Students who are placed outside of their school district by a state agency or a licensed child placement agency, or who are residing in a program for pregnant and parenting women, or are placed in a residential treatment facility by a state agency are considered "state-placed".
Sometimes children need additional supports and services beyond what the school is providing. Act 264 is a law that ensures coordination of services for students with an emotional disability who are receiving services from more than one agency for example their local school and the local Mental Health Clinic. With the reauthorization of the Interagency Agreement under IDEIA, the Agency of Human Services is seeking to extend the coordination of services to other populations of children it serves such as those who have a developmental disability or those in need of substance abuse treatment.
Request for Reimbursement & Billing Forms for a State-Placed
Student Who is NOT Special Education Eligible
Vermont statute 16 V.S.A. § 2950(a) allows the commissioner to
approve, at his discretion, payment for educational costs for
"state-placed" students who are not special education eligible,
when the costs are due to the special needs of the student. NOTE:
Documents marked with a (W) are designed to be downloaded to a
hard drive and completed with a word processing application.
Complete the form by using the "tab" key to move through the
document. This form requires a signature, so you must complete,
save and print a hard copy of a document for signature.
Electronic versions of the completed forms will NOT be accepted.
Count of State-Placed Students
Two worksheets have been prepared that school districts need to
use when they are billing on Worksheet A for portions of their
staff for specialized instruction for state-placed students and
need to bill for more than the state allowed rate. One is for
individual student services and one is for special education
programs. Use this link for the Special Education Expenditure
Report, instructions and all other related forms.
Tuition Reimbursement Form (SPS Form 5)
This form is completed only for the cost of regular education
tuition for state-placed students placed in towns that tuition.
The form is also offered in the following "writeable" formats.
NOTE: These forms are designed to be downloaded to a hard drive
and completed with a word processing application. Complete the
form by using the "tab" key to move through the document. This
form requires a signature, so you must complete, save and print a
hard copy of a document for signature. Electronic versions of the
completed forms will NOT be accepted.
Cathy Scott at email@example.com or (802) 479-1234
Page Last Updated on May 19, 2015