Student Referral and Admission

Guide to Initiating a Referral

  • The referral process begins with the phone call. Evergreen’s Admission’s Coordinator 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 Admission Coordinator 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 Coordinator will issue a letter explaining why  and will provide alternate placement recommendations.  All of this will occur within 48 hours of receipt of a referral packet.

  • 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 within 48 hours.

  • Within 48 hours after the screening has been conducted, 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?

Just call our Admission Coordinator at 508-478-2631 and communicate the urgency of the need for placement.  The prospective student will be screened within 48 hours 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.


Because Admission Day can be a busy and emotional time, we have provided the following lists of documents and materials which should be completed before admission. Completion of all documents in advance will help make the student’s transition as smooth as possible.

Documents Required Prior to Enrollment (including required signed release forms by guardian and/or physician)

  • Evergreen’s Contract for Special Education Services

  • Placement Agreement

  • Interim IEP

  • PL1-Placement page for IEP

  • Application Face Sheet

  • General Parent Release

  • Physical Therapy/Occupational Therapy Release

  • Health Record/Medications 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 wtihin the past 6 months)

  • Any legal documents pertaining to visitation schedule or visitation/contract restrictions for student

  • Approved Visitor listing

Move-In Checklist

  • 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.