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Special Education

2012-2013 Educable Child Applications

Before student applications can be accepted, the school must file the necessary documentation with the Mississippi Department of Education (MDE) Educable Child Program and be approved as a private school facility. A faxed copy of the application is not acceptable. In order for our office to proceed in a timely manner for this school year, please submit the requested information and forms by June 27, 2012.

After all necessary documents have been received and reviewed, you will receive a letter of notification indicating your status to participate in the Educable Child Program for the 2012-2013 school year.

The entire application package can be found on the links below. If our office can be of assistance, please contact Barbara Quarles at 601-359-3498.

  1. Private School Approval Application
      1. Directions
      2. School Approval Application 
      3. School Calendar (DI-SE-F69)
      4. Data Sheet Instructions (DIR-DI-SE-43B)
      5. Data Sheet (DI-SE-F43B)
      6. Certification Update (DI-SE-F1)
      7. Assurances and Approval Procedure
  2. Educable Child Procedures

  3. Applications
    (The entire application package must include the forms or reports as listed. Applications must be the latest revised version posted for the 2012-2013 school year. Please submit the application on the appropriate color of paper as requested. An incomplete application or partial data will result in the application being returned for completion and will delay approval. Make sure all copies of submitted data are legible and current in order to obtain approval. Faxed copies will not be acceptable.
All eligibilities (initial and re-evaluations) must be obtained from the district in which the student resides. Eligibilities from facilities will not be accepted.

  1. Mississippi Department of Human Services (DHS)
    1. Application for Financial Assistance (DI-SE-F68) - (Pink)
    2. A copy of the child’s current Determination of Eligibility Report (DER) and a copy of the current Evaluation Report (ER)
    3. A current Individualized Educational Program (IEP) developed in accordance with regulations
    4. Current (within one year) court order/legal document which grants custody of the child to the MS Department of Human Services or other State Agency
    5. A copy of the notarized Assignment of Tuition Reimbursement Form (DI-SE-F9)
  2. Parent-Medicaid
    1. Application for Financial Assistance (SDE-BSS-F11) - (Blue)
    2. A copy of the child’s current certification by Division of Medicaid which specifies the requirement for inpatient care in an ICF-MR facility or Psychiatric Residential Treatment Facility (PRTF) and the period for inpatient care
    3. A copy of the child’s current Determination of Eligibility Report (DER) and a copy of the current Evaluation Report (ER)
    4. A current Educable Child Form for Parentally Placed Students
    5. A copy of the notarized Assignment of Tuition Reimbursement Form (DI-SE-F9)
  3. Parent
    1. Parent/Guardian Application for Financial Assistance when placing a child with a disability in a private or parochial school (D1-SE-F11) - (Green)
    2. A copy of the child’s current Determination of Eligibility Report (DER) and a copy of the current Evaluation Report (ER)
    3. A current Educable Child Form for Parentally Placed Students
    4. A copy of the notarized Assignment of Tuition Reimbursement Form (DI-SE-F9)
  4. School District
    1. Public School District Application for Financial Assistance when placing a student with a disability in a private school/facility(DI-SE-F10) - (Yellow)
    2. A copy of the child’s current Determination of Eligibility Report (DER) and a copy of the current Evaluation Report (ER)
    3. A current Individualized Educational Program (IEP) developed in accordance with regulations
    4. Justification for Placement (DI-SE-F10a)
4. Reimbursement Forms
    a. DHS
        1. First Pay Period
            a. With Transportation Cost
        2. Second Pay Period
            a. With Transportation Cost
        3. Third Pay Period
            a. With Transportation Cost
        4. Fourth Pay Period
            a. With Transportation Cost
        5. Fifth Pay Period
            a. With Transportation Cost

     b. Parent
        1. First Pay Period
        2. Second Pay Period
        3. Third Pay Period
        4. Fourth Pay Period
        5. Fifth Pay Period

    c. Parent-Medicaid
    1. First Pay Period
    2. Second Pay Period
    3. Third Pay Period
    4. Fourth Pay Period
    5. Fifth Pay Period
    d. School District
        1. First Pay Period
        2. Second Pay Period
        3. Third Pay Period
        4. Fourth Pay Period
        5. Fifth Pay Period

5. Invoices
    a. Memo
    b. Invoice Form
    c. Invoice Parent Placement Only

 6. Official Drop Form

NOTE:   Forward all forms and reports to the Mississippi Department of Education, Office of Special Education, Attention: Program Coordinator, Educable Child Program, P.O. Box 771, Suite 301, Jackson, MS 39205.
 Fax copies will not be accepted.
Office of Special Education     P.O. Box 771     359 N. West Street, Suite 300     Jackson, MS 39205     Phone: (601) 359-3498     Parent Hotline: 1-877-544-0408
 

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