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It applies when an IEP meeting determines a least restrictive private residential placement and explains submission timing, required documentation, and limits such as no reimbursement for students 22 or older. It also outlines section-by-section checklist items including student identification, facility details, prior placement history, evaluation and IEP dates, contacted agencies, reintegration plan materials, required spreadsheets, satisfactory proof, and district assurances and signatures.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/application-for-room-and-board-reimbursement-of-emergency-and-student-specific-placement-in-anon-approved-residential-facility-form-34-43-instructions/535066/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/application-for-room-and-board-reimbursement-of-emergency-and-student-specific-placement-in-anon-approved-residential-facility-form-34-43-instructions/535066.png","ImageObject",300,407,{"name":92,"@type":93},"Kyle","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-09","2026-10-10",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"When is Form 34-43 required for a residential placement request?","Question",{"text":112,"@type":113},"It is completed when an IEP meeting determines the least restrictive environment is a private residential placement and approval is needed before the district effectuates the placement.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What reimbursement restriction applies to students 22 years or older?",{"text":117,"@type":113},"No room and board reimbursement is available for students who are 22 years or older.",{"name":119,"@type":110,"acceptedAnswer":120},"What must be submitted and how is approval handled if documents are incomplete?",{"text":121,"@type":113},"Submit the completed checklist with the application. 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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).  \nUse the instructions checklist below as a guide. Please submit the completed checklist with this application.  \n\n| PAGE | SECTION | SUBMISSION REQUIREMENT | PREPARER’S INITIALS |\n| --- | --- | --- | --- |\n| Page 3 | Section I | Check appropriate box for application (Initial/Continuing) . Provide projected start date for Initial Application. |  |\n|  |  | Provide facility information. |  |\n|  |  | Confirm all contact information is correct for resident district. |  |\n|  |  | Confirm Student Information System number and Region-County-DistrictType code for resident district is correct. |  |\n|  |  | Confirm all student information is correct (e.g. , gender, birthdate, primary disability, secondary disability, and tertiary disability [if applicable]) . |  |\n|  |  | 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. |  |\n|  |  | Verify that parent/guardian(s) were informed about the option to place the student in state prior to placing out of state. |  |\n| Page 4 | Section II | Provide history of prior placement. |  |\n| Page 5 | Section III | Verify services in the current/most recent placement. |  |\n\n\n|  |  | Verify services that are being requested for residential placement. |  |\n| --- | --- | --- | --- |\n| 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. |  |\n|  | Section V | Verify outside agencies that were contacted. |  |\n| 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. ) |  |\n|  | Section VII | Complete Reintegration Plan per instructions and/or attach/submit with the Form 34-43 Application. |  |\n| Page 8 | Section VIII | For Continuing Applications , complete the Documentation of Previous Reintegration Activities form noting the date, participants, and description of the activity. |  |\n|  | 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. ) |  |\n| 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. |  |\n|  | 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) . |  |\n|  | Section XII | Complete additional facility contact information and provide per diem rates for room an","cbCairC4Bg8vlBst","https://ap.wps.com/l/cbCairC4Bg8vlBst","pdf",546813,"English","# Application purpose and submission rules\n## When the form is required\n## Submission timing, copies, and checklist requirement\n# Instructions checklist by section\n## Section I: Identification\n## Section II: Prior placement history\n## Section III: Current placement services and requested residential services\n## Section IV: Evaluation and IEP meeting dates\n## Section V: Outside agencies contacted\n## Section VI: Narrative requirements\n## Section VII: Reintegration plan\n## Section VIII: Documentation of previous reintegration activities\n## Section IX: Required spreadsheet\n## Section X: Satisfactory proof\n## Section XI: Calendar for covered school year or summer session\n## Section XII: Facility contacts and per diem rates\n## Section XIII: Assurances and signatures","[{\"question\":\"When is Form 34-43 required for a residential placement request?\",\"answer\":\"It is completed when an IEP meeting determines the least restrictive environment is a private residential placement and approval is needed before the district effectuates the placement.\"},{\"question\":\"What reimbursement restriction applies to students 22 years or older?\",\"answer\":\"No room and board reimbursement is available for students who are 22 years or older.\"},{\"question\":\"What must be submitted and how is approval handled if documents are incomplete?\",\"answer\":\"Submit the completed checklist with the application. Applications may be submitted in sections, but reimbursement is not approved until all required documentation is received.\"}]","APPLICATION FOR ROOM AND BOARD REIMBURSEMENT OF EMERGENCY AND STUDENT-SPECIFIC PLACEMENT IN ANON-APPROVED RESIDENTIAL FACILITY - Form 34-43 Instructions | PDF",1791599659,25]