Project STAY Referral Form

REFERRING A STUDENT:

Specialized Learning Services Consortium member districts have access to Project STAY student observation, problem-solving, and intervention considerations. In order for a student to be referred to Project STAY the following steps need to occur:

1. ADMINISTRATIVE CONSENT: Approval by the Director of Special Education or Superintendent and Building Principal of the member district
2. PARENT CONSENT: Parent(s) or legal guardian need to sign a consent form to allow Project STAY to become involved 
3. INTAKE: An initial meeting for intake scheduled with Project STAY staff

You will need to upload a completed Parent Consent for Services with Authorization To Disclose Confidential Information in this online form. Please talk with your Director of Special Education, Superintendent, or Building Principal before beginning this referral. An electronic signature request will automatically be sent to the designated administrator (Director of Special Education, Superintendent, or Principal) for consultation approval upon submitting this referral form.

STARTING THIS REFERRAL FORM:

• NEXT: Click "Next" to begin this referral.
• SAVE: After starting, you may use the "Save and continue later" feature at the top of your screen to save your place and finish later.
• SUBMIT: Once finished, click "Submit" and this form will be sent to the Project STAY staff at Greenbush.

Completion and submission of this entire form online is required in order for Project STAY to take a case. For questions please contact the Project STAY team at Greenbush by email at projectstay@greenbush.org or call 620-724-6281 Ext 121.