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I. Presence of Severe Discrepancy. (Select either A or B and then complete items II through IV.) |
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Check appropriate area(s) |
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III. If ANY of the items below (A-E) are checked “Yes”, the student MAY NOT be identified as having a specific learning disability. |
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V. Basis for determination of eligibility |
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VI. Relevant behavior related to academic functioning, noted during observation |
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VII. Educationally relevant medical findings, if any (describe) |
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I agree with the conclusions stated above: |
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My assessment of this student differs from the above report as follows: Statement (attach additional pages as necessary) |
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