LAUSD Referral Form

Thank you so much for your referral to Help Group Schools. Please complete the information below so we can begin processing your referral request. A member of the Admissions Office will complete the “NPS Offer of FAPE” form as soon as a final decision is made. Should you have any urgent questions, please contact the Admissions Office at 877-943-5747 or email us at admissions@helpgroup.org.

Referring Partner Information

Name of Point of Contact for This Referral:(Required)

First Last

Email Address for Point of Contact:(Required)

Please upload the LAUSD NPS Explores Letter here:

Max. file size: 50 MB.

Student Information

Student Name:(Required)

First and Last Name

Statewide Student Identifier (SSID):(Required)

Student's Current Grade:(Required)

Primary Eligibility:(Required)

Specify primary eligibility:(Required)

The student's most recent IEP specifies:(Required)

General Education Program

Alternate Curriculum/Modified Core Curriculum Program

Other

Specify other curriculum:(Required)

Due Process Information

Is this referral the result of due process?(Required)

Yes

Please upload the Synopsis:(Required)

Max. file size: 50 MB.

Is there anything else you would like to share about your student's educational and social/emotional/behavioral history that you feel would be relevant in determining appropriate placement?

LAUSD Referral Form

Referring Partner Information

Student Information

Due Process Information

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