Assessment Team Summary Report - Eligibility Statement
Some items need revision (cannot save).
IEP Date
Student Name
Student
does
does not
does
does not
meet CCR Title 5-Section 3030 Criteria for Special Education Services in the following areas:
a. Specific Learning Disability (3030j) based on:
A severe discrepancy between intellectual ability and achievement is demonstrated in one or more of the following area(s):
Listening comprehension
Listening comprehension
Basic reading skills
Basic reading skills
Mathematics calculation
Mathematics calculation
Oral expression
Oral expression
Reading comprehension
Reading comprehension
Mathematics reasoning
Mathematics reasoning
Written expression
Written expression
AND
A disorder is demonstrated in one or more of the following basic psychological processes:
Auditory processing
Auditory processing
Visual processing
Visual processing
Sensory-motor skills
Sensory-motor skills
Attention
Attention
Cognitive abilities:
Conceptualization
Conceptualization
Association
Association
Expression
Expression
The discrepancy IS NOT primarily the result of: Environment; Cultural Differences; Economic Disadvantages; Mental Retardation; Emotional Disturbance; Visual; Hearing or Motor Impairments; and/or Poor School Attendance.
b.
Hearing Impairment (3030a)
c.
Hearing and Visual Impairments (3030b)
d.
Speech and/or Language Disorder (3030c)
e.
Visual Impairment (3030d)
f.
Severe Orthopedic Impairment (3030e)
g.
Other Health Impaired (3030f)
h.
Autistic-Like Behaviors (3030g)
i.
Significantly below average intellect (3030h)
j.
Emotional Disturbance (3030i)
k.
Traumatic Brain Injury (federal)
l.
Multiple disabilities (two or more)
Check Appropriate Statement(s):
Based on results of all available assessment reports, special education services are NOT warranted at this time. Student's needs can be met in the regular program. Recommendations are (if appropriate, include transition plans in this space):
The Individualized Education Program Team (IEPT) affirms that the psycho-educational summary, academic, language, health, DIS assessment results and other required information are adequate to declare the student eligible for special education services to develop an Individualized Education Program (IEP) and determine placement. The student's needs CANNOT be met with modification in the regular program (56031 Ed Code).