Open the evaluation referral form via <https://share.hsforms.com/1pWnNODeDRQ25f-zDRT0R1wd76zl>

Enter your email address, the student ID, and the school that the student attends.

Please Select
Alabama Connections Academy (ALCA)
Arizona Connections Academy (ACA)
Arkansas Connections Academy (ARCA)
California Connections Academy (CalCA) - *
Coastal Connections Academy (CoastalCA)
Colorado Connections Academy (ColoCA)
Falcon View Connections Academy (FVCA) *
Florida Connections Academy (FCA)
Georgia Connections Academy (GACA)
Great Lakes Connections Acadmey (GLLA)
Great River Connections Academy (GRCA)
Indiana Connections Academy (INCA)
Indiana Connections Career Academy (INCC)
Inspire Connections Academy (Inspire)
Iowa Connections Academy (IACA) *
Kansas Connections Academy (KCA)
Lighthouse Connections Academy (LCA)
Low Country Connections Academy (LCCA)
Maine Connections Academy (MCA)
Michigan Connections Academy (MICA) *
Minnesota Connections Academy (MNCA)
Missouri Connections Academy (MOCA)
Multiple School Locations - Admin Roles Only (Must list schools in help box)
Nevada Connections Academy (NCA)
Ohio Connections Academy (OCA)
Oklahoma Connections Academy (OKCA)
Oregon Connections Academy (ORCAP)
Pecos Cyber Academy *
Pennsylvania Connections Academy (REACH) *
South Carolina Connections (SCCA)
South Carolina Connections Academy (SCCA)
Tennessee Connections Academy (TNCAJ)
Texas Connections Academy (TCAH) *
Utah Connections Academy (UCA)
Virginia Connections Academy (VACA)
Washington Connections Academy (WACA)
Williamette Connections Academy (WillCA)
Wyoming Connections Academy (WYCA)

For Type of Request, select "Change in student's status"

Skip to form
Evaluation & Related Services Request Form
Once submitted, this form will automatically create a ticket that will be reviewed by the Operations Team.  You will receive notification when an evaluator or therapist has been assigned.  If you need to request more than one area of therapy or evaluation for the same student, please submit one form per area.  For example, a student who requires an OT evaluation and a psychological evaluation would need to have two forms submitted.
Email*
Please enter the e-mail address of the person submitting this request.
Student ID*
School Name*
Please Select
Alabama Connections Academy (ALCA)
Arizona Connections Academy (ACA)
Arkansas Connections Academy (ARCA)
California Connections Academy (CalCA) - *
Coastal Connections Academy (CoastalCA)
Colorado Connections Academy (ColoCA)
Falcon View Connections Academy (FVCA) *
Florida Connections Academy (FCA)
Georgia Connections Academy (GACA)
Great Lakes Connections Acadmey (GLLA)
Great River Connections Academy (GRCA)
Indiana Connections Academy (INCA)
Indiana Connections Career Academy (INCC)
Inspire Connections Academy (Inspire)
Iowa Connections Academy (IACA) *
Kansas Connections Academy (KCA)
Lighthouse Connections Academy (LCA)
Low Country Connections Academy (LCCA)
Maine Connections Academy (MCA)
Michigan Connections Academy (MICA) *
Minnesota Connections Academy (MNCA)
Missouri Connections Academy (MOCA)
Multiple School Locations - Admin Roles Only (Must list schools in help box)
Nevada Connections Academy (NCA)
Ohio Connections Academy (OCA)
Oklahoma Connections Academy (OKCA)
Oregon Connections Academy (ORCAP)
Pecos Cyber Academy *
Pennsylvania Connections Academy (REACH) *
South Carolina Connections (SCCA)
South Carolina Connections Academy (SCCA)
Tennessee Connections Academy (TNCAJ)
Texas Connections Academy (TCAH) *
Utah Connections Academy (UCA)
Virginia Connections Academy (VACA)
Washington Connections Academy (WACA)
Williamette Connections Academy (WillCA)
Wyoming Connections Academy (WYCA)
Zip code of Stude

A new field will appear that says Change in student's status. Select "Student withdrew from school during the evaluation process"

Please Select
Parent/guardian revoked consent for evaluation
Parent/guardian revoked consent for related services
Student withdrew from school during evaluation process

Enter a name for the ticket and include any relevant information in the description such as the person assigned to the evaluation.  Click submit to send the ticket to the Vendor Implementation Manager.

Evaluation & Related Services Request Form
Once submitted, this form will automatically create a ticket that will be reviewed by the Operations Team.  You will receive notification when an evaluator or therapist has been assigned.  If you need to request more than one area of therapy or evaluation for the same student, please submit one form per area.  For example, a student who requires an OT evaluation and a psychological evaluation would need to have two forms submitted.
Email*
Please enter the e-mail address of the person submitting this request.
Student ID*
School Name*
Please Select
Alabama Connections Academy (ALCA)
Arizona Connections Academy (ACA)
Arkansas Connections Academy (ARCA)
California Connections Academy (CalCA) - *
Coastal Connections Academy (CoastalCA)
Colorado Connections Academy (ColoCA)
Falcon View Connections Academy (FVCA) *
Florida Connections Academy (FCA)
Georgia Connections Academy (GACA)
Great Lakes Connections Acadmey (GLLA)
Great River Connections Academy (GRCA)
Indiana Connections Academy (INCA)
Indiana Connections Career Academy (INCC)
Inspire Connections Academy (Inspire)
Iowa Connections Academy (IACA) *
Kansas Connections Academy (KCA)
Lighthouse Connections Academy (LCA)
Low Country Connections Academy (LCCA)
Maine Connections Academy (MCA)
Michigan Connections Academy (MICA) *
Minnesota Connections Academy (MNCA)
Missouri Connections Academy (MOCA)
Multiple School Locations - Admin Roles Only (Must list schools in help box)
Nevada Connections Academy (NCA)
Ohio Connections Academy (OCA)
Oklahoma Connections Academy (OKCA)
Oregon Connections Academy (ORCAP)
Pecos Cyber Academy *
Pennsylvania Connections Academy (REACH) *
South Carolina Connections (SCCA)
South Carolina Connections Academy (SCCA)
Tennessee Connections Academy (TNCAJ)
Texas Connections Academy (TCAH) *
Utah Connections Academy (UCA)
Virginia Connections Academy (VACA)
Washington Connections Academy (WACA)
Williamette Connections Academy (WillCA)
Wyoming Connections Academy (WYCA)
Zip code of Student
This field

Hsforms

This article explains what to do if a student has already been referred for an evaluation but withdraws from school during the evaluation process.

How to Fill Out the Evaluation Form if a Student has Withdrawn from School