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The inclusion of students with disabilities, in their local school districts, requires a variety of educational supports and related services in order to maximize the students’ opportunities for success.
We at Cape May County Special Services School District (CMCSSSD), through the Shared Services Itinerant Program, can assist your school district in meeting this challenge.
We are staffed with highly qualified, experienced professionals in the areas of Special Education and Related Services, who are available upon request, to provide these services to students in your district.
For more information please download the Itinerant Services Brochure
and
please feel free to contact via email
Judy Lincoln, Supervisor of Related Services
or phone at 609-465-2720 ext. 4400
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Memo
TO: Directors of Special Education
FROM: Judy Lincoln, Supervisor of Related Services
RE: Revised Itinerant Services Request Form
Below is the Revised Itinerant Services Request form for your review. The ISR form is available for download by clicking on the Blue Link on the top of the ISR form's page below.
Please ONLY use this form when requesting services through Cape May County Special Services School District Itinerant Program.
Please take the time to review the ISR form and note any changes. You will need to complete and submit the ISR form when services are requested. Once you have completed the ISR form, it can be faxed to 609-465-8039, attention: Judy Lincoln, Supervisor of Related Services to expedite services.
When completing the ISR form, please be as specific as possible as to services requested including
(if applicable), the date by which you need an evaluation report. Do not put ASAP. Request for services will no longer be taken by telephone or by the itinerant providers.
Please make certain that all CST secretaries and/or case managers have copies of the form, as needed.
Once the Itinerant Services Request form is received, a qualified therapist or provider will be assigned.
If you have any questions, feel free to call me at 465-2721 ext. 4400 Thank you. |
CAPE MAY COUNTY SCHOOLS FOR SPECIAL SERVICES
Phone: 609-465-2721
Fax: 465-8039
ITINERANT PROGRAM REQUEST FORM (2006-2007)
Student’s Name: DOB:
Parent’s Name: Phone:
Address:
District/School: Date:
Teacher/Room: Grade:
Referred by: Phone:
Service Requested: (Please check all that apply)
Physical therapy evaluation Reason for referral for evaluation
Occupational therapy evaluation
Speech and Language evaluation
Learning evaluation
Evaluation report due
(please give specific date)
Social History
School Psychological evaluation
Audiological evaluation
Neurological evaluation
Psychiatric evaluation
Physical therapy services (frequency, duration)
Occupational therapy services (frequency, duration)
Speech therapy services (frequency, duration)
Special education services (frequency, duration)
Consultation services (type)
Attendance at a meeting (type)
Case Management services (be specific)
Other:
Additional Comments:
*Please fax your request to 465-8039, attention: Judy Lincoln, Supervisor of Related Services
• Mailing Address: 4 Moore Rd. DN 704, Cape May Court House, NJ 08210
Do not write below - for CMCSSSD Use ONLY
1. Date request is received
2. Assigned itinerant number -07-
Assigned to & copy of form sent to
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