CHILD FIND
The Brick Township Board of Education
provides Special Education Services for
resident special needs children ages 3-21
who experience significant delays in the
following areas:
Speech
Hearing
Vision
Motor Coordination
Developmental Delays in Learning
Social Adjustment
Chronic Illness
If your child experiences developmental
delays in any of the above categories, please
send a referral letter to:
Director of Special Services
Brick Township Public Schools
101 Hendrickson Avenue
Brick, New Jersey 08724
732-785-3000 X 4515
PROOF OF RESIDENCY AND ORIGINAL BIRTH
CERTIFICATE MUST BE PRESENTED WHEN
REGISTERING STUDENT AT:
Brick Township Public Schools
Central Registration
101 Hendrickson Ave
Brick, NJ 08724
732-785-3000 X 1068 & 1067
[ ] Early Intervention Referral
[ ] Head Start Referral
BRICK PUBLIC SCHOOLS SPECIAL SERVICES
REQUEST FOR PRESCHOOL CHILD STUDY TEAM EVALUATION
Student: _________________________________
Student’s SSN: _____________________
Referred By: _____________________________
Contact Person: _____________________
Address: ________________________________
Phone: ____________________________
Student’s Date of Birth: _____________________
Current Age: _________ Sex: _________
Parent/Guardian Name: __________________________________________________________
Home Address: _______________________________________________________________
Telephone - Home: _______________________
Work: ___________________________
Language used at home: ______________
Student lives with: (check one) Both Parents ____ Mother ____
Father ____ Guardian ____
 Check those that apply to the best of your knowledge:
__ Involvement with Division of Youth and Family Services
__ Motor difficulties experienced
__ Hearing difficulties experienced
__ Language difficulties experienced
__ Behavior difficulties experienced
__ Speech difficulties experienced
__ Medical difficulties experienced
__ Social difficulties experienced
_____________________________
__ Visual difficulties experienced
_____________________________
 Was the student in an early intervention program:
If yes,
Yes ______
No ______
Where: ___________________________________________________________
Contact Person: _______________________ Telephone: ___________________
Reason for request for screening/evaluation _______________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Page 1 of 4
Child Developmental Checklist
Yes
No
18 months to 2 years
Pushes and pulls large toys/objects
Jumps with both feet together
Refers to self by name, uses “I, you, me” (not always correctly)
Tells toilet needs occasionally
Takes off clothes with some help
Sits in chair without help
Points to pictures in book
Speaks in two words sentences (“Daddy gone,” “shut door)
Distinguishes between food and non-food items
2 years to 2 ½ years
Jumps from bottom step or low heights
Builds or stacks small blocks
Dries hands without help
Points to body parts (hair, eyes, nose, etc.)
Imitates drawing lines and circles (not always perfectly done)
2 ½ years to 3 years
Walks up and down stairs holding railing
Holds pencil with thumb and forefinger instead of fist
Joins in nursery rhymes and songs
Undresses completely without help
Page 2 of 4
Brick Public Schools
Report of/Authorization to Obtain Prior Evaluations
Student’s Name: _______________________________________________________________
Parent/Guardian’s Name: ________________________________________________________
Address: ______________________________________ Telephone #: ___________________
Prior evaluations: (Please attach copy of each, if available)
1.
Agency/Doctor: __________________________________________________________
Address: ________________________________________________________________
Contact Person: ________________________________ Phone: ____________________
Results: _________________________________________________________________
__________________________________________________________________
__________________________________________________________________
Please check here if copy is attached: _______
2.
Agency/Doctor: __________________________________________________________
Address: ________________________________________________________________
Contact Person: _______________________________ Phone: ____________________
Results: _________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please check here if copy is attached: _______
3.
Agency/Doctor: __________________________________________________________
Address: _______________________________________________________________
Contact Person: _______________________________ Phone: ____________________
Results: ________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Please check here if copy is attached: _______
I, as parent/guardian, authorize my child’s school and these agencies/doctors to release any information to the
Brick Public Schools Office of Special Services:
_____________________________________
SIGNATURE
Page 3 of 4
_____ ________
DATE
DESCRIPTION OF REFERRAL PROCESS
1. All referrals shall have an identification meeting within 20 days of receipt.
2. Parents/guardians and teacher may request a direct referral to the Child Study Team.
3. At the identification meeting, a determination shall be made if evaluation is warranted and if so
warranted, an evaluation plan shall be developed.
4. Consent for evaluation shall be obtained at the identification meeting. Written consent by the
parent/guardian shall be required before evaluation.
5. Parent shall receive written notice of the outcome of the identification meeting within 15 days.
6. After notice of the outcome of the identification meeting, the parent/guardian may take 15 days to
consider providing consent. Consent may be given prior to the 15 day consideration period. After
parental written consent is obtained for evaluation, evaluation shall be conducted as described in the
evaluation plan.
7. All evaluations and program placement shall be completed within a period of 90 calendar days. The
Child Study Team shall consider all records and materials provided to them as part of the evaluation
process. The parent/guardian shall be given notice to attend an eligibility and program development
meeting. Notice of meeting shall be provided with proper advance written notification.
8. After the completion of an eligibility or program development meeting, notice shall be provided to the
parent/guardian explaining the outcome of the meeting within 15 days.
9. If eligible for preschool service, the following information shall be required at the time of registration at
the Brick Schools:
a.
Medical examination
b.
Immunization record
c.
Birth certificate
d.
Speech evaluation
e.
Location card
f.
Child Study Team evaluation/IEP
g.
Development of a permanent record at the school of registration
10. The student’s Child Study Team preschool record shall be maintained in the Preschool Child Study
Team file.
11. The Case Manager shall notify the School Principal concerning student registration and program
enrollment.
Page 4 of 4
BRICK PUBLIC SCHOOLS
CHILD FIND
EARLY INTERVENTION SERVICE
L.E.A.P., INC. HEAD START
New Jersey’s Early Intervention System
provides services and family support for
infants and toddlers (from birth to the
child’s third birthday) who have
developmental delays or disabilities.
L.E.A.P., Inc. Head Start is a federally
funded, nonprofit, comprehensive child
development program which provides a
wide range of services to low-income
preschool children and families.
Ocean County ….888-653-4463
WHAT HAPPENS WHEN YOU CALL?
A service coordinator will listen to your
concern and will describe services and other
resources that may be available for your
child and family.
The Early Intervention Service Coordinator
may arrange for your child to have a
developmental evaluation at no cost to you.
This evaluation will determine if your child
is eligible for Early Intervention Services.
Early Intervention Services are provided to
children:
 Within the family’s routine;
 Within their natural environments (the
home and community);
 In settings which children without
disabilities participate;
 And with active participation of families.
SERVICE PROVIDED:
 Infant/Toddler Program
 Preschool – 3 and 4 year old children
LOCATIONS:
 Brick Head Start
491 Adamston Road
Brick, NJ 08723
732-477-1155
FEE:
 Free/based on income
CONTACT:
O.C.E.A.N., Inc. Head Start
40 Washington Street
Toms River, NJ 08753
732-244-5333
BRICK BOARD OF EDUCATION
SPECIAL EDUCATION
The Brick School District provides special
education programs for children ages 3-21
who have special learning or developmental
needs.
SERVICES PROVIDED:
 Free, appropriate public special
education and related services ages 3-21
Enrollment is ongoing as of the child’s third
birthday. Parental written consent for child
study team assessment is required. Upon
receipt of letter of service request or
preschool referral, a meeting shall be
conducted within 20 days to plan evaluation
procedures with the parent.
All required evaluations and programs are at
no cost to the parent. When possible, please
make referral 120 days prior to the
preschooler attaining age 3.
CONTACT:
Send Referral or Letter to:
Director of Special Services
Brick Township Public Schools
224-260 Chambers Bridge Road
Brick, NJ 08723