Forms

The Student Tracking Form should be used to provide the CSIU with information on new students and also to provide any updates for students.

The Restraint Entry Form is to be completed and submitted to the program supervisor any time a physical restraint is used with a student.

The Related Services Referral Form should be used to request the following services:

  • physical therapy
  • occupational therapy
  • vision service/orientation & mobility services
  • hearing therapy
  • itinerant autistic support
  • social work support

The referral process remains the same for 5 Star and Work Foundations+.

Completed tracking and referral forms should be uploaded to the appropriate folder in the e-File Upload Site.  Please refer to the e-File Document Transfer Site Directions for more information.


The Authorization to Release Information Form should be used to request student records from the CSIU Special Education Department.  Completed Release forms should be mailed or faxed to the following:

Central Susquehanna Intermediate Unit 16
Special Education Department
90 Lawton Lane
Milton, PA 17847
Fax: 570-523-0092

School-aged (K-12) students:  School-Aged Authorization to Release Information Form 
Preschool/Early Intervention students: Preschool/EI Autorization to Release Information Form