The referral process begins with the phone call. Evergreen’s Admission’s Director can be reached at 508-478-2631 Monday through Friday
between the hours of 8:30 a.m. and 5:00 p.m.
In non-emergency situations, Evergreen’s Admissions Director will ask you to forward all relevant information concerning the student being referred and will invite you to tour our
school and community residences.
Once all referral information is received, Evergreen’s Admission Team will review the information and decide whether the student is generally appropriate for admission. If
the student is not appropriate for Evergreen, the Admissions Director will issue a letter explaining why and will provide alternate placement recommendations.
If a referral is determined to be generally appropriate, you will be asked to bring the student to Evergreen to be evaluated by Evergreen’s interdisciplinary team. Under
circumstances where an on-site evaluation is not possible due to geographical or behavioral concerns, staff from Evergreen will travel to the student’s current placement site.
The Evergreen Center will issue a written statement regarding the student’s appropriateness. Moreover, where applicable, an admission date will be negotiated.
Is it an Emergency?
Call our Admissions Director at 508-478-2631, or email at firstname.lastname@example.org and communicate
the urgency of the need for placement. The prospective student will be screened regardless your geographical locations.
The Referral Packet Should Include:
A clinical statement of needs which have prompted the referral for residential education.
Copies of the most current educational and social assessments.
Medical history, including copies of pertinent medical records and current psychological testing (if available).
Treatment History, including list of physicians, including pediatrician (primary care physician), dentist, specialty physicians/clinics and hospitalizations/surgery.
Current Individual Education Plan (IEP).
Complete school records indicating last program attended.
The referring agency’s assessment regarding anticipated length of stay and goals for treatment.
Statement of financial responsibility (full funding, cost sharing, etc.) that guarantees payment of tuition.
The following list of documents and materials will need to be completed prior to admission.
Documents Required Prior to Enrollment
(including required signed release forms by guardian and/or physician)
Evergreen’s Contract for Special Education Services
PL1-Placement page for IEP
Application Face Sheet
General Parent Release
Copies of laboratory reports (blood work) and other tests such as EEG, MRI, head CT, X-rays, etc.
Seizure protocol (if applicable)
Medical Record Release and Information Release Form
Gym/Swim Activity Permission Slip
Student Routine Vaccination/Immunization Authorization consent form
Dental Summary, including copy of dental examination (must be within the past year)
Physical Examination Massachusetts School Health Record
Health Care Provider's examination (must be within the past year)
Immunization Records (must meet the Massachusetts DPH requirements for school entry
Also, complete Screening section including Hepatitis B Antigen & Antibody titer results, TB test results, lead screening results and Varicella titer (if applicable)
Authorization for program participation, Medication, Treatment & Dietary Needs
Signed Physician medication/treatment orders, including prescriptions, over the counter and PRN medications (as needed) with matching prescriptions
Copies of insurance cards
Documentation of Custody/Guardianship status, including copy of Rogers guardianship (if applicable)
Copy of completed AIMS (Abnormal Involuntary Movement Scale) if receiving psychotropic/neuroleptic medication (must be within the past 6 months)
Any legal documents pertaining to visitation schedule or visitation/contract restrictions for student
Approved Visitor listing
Any personal possessions students may want to bring to their new residence.
Personal belongings including a book of photographs of family and friends, a video tape of the student with family and friends or an audio tape of familiar voices that the student may
enjoy hearing. Audio cassettes of preferred music or favorite video tapes can also help put the student at ease in their new school and home setting.
Preferred blankets, pillows, or materials that the student may be accustomed to sleeping with.
A check or money order to establish the student’s personal needs account that will be used for community trips and outings. Special provisions are available for students in the
custody of a governmental agency.