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 students 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]