Forms → Staff → Educational Services → Request for Private Therapeutic Services in School
Form number: 273-2
Last revised: October 2018
INSTRUCTIONS: The parent/guardian is to complete the entire form and submit to the principal/designee of the student’s home school. A new request must be submitted each school year.
This request form is used by the school principal/designee to determine whether or not to approve requests from parents/guardians for a private therapist to work with a student at school during the school day. Each provider must be approved to work with a student; and there are no therapists or agencies that have been pre-approved to provide such private therapy services to multiple students*. It is the sole discretion of the principal/designee to approve or deny any request for school visitors in accordance with MCPS Regulation ABA-RB, School Visitors. Parent/guardian requests for private therapists to provide Applied Behavior Analysis (ABA) therapy and other related services (such as speech, occupational therapy, physical therapy, etc.) at school that would typically be provided pursuant to an Individualized Education Program (IEP) or Section 504 of the Rehabilitation Act of 1973 (Section 504) Plan—as opposed to crisis-related counseling from a psychologist, psychiatrist, or social worker-generally will be denied.
*This form does not apply to the following:
Forms require Adobe Acrobat Reader 8 or higher. Get Acrobat