APPLICATION FOR REIMBURSMENT OF PRIVATE RESIDENTIAL PLACEMENT IN NONAPPROVED FACILITY RESULTING FROM HEARING OFFICER DECISION - ISBE Form 51-77

Oct 10, 2026

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Application for reimbursement of private residential placement in a nonapproved facility following a hearing officer decision under the Special Education Department. Specifies eligibility timing and allowable costs for tuition and room and board for students aged 3 to 21, submission within required deadlines, and required documentation including a cost spreadsheet (Form 51-77A) and facility calendars. Includes sections for student identification, the hearing officer order details, cost information, and district assurances covering licensing, IEP implementation, record submission, and understanding of ISBE monitoring limits.

LanguageEnglish

CategoryExam

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

SECTION I: IDENTIFICATION

SECTION II: HEARING OFFICER ORDER

SECTION III: COST INFORMATION

Cost Spreadsheet

Allowable expenses

Unallowable expenses

Calendars

SECTION IV: ASSURANCES

Use your "Mouse" or "Tab" key to move through the fields and check boxes. After completing last field, save document to hard drive to make future updates or click print button. 100 North First Street Springfield, Illinois 62777-0001 APPLICATION FOR REIMBURSMENT OF PRIVATE RESIDENTIAL PLACEMENT IN NONAPPROVED FACILITY RESULTING FROM HEARING OFFICER DECISION SPECIAL EDUCATION DEPARTMENT Check one of the following: Initial Application Continuing Application Check one or both of the following: Request for Tuition Reimbursement Request for Room and Board Reimbursement Instructions: When a hearing officer orders a district to reimburse a parent or facility for services in a nonapproved residential placement, ISBE Form 51-77 is to be completed and submitted within 30 days of the hearing of the order. Allowable costs for tuition and room and board for students between the ages of 3 and 21 who are residents of the school district and have a parent other than a public agency will be considered for reimbursement. No room and board reimbursements will be made for students who have reached age 22. The student must be entered into I-Star per I-Star instructions. Complete and submit the application form and the accompanying cost spreadsheet and nonpublic facility calendars to [51_77Reimb@isbe.net](51_77Reimb@isbe.net). | SECTION I: IDENTIFICATION | | | | | | | | --- | --- | --- | --- | --- | --- | --- | | NAME OF STUDENT (First and Last Name) | | | | SIS NUMBER | | | | GENDER Male Female | | BIRTHDATE | | | REGION, COUNTY, DISTRICT, TYPE CODE | | | PRIMARY DISABILITY | | | SECONDARY DISABILITY | | | | | RESIDENT DISTRICT NAME AND NUMBER AND ADDRESS (Street, City, ZIP Code) | | | | | | | | NAME OF CONTACT PERSON | TITLE OF CONTACT PERSON | | PHONE OF CONTACT PERSON | | | EMAIL OF CONTACT PERSON | | SECTION II: HEARING OFFICER ORDER | | | | | | | | DUE PROCCESS CASE NUMBER (In lieu of the number, the district may submit a copy of the hearing officer’s decision. ) | | | | | | | | NAME AND ADDRESS OF RESIDENTIAL FACILITY ORDERED BY HEARING OFFICER | | | | | | | | NAME AND ADDRESS OF RESIDENTIAL SCHOOL ORDERED BY HEARING OFFICER IF IT DIFFERS FROM THE ABOVE | | | | | | | | SECTION III: COST INFORMATION | | | | | | | | FIRST DATE FOR WHICH REIMBURSEMENT WILL BE CLAIMED (Month, Day, Year) | | | | | | | (This is the date of student attendance in the facility for which the district became responsible for payment of tuition and room and board.) Cost Spreadsheet The district must complete Form 51-77A, which contains a summary of allowable costs that will be reimbursed. The district is responsible for ensuring that only allowable expenses, for tuition, and room and board are included, that can be validated by invoices from a facility are paid to the parent and/or the facility. Allowable expenses The following items are eligible for reimbursement and should be included in the spreadsheet if applicable to the hearing officer’s decision: • Room and board ( Must be separated from tuition. ) • Residential individual aide ( Must be included in the IEP. ) • Tuition – Regular term and summer term (IEP must indicate ESY. ) • Individual aide ( Must be included in the IEP. ) Unallowable expenses Do not include unallowable expenses in the spreadsheet. Items that are not eligible for reimbursement include, but are not limited to: • Summer camps • Fees for therapies/treatments not included in the IEP • Activity fees • Student activities unrelated to IEP – e.g. , ski trips • Clothing-uniforms • Psychiatric evaluations • Medical management – costs of doctor visits, medication, medical tests • Cost related to parent visits – food, hotel • Tutoring Reimbursement for allowable room and board and tuition costs will be subject to the same proration methodology as is applied to reimbursement for rates determined under 5/14-7 .02. Calendars T

FAQs

When must the ISBE Form 51-77 application be submitted after the hearing officer order?

The form must be completed and submitted within 30 days of the hearing of the order. For cases beginning in March 2022 and certain earlier cases, the timeline references the due process decision and notice from ISBE as described in the assurances section.

Which costs are eligible for reimbursement and how must they be reported?

Allowable items include room and board (separated from tuition), residential individual aide, tuition for regular and summer terms, and individual aide, provided they are included in the IEP. These allowable expenses should be included in the cost spreadsheet that summarizes reimbursable costs.

What assurances does the district provide regarding the student placement and ISBE responsibilities?

The district assures it submitted the hearing officer order or the due process case number, will provide attendance records on request, submitted the facility school calendar, entered the student into I-Star, and acknowledges ISBE does not monitor safety and health in non-approved residential programs while the district remains responsible for informing parents.

Oct 10, 2026

Uploaded by Mia