APPLICATION FOR ROOM AND BOARD REIMBURSEMENT OF EMERGENCY AND STUDENT-SPECIFIC PLACEMENT IN AN NON-APPROVED RESIDENTIAL FACILITY - Form 34-43 - Instructions and Checklist

Oct 10, 2026

Uploaded by Kyle

Instructions and checklist for completing Illinois Special Education Department Form 34-43 to request room and board reimbursement for emergency and student-specific residential placements under an IEP when the least restrictive environment requires private residential placement. The application supports school districts seeking reimbursement for facilities not approved by the Illinois State Board of Education, requires submission with a completed checklist and supporting documentation before placement, and includes detailed verification steps across multiple sections and page-specific requirements.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Form 34-43 Instructions

Purpose and Submission Requirements

Instructions Checklist (Page/Section Requirements)

100 North First Street, N-253 Springfield, Illinois 62777-0001 APPLICATION FOR ROOM AND BOARD REIMBURSEMENT OF EMERGENCY AND STUDENT-SPECIFIC PLACEMENT IN ANON-APPROVED RESIDENTIAL FACILITY SPECIAL EDUCATION DEPARTMENT FORM 34-43 INSTRUCTIONS: This form is to be completed when a school district determines at an Individualized Education Program (IEP) meeting that the least restrictive environment for a student is a private residential placement. It must be submitted in a timely manner to allow approval prior to the district effecting the placement. This application is for school districts seeking reimbursement for costs of emergency and studentspecific placements in residential facilities that have not been approved by the Illinois State Board of Education. Please note: No room and board reimbursement is available for students who are 22 years or older. Complete and submit one copy of this application form PRIOR to placement, renewal due date, or change of placement. Applications may be submitted in sections. However, reimbursement will not be approved until all required documentation has been received. Application should be submitted [34_43Reimb@isbe.net](34_43Reimb@isbe.net). Use the instructions checklist below as a guide. Please submit the completed checklist with this application. | PAGE | SECTION | SUBMISSION REQUIREMENT | PREPARER’S INITIALS | | --- | --- | --- | --- | | Page 3 | Section I | Check appropriate box for application (Initial/Continuing) . Provide projected start date for Initial Application. | dw | | | | Provide facility information. | dw | | | | Confirm all contact information is correct for resident district. | dw | | | | Confirm Student Information System number and Region-County-DistrictType code for resident district is correct. | dw | | | | Confirm all student information is correct (e.g. , gender, birthdate, primary disability, secondary disability, and tertiary disability [if applicable]) . | dw | | | | Complete Illinois Department of Children and Family Services (DCFS) Interstate Compact if the student is under 18 years of age, being placed out of state, and this is an Initial Application. | dw | | | | Verify that parent/guardian(s) were informed about the option to place the student in state prior to placing out of state. | dw | | Page 4 | Section II | Provide history of prior placement. | dw | | Page 5 | Section III | Verify services in the current/most recent placement. | dw | | | | Verify services that are being requested for residential placement. | dw | | --- | --- | --- | --- | | Page 6 | Section IV | Verify dates of most recent evaluations and IEP annual review. Also include date of IEP meeting during which residential placement was recommended. | dw | | | Section V | Verify outside agencies that were contacted. | dw | | Page 7 | Section VI | Complete narrative per instructions and attach/submit with the Form 34-43 Application. (Follow directions for Initial or Continuing , as appropriate. ) | dw | | | Section VII | Complete Reintegration Plan per instructions and/or attach/submit with the Form 34-43 Application. | dw | | Page 8 | Section VIII | For Continuing Applications , complete the Documentation of Previous Reintegration Activities form noting the date, participants, and description of the activity. | dw | | | Section IX | Complete spreadsheet per the application instructions. Attach/submit spreadsheet with Form 34-43 Application. (NOTE: It is helpful to have the list in alphabetical order according to facility name. ) | dw | | Page 9 | Section X | Complete all items in the Satisfactory Proof section on page 10 of this document and attach/submit with the Form 34-43 Application. | dw | | | Section XI | For both Initial and Continuing Applications , submit a calendar for any school year or summer session that might be covered by the approval (possibly one year from start date) . | dw | | | Section XII | Complete additional facility contact information an

FAQs

When must Form 34-43 be completed and submitted?

Complete and submit one copy prior to placement, the renewal due date, or a change of placement. Submit with the completed checklist and required documentation to support approval.

What placements does this reimbursement application cover?

It covers costs for emergency and student-specific placements in residential facilities that have not been approved by the Illinois State Board of Education, based on recommendations from an IEP meeting.

Are there age limits for room and board reimbursement?

Room and board reimbursement is not available for students who are 22 years or older.

Oct 10, 2026

Uploaded by Kyle