Visually Impaired Program
The Visually Impaired Program provides an individualized education program to meet the varied needs of students with vision disabilities. Students verified as visually impaired may be served through this program. The intent of the Visually Impaired Program is to work with parents, teachers and students to create the best learning environment for each student.
Referral Process for Vision Services
— Send vision referral form and current eye report to teacher of the visually impaired (TVI) at ESU 1 Vision Department/Stacey Richart:
Email: srichart@esu1.org
ESU #1 Vision Department
211 Tenth Street,
Wakefield, NE 68784
Fax: 402-287-2065
• TVI will review eye report and give recommendations whether to proceed with referral based on medical findings and alignment with Rule 51 verification guidelines for visual impairment.
If medical findings are in alignment with verification guidelines, continue referral process steps.
If medical findings are not in alignment with verification guidelines, referral process stops.
• Complete a release of information form with optometrist or ophthalmologist listed (this allows TVI to contact eye doctor for clarification or to obtain additional records).
• If student already receives SPED services, send current MDT/IEP (adding TVI to their team on SRS for review of educational records).
• Complete consent for evaluation on SRS (list functional vision assessment).
• Complete parent and classroom teacher interview forms.
• Return Vision Services Referral Checklist with referral packet (including all required documents). Send all referral packet forms and documentation to ESU 1 Vision Department/Stacey Richart (Vision Dept. Coordinator).
• The TVI will complete observations of student and conduct a functional vision assessment (FVA) to verify eligibility as a student with a visual impairment. The assessment will determine the student’s level of visual functioning, access to educational or developmental materials, and the need for any material adaptations or accommodations.
School-age forms (all forms required)
Classroom Teacher Interview
Parent Interview
Referral Checklist
Release of Info – Vision
Vision Concerns Checklist
Vision Referral Form
Early childhood forms (all forms required)
Caregiver Interview
Teacher Interview
Referral Checklist
Release of Info – Vision
Vision Concerns Checklist
Vision Referral Form
Multiple disabilities forms (all forms required)
Caregiver Interview
Teacher Interview
Referral Checklist
Release of Info – Vision
Vision Concerns Checklist
Vision Referral Form