCPS) for special education services must complete this form and provide a copy of the student’s birth certificate or other evidence of birth as noted on the form. On page 2 of this form, there are links to other MCPS forms that are required to be completed as part of a comprehensive referral packet. We ask that parent(s)/guardian(s) provide a copy of any private assessments with the completed referral packet if they would like the Individualized Education Program (IEP) team to consider the assessment findings.
Please submit all required forms and any additional documents as a completed packet electronically via e-mail or mail to: MCPS,Private/Parochial Office, 850 Hungerford Drive, Room 225, Rockville, MD 20850.
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