DHH Student Referral Information

  • We have a new Student Referral Form. Please discard and do not use versions distributed previous to August, 2017.

    When referring students to request an evaluation to determine eligibility under Hearing Impairment (HI), you must include a copy of a current audiogram with the referral.

    When requesting an audiological evalution (only available to children aged birth-to-five), you must provide documentation of two failed hearing screenings.

    To initate services from a teacher of the deaf/hard of hearing for a student with an existing HI eligibility, you must submit a copy of the current HI eligibility statement with the referral, a copy of the current IEP or IFSP, and (if available) a copy of a current audiogram and medical or health assessment statement.

    Fax or mail the completed Student Referral Form and required documents to:

    • Fax: 503-916-5576
    • Mail: Columbia Regional Program - 833 NE 74th Ave. Portland, OR 97213


    (in development)

    If you have additional questions, contact Stephanie Corvi scorvi@pps.net or call 503.916.5570 ext. 78317

    Return to the main Student Referral page.