FORM 22A ASSESSMENT PLAN

 

The assessment plan is to be completed by the assessment team and approved by the parent(s)/guardian/surrogate/adult student in writing at the initial referral for special education and/or request for assessment and each time the Local Education Agency (LEA)/District proposes to conduct assessment. There are two versions of the Assessment Plan Form.  Form 22A does not have the titles of the personnel that made the referral for assessment. This is a requirement for Medi-cal billing.  Form 22C does have the referral section.

NOTE: For initial assessments, Some SELPAs use a Prior Written Notice Form 22B. Assessment" means an individual evaluation of a pupil in all areas of suspected disability in

accordance with Sections 56320 through 56329 of the Education Code and Sections 300.530 through 300.534 of Title 34 of the Code of Federal Regulations.

 

"Assessment plan" means a written statement that delineates how a pupil will be evaluated and meets the requirements of Section 56321 of the Education Code.

 

Note:  An assessment plan must be completed and signed and agreed to by the parent(s)/guardian/surrogate/adult student if the district plans to administer testing to the student that is not part of an assessment being administered to all or a group of students.

 

    Mark the reason the assessment plan is being sent: Initial, Annual, Triennial, Transition, or

Interim (or other such as Manifest Determination, Special Requested, etc.).

 

    Check the boxes to the left of each category of assessment that will be administered.  In the right column, state the professional title of the examiner that will be administering the assessment such as Speech & Language Specialist, Special Education Teacher, School Psychologist, NPA, etc. For alternate means of assessment list the alternate types of assessment that will be conducted such as criterion referenced, observation.

 

    Enter date that signed consent was received by the District/LEA.

 

Legal Citations:  2 CCR 60010; 30 EC 56321; 1 GC 7572; 30 EC 56043 (see below)

 

[Excerpted from the State SELPA IEP Manual, July, 2013]