ࡱ> a bjbjڤڤ KCbCb$+\ \ \ \ \ p p p 8 4!Lp >"0%F%F%F%z&&& <`=`=`=`=`=`=$@5Cb=\ &z&z&&&=\ \ F%F%4)>L212121&F\ F%\ F%<21&<2121o33F%<>3,C&,C33JC\ 4|&&21&&&&&==*,&&&>&&&&C&&&&&&&&&B ": Wisconsin Department of Public Instruction (DPI) SPECIAL NEEDS SCHOLARSHIP PROGRAM (SNSP) APPLICATION PI-SNSP-0002 (Rev. 07-19)INSTRUCTIONS: The parent or guardian must complete this application. Type or print clearly in ink. Return completed form and current residency documentation to the school. This collection is a requirement of Wis. Stat. 115.7915.School Applying To No abbreviations  FORMTEXT      School Year Applying For: 2019-20STUDENT INFORMATIONStudent s First Name Legal Name Only  FORMTEXT      MI  FORMTEXT   Last Name Legal Name Only  FORMTEXT      Suffix  FORMTEXT     Date of Birth Mo./Day/Yr.  FORMTEXT      2019-20 Grade Level  FORMTEXT      Gender  FORMCHECKBOX  Female  FORMCHECKBOX  MaleCheck One  FORMCHECKBOX  Hispanic/Latino  FORMCHECKBOX  Not Hispanic/LatinoCheck all that Apply  FORMCHECKBOX  American Indian/Alaska Native  FORMCHECKBOX  Asian  FORMCHECKBOX  Black/African American Native  FORMCHECKBOX  Hawaiian/Other Pacific Islander  FORMCHECKBOX  WhiteIEP OR SERVICES PLAN REQUIREMENTThe student must either have: (1) an Individualized Education Program (IEP) or services plan that is currently being implemented or (2) an IEP or services plan that was developed no earlier than September 15, 2016, AND have not subsequently been determined to no longer have a disability.Check which one the student has:  FORMCHECKBOX  IEP  FORMCHECKBOX  Services Plan (for student parentally placed at a private school)Name of Local Education Agency (LEA) That Developed the IEP or Services PlanDate of Last IEP Team or Services Plan Evaluation or Reevaluation FORMTEXT       FORMTEXT       FORMCHECKBOX  Yes  FORMCHECKBOX  No Since the IEP or services plan identified above was developed, did the student have a reevaluation that determined the student no longer had a disability?FAMILY INFORMATIONParent/Guardian First Name  FORMTEXT      MI  FORMTEXT   Last Name  FORMTEXT      Suffix  FORMTEXT     Telephone Area/No.  FORMTEXT      Parent/Guardian First Name  FORMTEXT      MI  FORMTEXT   Last Name  FORMTEXT      Suffix  FORMTEXT     Current Resident School District  FORMTEXT      Home Street Address  FORMTEXT      City  FORMTEXT      State  FORMTEXT   Zip  FORMTEXT      PARENT OR GUARDIAN CERTIFICATIONInitial here certifying that you received the comparison of the rights of students with disabilities under special education law and under the SNSP.Initial here certifying that you have received a profile of the private schools special education program.I, AS THE PARENT OR GUARDIAN, CERTIFY that all of the information on this application is true and correct. I understand that any of the information on this application or related to this application, including the IEP/services plan and residency documentation, may be subject to further review and verification by school and/or state officials. I ALSO UNDERSTAND that, no more frequently than once every three years, I must make the student available for an IEP reevaluation within 60 days following a request from the public school district for the student to continue to be eligible. I give LEAs permission to release any IEP or services plan for my student to the private school listed above for use in connection with Wis. Stat. 115.7915 and Wis. Admin Code PI49. Further, the private school listed above may provide any IEP or services plan to SNSP auditors and the DPI.Signature of Parent or Guardian MUST be the same name as one of the parents / guardians listed above. ( Date Signed Mo./Day/Yr.  FORMTEXT      FOR SCHOOL USE ONLY FORMCHECKBOX  Yes  FORMCHECKBOX  No Based on the information provided by the parent or guardian, the student is eligible pending verification that the IEP/services plan requirement was met.Date Application Received Mo./Day/Yr.  FORMTEXT      The LEA provided a copy of the following in response to the request that the LEA verify that the student had an IEP or services plan that meets the requirements described in the IEP or services plan requirement section. Retain a copy of the verification from the LEA with the application.  FORMCHECKBOX  IEP (the student is eligible)  FORMCHECKBOX  Services Plan (the student is eligible)  FORMCHECKBOX  Neither an IEP or a Services Plan or the student was determined to no longer have a disability (the student is not eligible)I, AS THE ADMINISTRATOR OR DESIGNEE RESPONSIBLE FOR PUPIL ADMISSIONS, have reviewed the student application and have determined that it is properly and completely filled out to the best of my knowledge. I attest that I have received the residency document(s) and IEP/ services plan from the LEA in response to the IEP/services plan verification request. Signature of School Administrator or Designee (Printed Name of School Administrator or Designee  FORMTEXT      Date Signed Mo./Day/Yr.COMPARISON OF RIGHTS OF STUDENTS WITH DISABILITIES AND THEIR FAMILIES UNDER STATE AND FEDERAL SPECIAL EDUCATION LAW AND UNDER THE WISCONSIN SPECIAL NEEDS SCHOLARSHIP PROGRAMEnrolled in Public School IDEA and Chapter 115Special Needs Scholarship Program 115.7915 Parentally-Placed Private SchoolA public school district must provide a free appropriate public education to students with disabilities. A free appropriate public education (FAPE) includes special education and related services that: Are provided at no cost to parents Include an appropriate preschool, elementary or secondary school education; Are provided consistent with an Individualized Education Program (IEP); and Meet the standards of the Wisconsin Department of Public Instruction Special education is specially designed instruction to meet the needs of the student with a disability. Examples of related services include speech-language therapy, physical and occupational therapy, audiology services, counseling services, and transportation. A public school district must also provide supplementary aids and services to allow the student to participate in regular education. Examples of supplementary aids and services include assistive technology devices or software, modification of assignments or tests, and use of specialized equipment. Students participating in the Special Needs Scholarship Program are parentally placed private school students. No FAPE entitlement. A participating student receives a scholarship in an amount set forth in state law to pay for attendance at an approved private school. Additional tuition or fees may be charged to students.Individualized Education Program (IEP) A public school district is required to develop an IEP for each student with a disability. The IEP must describe how the student is currently performing, and include annual goals and services so the student can make progress both toward attaining the annual goals and meeting grade-level expectations. The IEP must also describe how the students parents will be informed of the students progress. The IEP team must meet at least annually to review the IEP, and revise it as necessary. A public school district must fully implement the IEP and provide all services described in the IEP. If the IEP is not fully implemented, the parent can seek relief, including compensatory services, under the state special education complaint process, mediation, or due process. A participating private school is required to implement the most recent IEP or services plan, as modified by agreement between the private school and the students parent. There are no rights to relief if disputes arise and no requirement for an annual review of the IEP. Child Find A public school district is responsible for identifying, locating and evaluating students with suspected disabilities, including parentally-placed students in private schools. Reevaluation A public school district must generally reevaluate students with disabilities at least once every three years.Upon the request of the students resident school district, the IEP team must conduct a reevaluation no more frequently than once every three years for SNSP eligibility purposes. Independent Educational Evaluation (IEE) Parents may obtain an IEE free of charge if the parent disagrees with an evaluation conducted by the public school district, unless the school district initiates a due process hearing to defend its evaluation.Parents of participating students retain the right to an IEE free of charge if they disagree with an evaluation conducted by a public school district, unless the school district initiates a due process hearing to defend its evaluation.Discipline Students with disabilities are entitled to protections regarding school disciplinary practices. 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This covers a wide range of issues that include evaluations, development of the IEP, implementation of the IEP, where services will be provided, and disciplinary practices.Access to the mediation system is limited to disputes with the public school district over the evaluation of their child. State Special Education Complaints Parents may file a complaint with the Department of Public Instruction (DPI) if they believe the public school district did not follow state or federal special education law. This covers a wide range of issues that include evaluations, development of the IEP, implementation of the IEP, where services will be provided, and disciplinary practices.Parents may file a state IDEA complaint with the DPI only regarding disputes concerning the evaluation of their child by the public school district. Due Process Hearings Parents may request a due process hearing about disputes regarding the identification, evaluation, educational placement or provision of a free appropriate public education by a public school district. This covers a wide range of issues that include evaluations, development of the IEP, implementation of the IEP, where services will be provided, and disciplinary practices.Parents may request a due process hearing only regarding the evaluation of their child by a public school district. Records Parents of students with disabilities must be allowed to review all special education records maintained by the public school district.Parents of students with disabilities have the right to review special education records maintained by the public school district. Prior Written Notice Public school districts must provide parents with written notice before any activity affecting a students special education identification, evaluation, educational placement or the provision of FAPE.     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