FORM 9A

SPECIFIC LEARNING DISABILITY – DETERMINATION OF ELIGIBILITY

 

This form documents the requirements for identifying a student as having a specific learning disability.

 

A draft of this form is typically completed prior to the IEP meeting with a discussion and final decision reached by the IEP team during the meeting.

 

The Case Manager completes the form with input from the appropriate IEP team members (School Psychologist, Special Education Teacher, General Education Teacher, etc.)

 

·         Fill out the appropriate information based on the evaluations indicating the area of achievement that is severely discrepant from the level of intellectual ability and the processing disorder associated with this discrepancy.

 

·         Indicate whether the discrepancy is or is not caused by poor attendance, environmental, emotional, sensory or the other reasons listed in Section III.

 

·         Include any medical findings that are educationally relevant and the other information required on this form.

 

·         If there is a team decision that is not based on the standard measures indicated, support that decision.

 

·         Obtain signatures from all participants in the IEP meeting on this form.

 

 

 

[Excerpted from the State SELPA IEP Manual, July 2009. For the 2008-2009 form set.]