Assessment Report
Student's Name ,
 
Gender Grade   Birthdate Age
 
School Teacher (if appropriate)
 
By  
 
Title Date Date
 
This report shall include but not be limited to (a) whether the student has a disability and the basis for making that determination; (b) relevant behavior during observation and its relationship to academic and social functioning; (c) educationally relevant medical finding if any; (d) any discrepancy between achievement and ability that cannot be corrected with special education and/or related services; and (e) effects of environment, cultural, or economic disadvantage, where appropriate.