Adapted Physical Education
Referral Information
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What:
APE referral is used to request assistance, curriculum modifications, equipment modifications, or a
screening/evaluation for
any student not able to meet grade level outcomes in physical education.
Who:
Parents, teachers, administrators, guidance counselors, physicians; anyone can complete an adapted physical
education referral.
When:
As soon as it is apparent the student can not meet grade level outcomes in the present setting.
How:
The APE referral form can be obtained from the web 1 site, main office, physical education teacher
or the case manager. The physical education teacher will need to indicate the current level of gross
motor performance on the form and sign the bottom. The principal will have to sign to give permission.
A meeting will need to be held to acquire parent permission on the SE-3 form.
Where:
Send the completed form to Mrs. Virginia Popiolek, Supervisor of Elementary/ Middle School Physical
Education and Adapted Physical Education, 23 N. Main Street. She will forward the signed form to Kay
Lambert, Teacher Specialist for Adapted Physical Education. The referral will then be sent to the APE
consultant who services that school.