FORM
22B PRIOR WRITTEN NOTICE
FOR INITIAL ASSESSMENT
The Prior Written Notice form must be completed and sent with the Assessment
Plan for all
initial referrals for assessment.
• Enter date.
• Evaluation procedure(s) – List the types of assessment data that were used in making the decision to assess the student
(i.e., observation,
standardized testing, statewide assessment, etc.).
• Assessments – List the assessments used to make the determination to engage in further
assessment
• Record(s)
– List any records that are or are not part of the student’s cumulative file to make the determination to assess.
• “Alternatives considered/rejected” – List any other
options that were considered and rejected such as intervention programs offered,
curriculum adaptations, etc.
• “Other factors” – list any other
relevant factors to be considered such as: the student
has been retained, the student is working far
below grade level, and the student has received scientific-based intervention and has not
responded, etc.
Legal Citations:
30 EC
56500.4
[Excerpted from the State SELPA IEP Manual, July, 2013]