Evaluation Plan (continued)
Name
Date
Cognitive Functioning
Cognitive Functioning
Administered by:
Administered by:
Purpose: These tests measure how well a student remembers what has been seen and heard in the environment, how well the student can use the information, and how well he/she solves problems. (Tests yielding IQ scores cannot be administered to African American students). Tests may include, but are not limited to:
Bateria Woodcock-Muņoz
Bateria Woodcock-Muņoz
Ravens Progressive Matrices
Ravens Progressive Matrices
Bayley Scales of Infant Development
Bayley Scales of Infant Development
Stanford-Binet Intelligence Scale
Stanford-Binet Intelligence Scale
Comprehensive Test of Non-Verbal Intelligence (C-TONI)
Comprehensive Test of Non-Verbal Intelligence (C-TONI)
Wechsler Tests of Intelligence
Wechsler Tests of Intelligence
Kaufman Assessment Battery for Children (K-ABC)
Kaufman Assessment Battery for Children (K-ABC)
Woodcock Johnson Part I-R-Cognitive Battery
Woodcock Johnson Part I-R-Cognitive Battery
Leiter-International Performance Scale
Leiter-International Performance Scale
Other:
Social/Emotional Adaptive Behavior
Social/Emotional Adaptive Behavior
Administered by:
Administered by:
Purpose: These tests measure the student's general adjustment to life and school. They indicate what individuals can do for themselves and how well they get along with others. Tests may include, but are not limited to:
AAMD Adaptive Behavior Scales
AAMD Adaptive Behavior Scales
Roberts Apperception Test
Roberts Apperception Test
Behavior Assessment System for Children (BASC)
Behavior Assessment System for Children (BASC)
Sentence Completion
Sentence Completion
Child Behavior Checklist
Child Behavior Checklist
Vineland Adaptive Behavior Scales
Vineland Adaptive Behavior Scales
Draw a Person/Draw a Family
Draw a Person/Draw a Family
Wisconsin Behavior Rating Scale
Wisconsin Behavior Rating Scale
Functional Analysis of Behavior
Functional Analysis of Behavior
Other:
Piers-Harris
Piers-Harris
Prevocational/Vocational
Prevocational/Vocational
Administered by:
Administered by:
Purpose: Prevocational/vocational tests assist in the identification of a student's interest and aptitude which can be utilized to explore career options. Tests may include, but are not limited to:
Vocational Interest Inventory
Vocational Interest Inventory
Other:
Additional and/or Alternative Assessment
Additional and/or Alternative Assessment
Administered by:
Administered by:
Purpose: Alternative assessment may provide different and/or additional information in a variety of areas. Tests may include, but are not limited to:
Criterion Referenced
Criterion Referenced
Portfolio
Portfolio
Curriculum Based
Curriculum Based
Other:
Health
Health
Administered by:
Administered by:
Purpose: Alternative assessment may provide different and/or additional information in a variety of areas. Tests may include, but are not limited to:
Audiological Evaluation
Audiological Evaluation
Vision Screening
Vision Screening
Health and Developmental History
Health and Developmental History
Other:
Hearing Screening
Hearing Screening
If you have any questions about this Evaluation Plan, or would like more information regarding a test identified above, please contact:
Name
Position
Phone
PARENT ACKNOWLEDGEMENT
Are there any other areas of suspected disability that you would like to be evaluated?
___ No ___ Yes
If yes, please specify
Do you have any independent assessments you would like to have considered?
___ No ___ Yes
If yes, please specify and provide a copy of the assessment for your child's file which will be considered by the IEP team.
Please initial the appropriate responses and sign below:
( ) I understand the proposed evaluation plan.
( ) I give permission for the evaluation as indicated. OR ( ) I give my permission on for the following assessments:
( ) I will make my child available for the evaluation.
( ) If an evaluator feels additional test are needed, she/he may contact me to obtain verbal permission at ( )
( ) I have received a copy of the NOTICE OF PROCEDURAL SAFEGUARDS.
Parent/Guardian/Surrogate/Student Signature
Date