1. Re-evaluation/ Continuing Eligibility Team Report
    2. SCREENING/EVALUATION DATA SUMMARY
      1. BASIS for CONINUING ELIGIBILITY DETERMINATION
      2. Data sources used to support response:
      3. Data sources used to support response:



Re-evaluation/ Continuing Eligibility Team Report
 

 
Student’s Name: ________________________________________ Date of Birth: ____________________
 
Enrolling School: _______________________________________ Grade: _________________________
 
Report Date:________________________________
 



SCREENING/EVALUATION DATA SUMMARY

General education interventions or screening results:
 
 
 
Record review:
 
 
Interview:


Observation: (include relevant behavior noted during the observation and the relationship of the behavior to the student’s academic functioning.)
 
 
Tests:
 
 
Any educationally relevant medical findings:
 
 
 



BASIS for CONINUING ELIGIBILITY DETERMINATION
 

Question 1: Does the child continue to be a child with an exceptionality?   Yes No



Data sources used to support response:
GEI/Screening Record Review Interview Observation Testing
Discussion of how data led you to the response:
 
 
 
 
 
 
 
 
Question 2: Does the child continue to need special education and related
services?                 Yes No



Data sources used to support response:
GEI/Screening Record Review Interview Observation Testing
Discussion of how data led you to the response:
 
 
 
 
 
 
 
 
It is the judgment of the undersigned members of the evaluation team, including parents, that an evaluation addressing all areas of concern has been completed and:
       The student is eligible for special education because:
The criteria as a child with an exceptionality, as determined by district eligibility indicators, has been met
   and
Special education services are necessary to enable this student to receive educational benefits in accordance with his/her abilities or capabilities
 
The student is not eligible for special education because:
The criteria as a child with an exceptionality, as determined by district eligibility indicators, has not been met
 or
Special education services are not necessary to enable this student to receive educational benefits in accordance with his/her abilities or capabilities
 

(Check all criteria met)
 
AM:
Communication Social Interaction Before Age of 3
 
DB:
Vision Loss Hearing Loss
 
DD:
1.5 SD Delay Diagnosed Condition Assessment Unreliable
 
ED:
Interpersonal relationships Behavior/Emotions Physical Symptoms/Fears Time/Degree
 
GI:
Aptitude Achievement Products
 
HI:
Hearing Loss Educational Impact
 
LD:
Aptitude-Achievement Discrepancy Processing Deficit Exclusions
 
MD:
At Least Two Disabilities Severe Educational Needs
 
MR:
Aptitude Adaptive Behavior Achievement
 
OHI:
Health Condition Limited Strength Limited Vitality Limited Alertness
 
OI:
Orthopedic or Health Impairment Educational Impact
 
SL:
Language Voice Fluency Articulation/Phonology
 
TBI:
Injury to brain from external source Impaired Functioning
 
VI:
Vision Loss Education Impact

 
RECOMMENDATIONS: The following are areas of discrepancy/areas eligible for special education services.
1.__________________________________________ 2._______________________________________
 
3.__________________________________________ 4._______________________________________
 
5.__________________________________________ 6._______________________________________
 
 
Signature of Team Member    Date      Position
 
_________________________________ ___________________ ____________________________
 
_________________________________ ___________________ ____________________________
 
_________________________________ ___________________ ____________________________
 
_________________________________ ___________________ ____________________________
 
_________________________________ ___________________ ____________________________
 
_________________________________ ___________________ ____________________________
 
DISSENTING TEAM MEMBER (S) SIGNATURE AND ATTACHED STATEMENT REPRESENTING HIS/HER CONCLUSIONS:
 
Signature of Team Member    Date      Position
 
_________________________________ ___________________ ____________________________
 
_________________________________ ___________________ ____________________________
 
Attachments _______ Yes ______ No
 

Back to top