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Adapted Physical Education
Referral Procedures
  1. Consult with the student's physical education teacher to obtain current motor performance levels. If the current motor performance is mostly on grade level with one area of difficulty, parent permission can be obtained by the physical educator for several weeks of pull-out services to address a specific area of motor skill development. Parent permission form on web 1 site for short term pull-out, no APE referral is needed. If the current motor performance is below grade level in several areas, please proceed to the next step.

  2. If the physical education teacher assessments of the student reflect modifications are needed to meet grade level/course outcomes or there are significant medical concerns then a meeting should be scheduled to obtain parent permission on the SE-3 form. The physical education teacher needs to complete the adapted physical education referral form and present it at the meeting along with PE class assessments. Please invite APE consultant and physical education teacher to all meetings.

  3. Please complete all sections of the APE form and remember to attach all pertinent information. Referral form on web site, please print out on yellow paper.
    1. When indicating the reason for request, please consider the following:
      1. Screening/evaluation - this will evaluate student performance and needs in their current program. Formal evaluation will be performed if gross motor delays present in the screening and /or class assessments.
      2. High school credit - for diploma track students that need a modified physical education course to obtain high school credit.
    2. Have the student's physical education teacher complete the lower portion of the box.
    3. Completed APE and SE-3 forms need to be sent to Ginny Popiolek 23 N. Main Street.

  4. Once the APE referral form has been received, the adapted physical education consultant will proceed with the request.



504 Plan:
Referrals can also be completed for any 504 student with needs impacting their physical education program. The above process needs to be followed when completing the APE referral form. It is important to attach any medical information and/or restrictions to the yellow form. A 504 plan can be written to reflect modifications within the regular physical education curriculum to allow the student maximum participate while adhering to the doctor's restrictions.