The parent/guardian is to complete the entire form and submit to the principal/designee of the student’s school of attendance. A new request must be submitted each school year per provider. This request form is used by the school principal/designee to determine whether or not to approve requests from parents/guardians for a private (non-partner) practitioner to work with a student at school during the school day. Each private (non-partner) practitioner must be approved to work with a student1 . MCPS reserves the authority to limit the approvals for private practitioners on MCPS property in accordance with MCPS Regulation ABA-RB, School Visitors and Regulation IJA-RC, Non-MCPS Providers of Supporting Services to Students. All absences due to telehealth appointments shall follow MCPS Regulation JEA-RA, Student Attendance, but may not conflict with a student’s IEP services.
This form does not apply to the following:
• A partner provider means a community social-emotional and mental health provider with whom MCPS has a written contract or Memorandum of Understanding (MOU), developed by the Division of Legal Services at the request of the Division of Specialized Support Services, for the purpose of specifying partnership roles and responsibilities, referral processes, safety planning, decision-making rules, and confidentiality and data-sharing protocols.
• Private therapists or providers who are conducting observations or evaluations for special education eligibility or under an approved Independent Education Evaluation (IEE).
• Outside service providers authorized by court order and/or by the Montgomery County Department of Health and Human Services, Child Protective Services.
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