FORM
22C
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]