If you wish more information about the different ACES Services and Programs, please visit our Schools and Programs page.

ACES Special Education Schools/Programs

ACES at Ansonia Middle School

ACES Center for Autism Spectrum and Developmental Disorders

ACES Perry Hill NEST

Brightwell Academy

Mead/AAMS

Mill Road ASCEND

Mill Road School

The Bridge at ACES

Village School

Village School EIBI Program

Whitney Academy CREATE

Whitney Academy EXPLORE

Whitney High School North

Click here if unsure of school or program placement

Sending District Code and Name

Note: We've updated the Sending District field to be a pull down that contains both district code and name. Simply start typing either the number or name to autofill the field. There is also an option for "999 - Out of State" or "9999 - Other".

If other or out of state, please specify

If other, please specify

Sending District Requestor

Requestor Telephone Number

Student First Name

Student Last Name

Reason for Referral

Special Education Label/Classification/Diagnostic Placement

Please choose one from the dropdown.

Student Date of Birth

Student SASID

Student Current Grade Level

Student Street Address

Student City, State, Zip Code

Parent/Guardian Name

Parent/Guardian Telephone Number

Parent/Guardian Email

Please attach the students latest IEP and the Parent/Guardian Signed Release Form below. Any other significant documents can also be attached here, including pertinent records that you feel will help ACES; staff make the best selection for programming, such as Cognitive, Speech/Language, Achievement, and Social Work Assessments.

Note: To attach more than one document to the referral, the files must exist in one folder on your computer. Select multiple files using Shift/Click if they are in sequence or Cntrl/Click if non-sequential.

Please review this video to see a sample of how to attach multiple files.

Document Attachment

File attachments associated with the ticket.

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Pupil Services Referral Checklist

Student's most recent IEP

Parent/Guardian Signed Consent Form

Assessments (Cognitive & Achievement Evaluations)

Other (please list in next section)

New ACES Student Referral

If you wish more information about the different ACES Services and Programs, please visit our Schools and Programs page.

Other Fields