Evaluation Plan

Some items need revision (cannot save).

Date Date   Date of Referral Date of Referral
  Date Received by District Date Received by District
  IEP Due Date IEP Due Date

 
Your child has been referred for:* Your child has been referred for:*     (Specify if other purpose:)
 
Student   Date of Birth
 
   
  Last First  
 
School   Grade
 
   
 
Primary Language -   ELL  Yes No   Language Assessment Date Language Assessment Date
 
   
     
 

If student's primary language is other than English, an interpreter will be used to assure accuracy of assessment.

In order to meet your child's individual education needs, the following evaluation is proposed. This evaluation will provide information related to enabling your child to participate in the general curriculum (or appropriate activities for preschool children). The evaluation will be conducted by qualified personnel and is designed to assess your child in all areas of suspected disability. In addition to the assessments indicated below, a variety of tools and strategies will be utilized, which may include observation of the student, teacher/parent/student interviews, reviews of school records and prior assessments. The assessment instruments have been validated for the specific purpose for which they will be used, unless otherwise indicated, and are selected so as not to be discriminatory on racial or cultural basis. You will receive a copy of the evaluation report(s). You will be asked to participate in a meeting of the individualized education program (IEP) team following completion of the evaluation. If your child is determined to have a disability as defined in state/federal law, the evaluation information will provide input into the content of the IEP. The team may recommend special education and/or services. No single procedure will be used as the sole criterion for determining an appropriate education program for your child. No placement in special education services will be initiated without your written permission.

Areas to be assessed are checked

   Administered by: Administered by:  
 
Purpose: These tests measure a student's current reading, writing, mathematics, or pre-readiness skills. Tests may include, but are not limited to:
 
  Bateria Woodcock-Muņoz Peabody Individual Achievement Test, Ref. (PIAT)
  Brigance Inventory of Basic Skills Wechsler Individual Achievement Test (WIAT)
  Early Screening Profiles (ESP) Woodcock-Johnson Achievement Battery III
  Kaufman Test of Educational Achievement (KTEA) Other: 
  Key Math  

   Administered by: Administered by:  
 
Purpose: Instruments in this area measure how well students coordinate body movements in small and large muscle activities. They may also include visual perceptual skills. Tests may include, but are not limited to:
 
  Bender-Gestalt Motor Free Visual Perception Test (MYPT)
  Bruininks-Oseretsky Test of Motor Proficiency Test of Visual Perceptual Skills (TYPS)
  Detroit Test of Learning Aptitude Other: 
  Development Test of Visual Motor Integration (VMI)  

   Administered by: Administered by:  
 
Purpose: These tests measure a student's ability to understand, relate to and use language, and to speak clearly and appropriately. Tests may include, but are not limited to:
 
  Clinical Evaluation of Lang. Fundamentals (CELF) Peabody Picture Vocabulary Test III (PPVT)
  Comprehensive Assessment of Speech and Lang (CASL) Receptive One Word Picture Vocabulary Test
  Comprehensive Test of Phonological Processing (CTOPP) Test of Auditory Perceptual Skills (TAPS)
  Expressive One Word Picture Vocabulary Test Test of Auditory Reasoning & Processing Skills (TARPS)
  Expressive Vocabulary Test (EVT) Test of Language Development (TOLD)
  Goldman Fristoe Test of Articulation Test of Problem Solving (TOPS)
  Language Processing Test (LPT) Voice and/or Fluency Measurements
  Language Sample Other: 
  Oral & Written Language Scales