Forms → Staff → Educational Services → Referral for Alternative Program Placement
Form number: 336-55
Audience: School Staff
Last revised: December 2018
Directions: (Before referring a student to a Level 2 Alternative Program, the referring school’s Educational Management Team (EMT), including a Pupil Personnel Worker (PPW), is responsible for conducting an assessment to determine that any prescribed instructional and/or behavioral interventions and strategies have been provided consistently in the Level 1 Alternative program, or other structured setting such as a resource class, over a measureable period of time.)
1. This form should be completed by a school EMT to refer a student to a Level 2 Alternative Program and for review by the Alternative Programs Admission Committee (APAC). The parent/guardian, and eligible student as appropriate, must be notified of the EMT meeting and every effort should be made to schedule the meeting at a time when they can attend and provide input.
2. The referring school PPW submits completed packets to: Director, Division of Pupil Personnel and Attendance Services, CESC, Room 211
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