Revised July 16, 2015 Page 1 of 28 Name of Proposed School: COMMONWEALTH OF VIRGINIA DEPARTMENT OF EDUCATION PRIVATE SCHOOLS FOR STUDENTS WITH DISABILITIES P. O. Box 2120 Richmond, Virginia 23218-2120 Fax Number: 804-371-8796 2015 - 2016 APPLICATION TO OPERATE A PRIVATE SCHOOL FOR STUDENTS WITH DISABILITIES Private School Specialists Judith McKinney Telephone: 804-225-2725 Email: [email protected]Christina Owens Telephone: 804-225-4551 Email: [email protected]Karen Schonauer Telephone: 804-786-3234 Email: [email protected]General Overview – “School for students with disabilities,” “school,” or “schools” means a privately owned and operated preschool, school or educational organization, no matter how titled, maintained, or conducting classes for the purpose of offering instruction, for a consideration, profit or tuition, to persons determined to have autism, deaf-blindness, a developmental delay, a hearing impairment including deafness, intellectual disability, multiple disabilities, an orthopedic impairment, other health impairment, an emotional disturbance, a specific learning disability, a speech or language impairment, a traumatic brain injury, or a visual impairment including blindness. (§ 22.1-319 of the Code of Virginia) When an individual or corporation is in the early planning stages of opening a private school for students with disabilities, it is recommended that the Virginia Department of Education (Department) be contacted for preliminary consultation. The Department shall evaluate each application within 60 calendar days from the date received and advise the applicant in writing of approval or deficiencies. The applicant shall correct all deficiencies within 30 calendar days from the date of the written assessment of the application. The Department may grant an extension for a reasonable period of time. Before a license can be issued to an applicant, the Department shall conduct an on-site inspection or review photographs or videos of the school building and grounds to determine its suitability for the operation of a school for students with disabilities. (8VAC20-671-120, 130) PROPOSED SCHOOL CONTACT INFORMATION Name of School: Contact Person: Physical Address: E-Mail Address: Mailing Address: Web Address: Telephone Number: Fax Number:
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Revised July 16, 2015 Page 1 of 28
Name of Proposed School:
COMMONWEALTH OF VIRGINIA DEPARTMENT OF EDUCATION
PRIVATE SCHOOLS FOR STUDENTS WITH DISABILITIES
P. O. Box 2120
Richmond, Virginia 23218-2120
Fax Number: 804-371-8796
2015 - 2016 APPLICATION TO OPERATE
A PRIVATE SCHOOL FOR STUDENTS WITH DISABILITIES Private School Specialists
15. _____ Identify requirements for a diploma. 8VAC20-671-10-
610.B
16. _____ Process and procedures regarding
administration of statewide assessments.
8VAC20-671-10-
450.D
17. _____ Describe how the school cooperates with
public schools in the administration of
SOL tests.
8VAC20-671-10-
450.D
18. _____ Process and procedures regarding
development of Individualized Education
Programs (IEPs).
8VAC20-671-10-460
19. _____ Process regarding development of
Individualized Instruction Programs (IIPs)
for privately placed students.
8VAC20-671-10-470
20. _____ Describe how the school shall provide a
program of instruction that clearly
articulates learning outcomes for core
subjects: English, mathematics, science,
and history/social science.
8VAC20-671-10-
490.F
21._____ Describe how the school shall require
students to participate in a program of
health and physical fitness during the
regular school year.
8VAC20-671-10-
490.G
22. _____ Describe how the school shall provide
students with opportunities to gain
appreciation for art and music.
8VAC20-671-10-
490.H
23. _____ Describe how the school will assign,
collect, and evaluate make-up work.
(Recommended)
24. _____ Describe the school’s Individual Student
Alternative Education Plan (ISAEP)
program.
8VAC20-671-10-530
25._____ Describe the transition services designed
within an outcome-oriented process for all
students, as appropriate, that promotes
movement from the private school to a
public school the child would normally
attend; movement from school to post-
school activities, including postsecondary
education, vocational training, integrated
employment (including supported
8VAC20-671-10-
540.B
Revised July 16, 2015 Page 19 of 28
Name of Proposed School:
Item Number Required Items 8VAC20-671 Handbook
Page
employment), continuing and adult
education, adult services, independent
living, or community participation.
26. _____ Describe the process and procedures that
the school will implement to address the
following: 1) School-sponsored
extracurricular activities shall be under the
direct supervision of staff and organized to
avoid interrupting the instructional
program; 2) CPR and first aid certified
staff shall accompany students on school-
sponsored activities; and 3) Schools that
take students on outdoor adventure
activities and offer programs such as
canoeing, skiing, camping, and rock
climbing shall develop policies and
procedures to ensure supervision, health
and safety, and medical management.
8VAC20-671-10-
550.A., B., and C
27. _____ Describe the curriculum used for the
Family Life Education Program and a
statement that written parental consent is
required.
8VAC20-671-10-
560.A., B
28. _____ Describe the school places students on
work-study, on-the-job training, or any
other form of employment which shall
ensure compliance with the applicable
laws governing the employment of
children.
8VAC20-671-10-570
29. _____ Describe how virtual courses will be
offered through accredited providers and
supervision responsibilities of school staff.
8VAC20-671-10-
580.A., B.
30. _____ Describe the equipment, instructional
materials, and library media available to
support the instructional program.
8VAC20-671-10-590
31. _____ Insert a copy of the school’s academic
calendar.
8VAC20-671-10-600
32. _____ Include the school rules and expectations
relating to conduct.
8VAC20-671-10-620
33. _____ Describe the school's behavior
intervention policies and procedures
8VAC20-671-10-630
34. _____ Provide written protocol regarding the use
of timeout.
8VAC20-671-10-640
35. Provide a list of prohibitions. 8VAC20-671-10-650
36. _____ Include the school’s protocol regarding the
use of restraint and seclusion in
emergency situations.
8VAC20-671-10-660
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Name of Proposed School:
Item Number Required Items 8VAC20-671 Handbook
Page
37. _____ Describe the annual professional
development and refreshers required of
staff.
8VAC20-671-10-
350.F
38. _____ Describe the process when making
referrals to Children’s Protective Services
(CPS), including documentation,
reporting, and required notifications.
8VAC20-671-10-690
39. _____ Include nformation related to the
requirement of a comprehensive physical
examination and current record of
immunization in each student record.
8VAC20-671-10-
710.A, B
40. _____ Describe the medication management
procedures, including training,
transporting, storing, administering, and
disposal of medication.
8VAC20-671-10-710.
E - K
41. _____ Describe the school’s food service
program.
8VAC20-671-10-720
42. _____ Describe the transportation services
provided by the school.
8VAC20-671-10-730
43. _____ Define the criteria for discharge. 8VAC20-671-10-740
44. _____ Describe the maintenance of student
records.
8VAC20-671-10-750
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Name of Proposed School:
VIRGINIA DEPARTMENT OF EDUCATION
REGULATIONS FOR GOVERNING PRIVATE SCHOOLS FOR STUDENTS WITH DISABILITIES
8VAC20-671-10 et seq.
POLICIES AND PROCEDURES REVIEW
Name of School: Administrator:
School Self-
Monitoring
Review
Name(s) of school staff: Date(s):
Initial
Application
On-Site
Licensure
Review
Name(s) of VDOE Specialists:
Date(s):
Regulation Responsibilities of the licensee C NC
210.2 Develop and implement a written decision-making plan that shall
include provision for a staff person with the qualifications of the
school administrator or education program director to be designated to
assume the temporary responsibility for the operation of the school in
the absence of the school administrator. The plan shall include a
current organizational chart.
210.4 Develop a written statement of the objectives of the school including a
description of the target population and the program offerings.
210.5 Develop and implement written policies and procedures to monitor and
evaluate the effectiveness of the education program on a systematic
and ongoing basis and implement improvements when the need is
determined.
210.7 Develop a written policy prohibiting the consumption of tobacco
products, illegal drugs, and alcohol or being under the influence of
intoxicating or hallucinogenic agents while on campus and at school-
sponsored student activities.
210.13 Develop and implement an accessible policy and procedures to handle
school related complaints from students, parents, and employees.
Schools are required to provide written notification of the right to file a
complaint with the Department’s private school licensure office.
210.14 The school shall have a written policy and procedure that the school
does not discriminate according to state and federal law.
Regulation Fiscal accountability
220.C There shall be written policies and procedures that address the day-to-
day handling of the school's funds.
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Name of Proposed School:
Regulation Personnel policies and procedures C NC
270.A The licensee shall have written personnel policies and procedures that
include, but are not limited to, job qualifications, job descriptions,
supervision, evaluation, dispute resolution and termination.
270.A.1 The licensee shall develop and implement written policies and
procedures that persons appointed or designated to assume the
responsibilities of each position possess the education, experience,
skills, and abilities specified in the job description.
270.B The licensee shall maintain a current organizational chart of all
full-time and part-time positions.
Regulation Job descriptions
290 There shall be a written job description for each position that includes
job title; duties and responsibilities; job title of the immediate
supervisor; and minimum education, experience, skills, and abilities
required for entry-level performance of the job.
Regulation Staff supervision
340 The licensee shall develop and implement written policies and
procedures regarding the supervision of employees, full-time and part-
time, and all other staff including volunteers and student interns
working in the school building or on the school grounds.
Regulation School facilities and safety
370.K There shall be a written policy regarding safeguards for school-
sponsored activities including adventure and wilderness activities.
Regulation Contingency plan
380.B.1 Written procedures to follow in emergencies such as fire, injury,
illness, and violent or threatening behavior. Contingency plans should
be developed with the assistance of state or local public safety
authorities. Such plans shall be outlined in the student handbook and
reviewed with staff and students during the first week of each school
year.
380.B.3 A written procedure for responding to violent, disruptive, or illegal activities by students on school property or during a school-
sponsored activity.
380.D.3 Written emergency management policies outlining specific
responsibilities for provision of:
380.D.3 administrative direction and management of response activities; coordination of logistics during the emergency; communications; life safety of students, employees, contractors, student interns,
volunteers, and visitors;
property protection; community outreach; and recovery and restoration.
380.D.4 Written emergency response procedures for:
protecting equipment and education records; and restoring services.
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Name of Proposed School:
380.D.5 Emergency procedures, which shall address: C NC
380.D.5 communicating with employees, contractors, volunteers, student
interns, and community responders;
warning and notification of students; providing emergency access to secure areas and opening locked doors; conducting evacuations to emergency shelters or alternative sites and
accounting for all students;
relocating students and staff, if necessary; notifying family members and legal guardians; alerting emergency personnel and sounding alarms; and
locating and shutting off utilities when necessary.
380.I The procedures and responsibilities reflected in the emergency
procedures shall be communicated to all students within seven days
following admission or a substantive change in the procedures.
Regulation Weapons
390 The licensee shall develop written policies and procedures governing
the prohibition of weapons on school property. The staff and students
shall annually be informed of the policies and procedures regarding the
prohibition of weapons.
Regulation Searches
400.A A school that does not conduct pat downs shall have a written policy
prohibiting them.
400.B A school that conducts pat downs shall develop and implement written
policies and procedures that shall provide the following:
1. Pat downs shall be limited to instances where they are necessary to
prohibit contraband;
2. Pat downs shall be conducted by personnel of the same gender as the
student being searched;
3. Pat downs shall be conducted only by personnel who are specifically
authorized to conduct searches by the school's written policies and
procedures; and
4. Pat downs shall be conducted in such a way as to protect the
subject’s dignity and in the presence of one or more witnesses.
Regulation Student application and admission
410.A The school's written admission policy shall include:
410.A 1. A description of the population to be served; 2. A description of the types of services offered; 3. Admission procedures; 4. Exclusion criteria that identify behaviors or conditions the school
will not accept; and
5. A description of how educational services will be delivered.
Regulation Standard school year and school day
420.C Each school shall have policies and procedures that address make-up
days when the school is unable to meet the required instructional time.
Regulation Extracurricular and other school activities, and recess
550.C Schools that take students on outdoor adventure activities and offer
programs such as canoeing, skiing, camping, and rock climbing shall
develop policies and procedures to ensure supervision, health and
safety, and medical management.
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Name of Proposed School:
Regulation Equipment, instructional materials, and library media C NC
590.C Each school shall establish written policy on the use of computers,
including the use of the Internet and email.
Regulation Diplomas
610.B Each school that offers a diploma upon graduation shall have
written policies and procedures that address the following:
610.B 1. The requirements for a diploma shall be those in effect when the
student enters the ninth grade for the first time.
2. The requirements for a diploma shall be based upon completion of
program requirements that demonstrate academic rigor.
Regulation Student conduct
620.B Each school shall have written policies and procedures that
address standards of student conduct and procedures for
enforcement to include:
620.B attendance,
truancy,
suspension,
expulsion, alcohol, drugs,
weapons, fighting,
bullying, sexual and disability harassment, pornography, and
other areas as appropriate.
Regulation Behavior intervention
630.A Each school shall develop and implement written policies and
procedures that emphasize positive behavior interventions.
Regulation Time-out
640
Policies and procedures shall be written that govern the
conditions under which a student may self-select or be placed in
time-out and the maximum length of time a student may be in
time-out. The conditions for time-out and length of time a
student may be in time-out shall be based on the student’s
chronological and developmental levels. The school’s policy and
procedures shall include:
640
1. Each student is entitled to be completely free from any unnecessary
use of time-out.
2. A door to a time-out room shall not be locked nor secured in a
manner that prevents the student from opening it.
3. A student in time-out shall be able to communicate with staff. 4. Staff shall check on the student at least every 15 minutes and more
often depending on the nature of the student's disability, condition or
behavior.
5. The use of time-out and staff checks on the student shall be
documented.
6. Staff shall review procedures when a student consistently chooses to
Revised July 16, 2015 Page 25 of 28
Name of Proposed School:
stay in time-out beyond the determined time limit to determine that it
has not become reinforcement.
Regulation Managing student behavior in emergency situations C NC
660.A
Each school shall have written policies and procedures made
available annually to students, parents, and placing agencies that
include, but are not limited to:
660.A
1. Methods for preventing student violence, self-injurious behavior,
and suicide, including de-escalation of potentially dangerous behavior
occurring among groups of students or with an individual student.
2. A statement that corporal punishment and abusive techniques and
interventions are not authorized, permitted, or condoned.
3. A statement that behavior management techniques are applied in
order of their degree of intrusiveness or restrictiveness and the
conditions under which they may be used by trained personnel.
Regulation Videotaping
670.A Schools shall have written policy and procedures regarding videotaping
students while in school and any school-sponsored activity, including
those used for staff training.
Regulation Suspected child abuse and neglect
690.A Written policies and procedures related to child abuse and
neglect shall comply with the requirements of § 63.2-1509 of the
Code of Virginia and distributed to all staff members. Policies
and procedures shall include:
690.A 1. Handling accusations against staff; and
2. Reporting immediately, but no later than 24 hours after having a
suspicion of a reportable offense of child abuse and neglect to the local
department of social services child protective services unit of the
county or city wherein the abuse or neglect was believed to have
occurred or to the Department of Social Services toll-free child abuse
and neglect hotline and for cooperating with the unit during any
investigation.
Regulation Medication and health
710.H The provider shall develop and implement written policies and
procedures regarding:
710.H 1. Managing medication errors to include the following:
administering first aid;
contacting the poison control center;
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Name of Proposed School:
notifying the prescribing physician;
taking action as directed; documenting the incident;
reviewing medication errors and staff responses; and
reporting errors to the parent and placing agency.
2. Handling adverse drug reactions;
3. Revising procedures as events may warrant;
4. Disposing of medication and medical supplies such as needles,
syringes, lancets, etc.;
5. Storing of controlled substances;
6. Distributing medication off campus; and
7. Documenting medication refusals.
Regulation Student Discharge
740.A Each school shall have policies and procedures that address conditions for
which a student may be discharged from the school.
Regulation Maintenance of student records
750.A The school shall have written policy and procedures for the management of
all records, print and non-print, regarding confidentiality, accessibility,
security, retention, and disposition.
Revised July 16, 2015 Page 27 of 28
Name of Proposed School:
COMMONWEALTH OF VIRGINIA DEPARTMENT OF EDUCATION
PRIVATE SCHOOLS FOR STUDENTS WITH DISABILITIES
P. O. Box 2120
Richmond, Virginia 23218-2120
Fax Number: 804-371-8796
GENERAL INDEX OF SCHOOL FORMS, AND OTHER DOCUMENTS Below is a list of forms, reports, and other documents often used in Private Schools for Students with
Disabilities. This list is not exhaustive and prospective schools may consider developing forms to meet the
unique needs of the school and student population to be served. Include copies of all sample forms or blank
templates that the school plans to use with the application packet.
1. ______ Acceptance Letter
2. ______ Application for Admission
3. ______ Behavior Management Program Consent Form (student, parent/guardian/LEA)
4. ______ Calendar (i.e. Including school contact information and operating hours)
5. ______ Complaints to Child Protective Services
6. ______ Computer Use Agreement
7. ______ Confidentiality Form (see Visitor Sign-In Form)
8. ______ Consent to Administer Medication (from parent and doctor)
9. ______ Consent to Exchange Information
10. ______ Consent to Photograph or Videotape
11. ______ Contracts with Parents/Guardians, LEA, and other agency representatives
12. ______ Documentation of Emergency Preparedness (i.e. weekly fire drills for first month)
13. ______ Emergency Preparedness Plan
14. ______ Emergency Drill Forms (i.e. earthquake, fire drill, intruder/lockdown, and tornado drill)
15. ______ Enrollment and/or Placement Agreements
16. ______ Field Trip Permission Form
17. ______ Grading Scale
18. ______ Individualized Instruction Plan (IIP)
19. ______ Incident and Serious Incident Reports
20. ______ Internet or Technology Use Consent/Agreement Form
21. ______ Request for Student Records
22. ______ Medical History Form
23. ______ Medication Administration Log and Transfer of Medication Log (for school use)
24. ______ Medication Error Form (school use)
25. ______ Parent, LEA, and other Agency Contact Logs
26. ______ Permission to Photograph or Videotape
27. ______ Permission to be transported by school staff
28. ______ Progress Reports for Individualized Instruction Plan (IIP)
29. ______ Related Services Documentation Forms (hours and dates of service delivery)
30. ______ Report Cards (interim, quarterly) and Transcripts
31. ______ Staff Professional Development Calendar of Training and Certification documents
32. ______ Student Record Access Form (to be placed in the front of student file)
33. _____ Time Out and Seclusion Records
34. ______ Toileting/Diapering Consent Form
35. ______ Vehicle Safety and Inspection Forms
36. ______ Visitor Sign-In Form (see Confidentiality Form)
37. ______ Volunteer Approval and Documentation
Revised July 16, 2015 Page 28 of 28
Name of Proposed School:
COMMONWEALTH OF VIRGINIA DEPARTMENT OF EDUCATION
PRIVATE SCHOOLS FOR STUDENTS WITH DISABILITIES
PERSONNEL QUALIFICATIONS FORM
(Include all administrators, teachers, and ancillary personnel)
Name of School:
Disability Category(ies) to be served by the school: