Sonoma County Office of Education

Program for Students With Visual Impairments

The Special Education Department at SCOE provides services and learning resources for students from 3 to 22 years old who meet the eligibility criteria for Visual Impairment (VI). VI support may range from daily intervention for students with intense needs – Braille users or students with very low vision, for example – to monthly consultation for students who require less assistance. Learn more in this overview of Services for Students with Visual Impairments (pdf).

Accessibility Notice

If you need assistance with any of the forms provided on this page, please contact: Chelsea Siegel, Principal, for assistance by phone at 707- 524-2700, or email at

Referral to the V.I. Program

Referral Forms

Physician Response Form (pdf)
Special Education Referral, SELPA 21 (pdf)
Special Education Referral Addendum (pdf)
VI Consent to Release Form (pdf)
VI Consent to Release Form, Spanish (pdf)

Referral Instructions

Submit referrals to:
SCOE VI Program
Sonoma County Office of Education
5340 Skylane Boulevard
Santa Rosa, CA 95403
Fax (707) 578-3156