LEA Request for TSB Outreach Services

The Tennessee School for the Blind's Outreach program offers a variety of high-quality services that Local Education Agencies (LEA) in Tennessee may request for students in their districts. These services are provided, free of charge, to districts and families and consist of consultations, evaluations, and direct IEP services.

Learn more about the types and extent of services offered at https://www.tsbtigers.org/apps/pages/outreach-services. 

Submitting a request does not guarantee the requested service will be provided, especially if a student's requested IEP level of service exceeds the program's service parameters for direct services. Furthermore, while efforts are taken to process requests in a timely manner, TSB Outreach does not guarantee the provision of services, particularly evaluations, within certain timeframes. This is due to factors such as existing service obligations, weather, and holidays. As such, TSB Outreach recommends LEAs to not collect formal permission to test from parent/guardians until the request has been accepted and an evaluation date has been determined.

Parents and non-LEA agencies are not eligible to request services from TSB Outreach. Inquiries about vision services and related questions may be directed to Dr. Allen Huang, Director of Statewide Services, at [email protected]. 

Note:

• The Initial Request for TSB Outreach Services - Parent/Guardian and LEA Signature Form must be signed and uploaded with this request. The Signature Form includes space for parents/guardians to provide their personal input.
• ALL required and available documentation must be submitted for a request to be considered. This typically consists of current eye reports, Individualized Education Plans, Functional Vision Learning Media Assessments, and Orientation and Mobility assessments. Outreach staff will follow up if additional information is required.
• Evaluations and Direct Services are distinct services and cannot be requested together at the same time.
• Requests may only be submitted by LEA representatives. Parents should discuss eligibility and programming concerns with their school district, and the LEA can submit a request for service if appropriate.

LEA Contact Information

Student Information

Service Request Details

Required Documentation

Upload the following required documents below. 

• Parent/Guardian and LEA Special Education Director Signature Form
  • Establishes both parties:
    • Understand the types and extent of services offered
    • Agree regarding the service being requested
    • Consent to have TSB Outreach staff conduct the requested service
• Eye exam/evaluation report
  • Should document an eye condition with the best possible correction and ideally describe etiology, diagnosis, and prognosis of the eye condition.
  • Must be current within 1 year if a FVLMA is being requested.
• Current IEP 
  • Not applicable for cases of evaluations for new referrals for vision services.
  • If direct services are being requested, visual impairments eligibility must already be established with corresponding services listed.
• Current FVLMA report
  • Include older reports if no current report within last 3 years is available
• Orientation & Mobility assesment report (if available)

Sign below if you have uploaded all required and available documentation for this service request, including a fully completed Parent/Guardian and LEA Signature form.