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Referral and Intake Process for Special Education

Intermediate School District 917 is composed of nine member school districts located in Dakota County and southern Hennepin County. These school districts identify and refer students with low-incidence disabilities to Intermediate School District 917 to receive services for their special education needs.  Services are offered in the least restrictive environment appropriate to each student.  If a learner resides within a member district and is in need of services, referrals are made by the local director of special education.

Below you will find a listing of items necessary to complete a referral to Intermediate School District 917 site-based programs.  The actual forms are found in order at the bottom of the web page. 

Districts completing a referral for Intermediate School District 917 purchase of services need to complete an Intermediate School District 917 Referral for Special Education Services Form only, and for requests for Intermediate School District 917 physical therapy services, the additional Intermediate School District 917 Physical Therapy Physician Referral Form.




Get Acrobat Reader  ISD 917 Referral Process Procedure  
Get Acrobat Reader  ISD 917 Referral for Special Education Services Form-Adobe Version (for external use)  
 ISD 917 Referral for Special Education Services Form-Fill-in Version (for external use)  
Get Acrobat Reader  Referral for Services Within District 917 (for ISD 917 internal use only)  
Get Acrobat Reader  ISD 917 Supplemental Transition Plan  
Get Acrobat Reader  ISD 917 Intake Form (for ISD 917 internal use only)  
Get Acrobat Reader  Ethnicity/Race Form  
Get Acrobat Reader  ISD 917 Health Information Form  
Get Acrobat Reader  MDE Home Language Questionnaire  
Get Acrobat Reader  ISD 917 Lunch Information Parent Letter 2011-12  
Get Acrobat Reader  MDE Free/Reduced Lunch Application Form  
Get Acrobat Reader  ISD 917 Medication Authorization Form  
Get Acrobat Reader  Parent Sign-off Form from ISD 917 Parent/Guardian-Student Handbook  
Get Acrobat Reader  ISD 917 Physical Therapy Physician Referral Form  
Get Acrobat Reader  ISD 917 Use of Restrictive Procedures Notice  
Get Acrobat Reader  ISD 917 IEP Billing Consent Letter to Parents  
Get Acrobat Reader  Dept of Human Services Brochure for IEP Billing  
Get Acrobat Reader  Minnesota Health Care Programs-Spanish Version  
Get Acrobat Reader  ISD 917 Combined IEP Billing Consent Form  
Get Acrobat Reader  ISD 917 Student Emergency Contact Information Form  
Get Acrobat Reader  ISD 917 Transportation Plan Form  
Get Acrobat Reader  MDH Immunization Information-Are Your Kids Ready for School? English  
Get Acrobat Reader  MDH Immunization Information-What About Varicella (Chickenpox) Shots?  
Get Acrobat Reader  MDH ECFE Pupil Immunization Record Form  
Get Acrobat Reader  MDH Pupil Immunization Record Form  
Get Acrobat Reader  ISD 917 DNR-DNI Policy