ELIGIBILITY REPORT - SPECIFIC LEARNING DISABILITYidahotc.com/Portals/23/Docs/8) SLD OE and LC sample eligibilty... · ELIGIBILITY REPORT - SPECIFIC LEARNING DISABILITY Student's Name:

ELIGIBILITY REPORT - SPECIFIC LEARNING DISABILITYStudent's Name: Sally Asample District ID:13 State ID: Grade: 04 Sex: FemaleNative Lang: English Ethnicity: White (Non-

Hispanic)Birth Date: 12/27/01 Age: 9y 11m

District:Oneida School District #351 School: Stone Elementary

Document Date: 12/02/11 Initial Assessment Reassessment 3-Year Reevaluation

Parent/Guardian Name: Super and Great Asample Home Phone: (555)555-7777Address: 5555 Wonderful Street, Awesome Towne, ID 77777Native Language: English Daytime Phone:Parent/Guardian Name: Home Phone:Address:Native Language: Daytime Phone:

EVALUATION TEAM INFORMATION

Directions: Provide a complete list of those in attendance at the eligibility team meeting, be sure to provide name, position or title,and check whether you have agreed with report.

Agreement with ReportNames of All Evaluation Team Members Invited to

AttendPosition or Title Yes No

Stephanie Dahlke School PsychologistBest Teacher General Education TeacherNice Teacher Special Education TeacherGreat Leader PrincipalLanguage Jones Speech/Language PathologistMr. and Mrs. Asample Parents

Note: Each member must indicate whether the report reflects that member's conclusions. Any evaluation team member who disagreeswith the conclusions of this team report must attach a separate written statement of his or her conclusions.

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25 E. 50 S., Suite AMalad, ID 83252(208) 766-9235

Oneida School District #351

ELIGIBILITY REPORT - SPECIFIC LEARNING DISABILITYStudent's Name: Sally Asample District ID: 13 State ID: Grade: 04 Sex: FemaleNative Lang: English Ethnicity: White (Non-


District: Oneida School District #351 School: Stone Elementary

Document Date: 12/02/11

Section A: Do Any One of the Following Factors Contribute to the Student's Learning Difficulty?

Directions: Please complete this section by carefully reviewing items 1 through 5 prior to considering SLD eligibility. Place a checkin the box marked "yes" or "no". If "yes" was checked in items 1 through 5, use the text box provided below to provide additionalnarrative information.

1. A visual, hearing or motor impairment Yes No2. Cognitive impairment Yes No3. Emotional disturbance Yes No4. Environmental or economic disadvantage Yes No5. Cultural factors Yes No

For any of the above factors marked "yes", describe how the student's performance is impacted and indicate if this factor is a primaryfactor in the student's learning difficulty.

If one or more of the factors listed in this section is found to be primary factor in the student's learning difficulty, the student may notbe found eligible for special education services under the category of Specific Learning Disability.

Section B: Student does not make sufficient progress in response to effective, evidence-based instructionand intervention for the child's age or to meet state-approved grade level standards in one or more ofthe following areas:

Academic Area(s) of Concern

Basic Reading Skills Oral Expression Written Expression Math Calculation Reading Comprehension Reading Fluency Listening Comprehension Math Problem Solving

1. Information shared by the parent(s)

Directions: In the text boxes below, describe the student's strengths and weaknesses as related to the area of concern that were sharedby the parent(s).

Student Strengths:Sally seems to try to listen to my directions and wants to tell me about her day. She can usually communicate to me but she uses shortor wrong words. We can usually figure it out.

Student Needs:Even though she tries, Sally can`t remember what I ask her to do or sometimes seems like she doesn`t know what I am saying.Sometimes she uses the wrong word to tell me about her day, and she gets angry if we try to correct her or ask her to repeat anything.

2. Educationally relevant developmental, health and medical findings.

Directions: Please note any developmental, health and medical findings that are educationally relevant. If none, please provideevidence that records were reviewed (e.g. Vision/hearing screening on August 10, 2010 indicate functioning in the normal range).

Sally`s mom reports that she was the product of a normal pregnancy with no complications during gestation or birth. According to aninterview with her parents, Sally met all developmental milestones at appropriate ages, except speaking. Sally did not speak in morethan one-word utterances until she was 3 or so. Even after she began to speak, her parents and previous teachers report that she oftenstructured sentences incorrectly and was somewhat difficult to understand.Sally does not have a history of any medical issues, and her parents report that she is a generally healthy child. She has her hearing andvision screened regularly and has always passed both screeners.

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3. The student's parents were notified about:

state and school district policies regarding the amount and nature of student performance data thatwould be collected and the general education services that would be provided,

Yes No

strategies for increasing the student's rate of learning, and Yes No

their right to request an evaluation. Yes No

Parents were provided data-based documentation of repeated assessments of achievement atreasonable intervals, reflecting formal assessment of student progress during instruction.

Yes No

4. Data that establishes that the core curriculum is effective for most students.

Directions: For each of the assessments, list the percentage of students within the student's grade level who meet grade-levelperformance benchmarks. (May include ISAT, IRI, Grade Level Curriculum Based Measures, other measures)

Name ofAssessment

Area Assessed Date PerformanceBenchmark

Percentage ofGrade levelpeers meetingperformancebenchmark

Percentage ofDisaggregatedGroup Level PeersMeetingPerformanceBenchmark (ifapplicable)

TargetStudentperformancelevel

ISAT Reading 4/4/2011 198 86 0 195ISAT Language Arts 4/5/2011 203 83 0 192

5. Document information that the student was provided with appropriate instruction in the general education setting byqualified personnel prior to or as a part of the referral process in the academic area(s) of concern.

Core Instruction ProvidedDuration

Academic Area Core Instruction BeginDate

(M/D/Y)

End Date(M/D/Y)

Total(weeks)

Frequency(how oftenper week)

Intensity(minutes

persession)

Language Arts Open Court 08/29/11 12/02/11 13 5 90

Intervention ProvidedDuration

Academic Area of Concern Intervention BeginDate

(M/D/Y)

End Date(M/D/Y)

Total(weeks)

Frequency(how oftenper week)

Intensity(minutes

persession)

Oral Expression Lindamood PhonemeSequencing (LiPS) Program

09/12/11 12/02/11 10 3 30

Oral Expression Direct instruction in sentencebuilding targeting subject-verbagreement.

09/12/11 12/02/11 10 3 30

Listening Comprehension Direct instruction in followingmultiple step directions with aparaprofessional under direction

09/12/11 12/02/11 10 3 30

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of SLP

The evaluation team determines that the student's learning difficulty is not due to lack of instruction.

The student was provided appropriate instruction by qualified personnel in reading, including theessential components of reading, instruction which includes explicit and systematic instruction in(A) phonemic awareness; (B) phonics; (C) vocabulary development; (D) reading fluency,including oral reading skills; and (E) reading comprehension strategies.

Yes No

The student was provided appropriate instruction by qualified personnel in math Yes No

6. Data-based documentation or repeated assessments of achievement at reasonable intervals, reflecting formal assessment ofstudent progress during instruction and intervention for each academic area of concern. For students who are culturallydiverse and/or English Learners, progress documenting the student's growth should be also compared against theirsubgroup's progress.

Attach to the evaluation report, a copy of the student's progress monitoring graph for each academic area of concern. The graph mustinclude the aimline, trendline, decision points, student's rate of improvement, and national or local norm for grade level peers. Forculturally diverse and English Learners, include comparisons to peer group progress.

Summary of the data demonstrating the student's progress during instruction and intervention in the academic areas ofconcern:Oral Expression:Sally was enrolled in the LiPS program in conjunction with direct instruction in subject/verb agreement and other grammatical andsyntactical components determined as weaknesses by the SLP through several language samples. The language samples revealeddifficulty with subject/verb agreement, switching tenses, incorrect subject/verb/object order. Sally was probed weekly by the SLPand language samples were used to determine her progress toward the goal of correct subject/verb agreement in 8 out of 10 sentencesover three consecutive sessions (baseline was 4 out of 10 correct). Despite direction instruction in sentence building targetingsubject/verb agreement but also addressing syntax and other grammatical errors, Sally failed to make adequate progress towardmeeting language development milestones according to Brown's Stages of Language Development, which is used as a normativescale for these skills.

Listening Comprehension:Sally received direct instruction in following multiple directions. At the beginning of the 10 week intervention, Sally could followone step directions independently 70 percent of the time. The goal was to independently follow two step directions 8 out of 10 times;however, after Sally failed to make adequate gains in following one step directions , the goal was changed to following one stepdirections independently 10 out of 10 times (see attached graph). Same age peers can independently follow three to four stepdirections 8 out of 10 trials as evidenced by classroom norms.

7. Observation of academic and behavior functioning in the area(s) of concern:

Directions: Include documentation of the results from an observation of the student during routine classroom instruction. (In the caseof a student less than school age or out of school, the student must be observed in an environment appropriate for the student's age).The observation should be conducted in a general education environment in which the suspected disability would be manifested.

Name and Title of Observer:Language Jones Speech/Language Pathologist

Date Conducted:11/08/11

Location of Observation:General Classroom during language arts

Duration of Observation:30 min

Summary of relevant behavior and relationship of behavior to academic functioning in the area(s) of concern duringobservation:Sally was observed during a group reading and question answering period. When Sally did not know the answer, she would make acomment off the topic to have something to say. Often, her comments contained grammatical errors making it hard for the other

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students and teacher to understand. She also spoke in a very quiet voice and was often asked to repeat herself, which appeared toaggravate her. Sally was observed using incorrect subject/verb agreement and structuring her sentences inappropriately.

When the class was given directions, Sally would watch her peers to see what they did. She was usually the last one to completetasks. Also, it was evident that she often did not understand what to do. For example, the teacher asked students to turn in theirspelling and get our their math books. Sally watched the other students turn in a paper, so she grabbed an already graded paper onher desk, put it in the same pile the other students were handing things into, then sat at her desk and got out a reading book.

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Document Date 12/02/11

Section C: Evidence of Low Achievement in One or More Areas

Basic Reading Skills Oral Expression Written Expression Math Calculation Reading Comprehension Reading Fluency Listening Comprehension Math Problem Solving

Area of Concern Date Name of Assessment Composite/Cluster orSubtest

SS %ile Evaluator/Title

ListeningComprehension

11/5/2011 WIAT-III Oral Discourse

Receptive Vocabulary

82

70

12

2

Nice Teacher SpecialEducation Teacher

Description of assessment measure, validity statement, and interpretive information:The WIAT-III is a norm-referenced, standardized academic achievement test. It was given to Sally in the morning. Sally presentedfor testing looking clean and attentive. It appears that she gave her full effort to each task. She employed some problem solvingskills and did not easily give up. Overall, this is considered an accurate measure of her current level of functioning. Oral discourserequired Sally to listen to a CD of spoken sentences and answer questions about what she heard. Receptive vocabulary required Sallyto listen to single words and point to a picture of that word. Her skills were in the Borderline (70) to Low Average (82) range.



Oral Expression 11/5/2011 WIAT-III Expressive Vocabulary

Oral Word Fluency

72

81

3

10

Nice Teacher SpecialEducation Teacher

Description of assessment measure, validity statement, and interpretive information:The WIAT-III is a norm-referenced, standardized academic achievement test. Expressive vocabulary required Sally to look at apicture and listen to a word then tell the word that meets that definition. Oral word fluency required Sally to name nouns belonging tocertain categories. Sally struggled greatly with these skills. Her skills are in the Borderline (72) to Low Average (81) range.

Section D: Pattern of Strengths and Weaknesses in Psychological Processing Skills That ImpactLearning

Directions: Provide the specific strengths and weaknesses of the student's psychological processing skills that have a direct impact onlearning as demonstrated through the evidence provided throughout this report. Be sure to include specific processing area and use across battery approach as needed to demonstrate the areas suspected as strengths and weaknesses.

Processing Area Date Name of Assessment Composite/Cluster orSubtest


CrystalizedIntelligence

11/14/11 Kaufman AbilityBattery for Children,second edition

Expressive Vocabulary

Verbal Knowledge

80

76

9

5

Stephanie DahlkeSchool Psychologist

Description of assessment measure, validity statement, and interpretive information:The KABC-II is a standardized, norm-referenced measure given to assess psychological processing skills. The area of CrystalizedIntelligence includes such skills as language development, listening ability, comunication ability, and oral production/fluency. TheExpressive Vocabulary subtest required Sally to define a word shown and given to her orally. The Verbal Knowledge subtestincluded looking at pictures while being read a definition, and pointing at a picture of what was being described.Sally's scores range from Low Average (80) to Borderline (76), placing her significantly below her peers.Sally appeared to give her best effort to each subtest. She was not easily distracted and displayed little peripheral movement. This is

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felt to be a valid assessment of her current ability.



Auditory Processing 11/7/11 Woodcock JohnsonPsycho-EducationalBattery , third edtion

Sound Blending

Auditory Attention

82

79

12

8


Description of assessment measure, validity statement, and interpretive information:The WJIII is a standardized, norm-referenced cognitive assessment. The subtests that measure Auditory Processing include SoundBlending (Borderline Range) and Auditory Attention (Borderline Range).Auditory Processing consists of general sound discrimination, memory for sound patterns, and general response to auditory stimuli.Sally was administered these tests in the morning, when it is reported she does best, and in a quiet location. This is considered to be avalid assessment of her current skills.



Fluid Intelligence 11/4/11 Kaufman AbilityBattery for Children,second edition

Pattern Reasoning

Story Completion

99

103

47

58


Description of assessment measure, validity statement, and interpretive information:Fluid intelligence consists of induction, quantitative reasoning, general sequencing reasoning, and speed of reasoning. This area is aparticular ipsative strength for Sally. She scored in the average range on both subtests.Sally noticeably enjoyed these subtests and worked at them diligently. This is considered to be a valid assessment of her currentabilities in this area.

Section E: Supplemental Assessment Information (when applicable)

Directions: Not all students will have assessment information to include in this section. This section is to be used to includeadditional information gathered through assessments not directly related to academic achievement or psychological processing. Thismight include assessments conducted to address additional areas of concern such as behavior.



Expressive Language 11/10/11 CELF-4 Recalling Sentences

Word Classes -Expressive

Formulated Sentences

EXPRESSIVECOMPOSITE

7

8

5

80

16

25

5

9

Language JonesSpeech/LanguagePathologist

Description of assessment measure, validity statement, and interpretive information:The CELF-4 is a standardized language assessment designed to identify students’ language strengths and weaknesses.The CELF-4 is divided into subtests that provide individual subtest scores as wells as cumulative index scoresincluding: Core Language Score, Receptive Language Index, and Expressive Language Index.Recalling SentencesThe Recalling Sentences subtest is used to evaluate the student’s ability to recall and reproduce sentences of varying

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length and syntactic complexity. The student imitates sentences presented by the examiner. Sally's scaled score of 4places her in the severely impaired range.

Word ClassesThe Word Classes subtest is used to evaluate the student’s ability to understand relationships between words that sharea variety of functional and conceptual relationships. The student is asked to choose the items that best represent thedesired relationship. Sally's score places her in the Borderline range.

Formulated SentencesThe Formulated Sentences subtest is used to evaluate the ability to formulate compound and complex sentences whengiven grammatical (semantic and syntactic) constraints. The student is asked to formulate a sentence using target wordsor phrases while using an illustration as a reference. Sally's scaled score of 8 places her in the low average range.



Receptive Language 11/10/11 CELF-4 Concepts andFollowing Directions

Word Classes -receptive

RECEPTIVELANGUAGECOMPOSITE

5

8

81

5

25

10

Language JonesSpeech/LanguagePathologist

Description of assessment measure, validity statement, and interpretive information:The CELF-4 is a standardized language assessment designed to identify students’ language strengths and weaknesses.The CELF-4 is divided into subtests that provide individual subtest scores as wells as cumulative index scoresincluding: Core Language Score, Receptive Language Index, and Expressive Language Index.Concepts & Following DirectionsThe Concepts & Following Directions Subtest is used to evaluate the student’s ability to interpret, recall, and executeoral commands of increasing length and complexity that contain concepts of functional language. The student identifiesobjects in response to oral directions. Sally received a scaled score of 5, placing her in the Borderline range. It wasnoted that Sally had difficulty with following directions that used sequencing terms (first, last, before, after, etc.).

Word Classes - ReceptiveThe Word Classes subtest is used to evaluate the student’s ability to understand relationships between words that sharea variety of functional and conceptual relationships. The student is asked to choose the items that best represent thedesired relationship. Sally scored a scaled score of 8, placing her in the average range.

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Document Date: 12/02/11

Section F: English Learner (EL)

Directions: Include information detailing how the student's language acquisition impacts his/her ability to learn.

1. Is the student's first language English? Yes No

2. Documentation of English Language Proficiency when the Student is an English Learner (EL):

Directions: Provide supporting evidence using information gathered through formal and informal assessments including: HomeLanguage Surveys, Idaho English Language Assessments (IELA) information, etc.

Date Assessments/Documentation Result/Score

3. Impact of English Learning on the student's academic functioning in the area(s) of concern

Directions: Describe how the student's English Learning impacts his/her ability to learn and their achievement level.

Sally is not an English Learner

Section G: Summary of Evidence and Eligibility Determination

Summarize evidence as documented in sections A through F of this report.

Describe the adverse effect that the student's Specific Learning Disability has on their educational performance in thegeneral education curriculum and ability to meet grade level achievement standards.Sally's low skills in grammar, syntax, and sentence construction make the academic work in the general education classroom difficult.The ability to speak with clarity of thought, understand and use appropriate grammar, follow directions, and listen effectively areskills needed to perform and participate successfully in the classroom. Without these, Sally will have a difficult time succeeding inthe regular classroom.Describe the specially designed instruction necessary for the student to be able to access and progress in the general

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Summarize the evidence regarding whether the student demonstrates low achievement in the suspected area(s) ofdifficulty indicated above as evidenced by a norm-referenced, standardized achievement assessment. For culturally andlinguistically diverse students, provide evidence indicating low achievement:Sally achieved scores in the severely impaired to Borderline range in Oral Expression and Listening Comprehension.These areas are significant ipsative weaknesses for Sally.

• Summarize the evidence regarding whether the student demonstrates a pattern of strengths and weaknesses inpsychological processing and the impact on academic achievement. For English Learners, provide the preponderance ofevidence that supports the psychological processing deficits are not related to the student's level of English acquisition.Sally shows normative weaknesses in her Crystalized Intelligence and Auditory Processing skills. These skill deficits tieto processing auditory stimuli and developing language as a whole. Sally showed a particular ipsative strength in herFluid Intelligence skills. Her reasoning abilities are a strength when she does not have to express answers verbally. Herother areas of processing fall in the normal range and consist of an otherwise normal profile.

The evidence in sections A through F of this report demonstrates that the student meets of the state criteria for SpecificLearning Disabilities. Yes No

• The impact on achievement of the following factors: visual, hearing or motor impairment, Cognitive impairment,Emotional disturbance, Environmental or economic disadvantage, Culture, or English Language Learning.Sally is in good health, has adequate hearing and vision. No emotional or cultural factors have been identified.

• Response to evidence based instruction and interventions in areas of concernSally was in an intervention with the speech and language pathologist for 10 weeks. During this time, Sally madenegligible gains toward meeting developmental milestones for language. She made little progress despite directinstruction. This progress is significantly lower than what is expected for 9 year 11 month old children.

•




education curriculum and grade level achievement standards:In order to benefit from her education, Sally will need direct instruction in expression, correct grammar and syntax, and thoughtorganization. She will also need instruction in following directions and receptive vocabulary. This may happen in pull-out therapy orin the classroom (gen ed or resource) and in small groups.

In consideration of the reported information, the evaluation team finds the student:

meets the criteria requirements and is eligible to receive special education services

does not meet the criteria requirements and is not eligible to receive special education services

under the category of Specific Learning Disability.

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Documents

ELIGIBILITY REPORT - SPECIFIC LEARNING DISABILITYidahotc.com/Portals/23/Docs/8) SLD OE and LC sample eligibilty... · ELIGIBILITY REPORT - SPECIFIC LEARNING DISABILITY Student's Name: