Triennial Reevaluation Determination (32)
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  Student name     Birthdate
 
  School   Date of determination Date of determination Date of determination
 
  Date triennial IEP due   Case manager
 

 
  Date of parent/legal guardian contact Date of parent/legal guardian contact Date of parent/legal guardian contact   Method of contact Phone conference
IEP meeting
Other meeting
Written correspondence
 
 
  As part of determining the need for reassessment the District/LEA has completed ALL of the following steps:
(all must be checked)
 
    Existing assessment data has been reviewed, including assessments provided by the parents.
 
    Current classroom-based assessments have been reviewed.
 
    Teacher and related services provider(s) observations have been reviewed.
 
    Parent/legal guardian input has been reviewed and considered.
 
  Based upon a review of the information referenced above, the LEA, in collaboration with parent, has determined that additional assessment is needed:
 
 
 
  If yes, it is recommended that assessment be completed in the following areas:
(check all that apply)
 
    Academic achievement
 
    Cognitive functioning
 
    Motor development
 
    Social/emotional
 
    Other:
 
    Health
 
    Language/speech communication development
 
    Adaptive behavior
 
    Post-secondary transition
 
    Alternate means of assessment
 
  (Describe alternate methods of assessing the student, if applicable)
 
 
 
  If yes, additional assessment data is needed to determine:
(check all that apply)
 
  1. Whether the student has a particular category of disability and/or continues to meet the eligibility criteria as a child with a disability.  
 
  2. The present level of performance of the student and the student's educational needs.  
 
  3. Whether the student continues to need special education and related services.  
 
  4. Whether any additions or modifications to special education and related services are needed to enable the student to meet the annual goals included in the student's IEP and to participate, as appropriate, in the general curriculum.  
 
  If no, reason(s) it was determined that further assessment data was not needed:
 
 
 
  The parent(s) has/have exercised the right to request an assessment to determine whether their child continues to meet special education eligibility criteria and to determine his/her educational needs.  
 

 
  The signatures below are documentation that the LEA reviewed the data referenced above in making the determination of whether to conduct further assessment and involved the parent / legal guardian in the process.  
 
         
 
 
 
  Relation    (if other, specify:) Date  
 
 
 
 
  Parent   Date  
 
 
 
 
  District / LEA representative   Date