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 Deaf/Hard of hearing (DHH), 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 DHH eligibility, you must submit a copy of the current DHH 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


    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.