Instructions for Completing STAC 5’s

8a. Public School District that has CPSE Responsibility. Public school district of the child’s current location (where the child resides).

8b. County of Child’s Current Location (where child resides). The county of the child’s current location. This is the county that will be reimbursed by SED.

8c. County at Time of Child’s Placement in Foster Care. The county where the child lived at the time the child was placed in foster care or temporary housing or became a resident in a facility licensed or operated by another state agency. This should be left blank if not applicable.

9. SED Approved Evaluator. Enter the name of the agency that conducted the evaluation.

10. Evaluation Components. Provide the month and year when each component of the evaluation was completed. These dates will be used to determine the rate of reimbursement.

For Bilingual Evaluations and Evaluations Conducted in Other Modes of Communication Only. Place a check mark on the line for any component(s) of an evaluation that required an individual (translator) in addition to the evaluation professional or the use of a bilingual professional.