Eligibility document for student: Tiffany L.

Parent(s) Name:

The following information is required before you can create this Draft Document
Eligibility Meeting Date: 8/11/09    65-Day Due Date: 7/6/09
Eligiblity Meeting Sataus: OVERDUE 23 Business Days (ON-TIME)

(flexible interface)
The eligibility date is beyond the due date.
Please provide an explanation by choosing from the list of reasons below:

Inclement weather
Paperwork error
Inconclusive testing results
Child not available (not parent failure)/child refusal
Staffing issue (specify)_________________________________________________
 Other reason(s) (specify)_______________________________________________
Parent repeatedly  failed or refused to make child available 
Student enrolled after the 65-day timeframe has started and prior to determination by the previous public  agency.  Receiving LEA made sufficient progress to complete evaluation, and parent and LEA agreed to a specific time to complete the evaluation ( All conditions must be met.)


Type of
Eligibility
Meeting:
Initial 
Re-evaluation

Determinate Factor in the
decision to refer for evaluation:
Significant Academic deficits
Significant behavioral difficulties
Persistent performance difficulties in multiple areas
Significant communication difficulties
Significant lack of progress and/or lack of response to intervention


Sources considered for eligibility determination: (check appropriate areas considered) (Note to Programmer - Previously: Recommendation on appropriate level of service(s))


 Psychological Testing
 Teacher Recommendations
 Academic Record
 Socio-Cultural Assessment
 Local Assessment(s)
 Response to Intervention data
 Achievement Testing
 Standardized Testing
 Speech and Language Evaluation
 Adaptive Behavior
 Parent / Family input
 Observations
 Hearing Screening (required for ALL Initial Evaluations)
 State Assessments
 Classroom Assessments
 Information Provided by Parents
 Developmental Testing
 Medical Reports / Evaluation
 Other

Eligibility Deliberations
Note the essential deliberations that were critical to the committee coming to its decision regarding eligibility .

PRONG ONE:
Does this student meet the criteria for a disability using Albemarle County guidelines? Make this determination by choose one or more appropriate disability category in order to review the criteria.

Meets Criteria?   Meets Criteria?  

Yes
No

 Autism

 Yes
No

 Orthopedic Impairment
Yes
No

 Deaf / Blindness

 Yes
No

 Other Health Impairment
Yes
No

 Developmental Delay

 Yes
No

 Speech or Language Impairment
Yes
No

 Emotional Disability

 Yes
No

 Specific Learning Disability
Yes
No

 Hearing Impairment

 Yes
No

 Traumatic Brain Injury
Yes
No

 Intellectual Disability

 Yes
No

 Visual /Impairment
Yes
No

 Multiple Disabilities

  

 

(Summarize below any essential deliberations that were critical to the committee coming to its decision):
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(If all responses above are “NO” - the eligibility meeting is over – the student is ineligible for services)

CONSIDERATIONS
Were assessments and other evaluation materials provided and administered in the language and form most likely to yield accurate information on what the child knows and can do academically, developmentally and functionally?
 Yes
No (“NO” indicates inappropriate identification under IDEA. Student should not be found eligibible.)

Were the assessment instruments, measures and materials used in the evaluation valid and reliable, technically sound, administered by trained and knowledgeable personnel, and administered in accordance with the instructions provided in the assessments?
Yes
No (“NO” indicates inappropriate identification under IDEA. Student should not be found eligibible.)

Specific observational and performance measures, test instruments, other materials and techniques were selected and administered so as to be nondiscriminatory on a racial or cultural basis.
 Yes
No (“NO” indicates inappropriate identification under IDEA. Student should not be found eligibible.)

PRONG TWO
Does the disability impair the student’s ability to achieve adequately in order to meet the standards that apply to all children?
(Summarize the essential deliberations that were critical to the committee coming to its decision):
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Yes (Review and attach data that supports concerns about achievement.)
No (If response is “NO” - end the eligibility meeting – the student is ineligible for services)

CONSIDERATIONS
Based on information available in the student’s record(s) and /or through parent/staff consultation, limited English proficiency, environment, cultural or economic issues were ruled out as the cause of the student’s underachievement.
 Yes
No (“NO” indicates inappropriate identification under IDEA. Student should not be found eligibible.)

PRONG THREE
Does this student require special education to make adequate progress to meet the standards that apply to all children?
(Summarize the essential deliberations that were critical to the committee coming to its decision):
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Yes (Review and attach RtI data to the final report.)
No (If response is “NO” - end the eligibility meeting – the student is ineligible for services)

CONSIDERATIONS
Documentation from the student’s scholastic record, such as achievement scores, screening results, and/or group standardized data, indicated academic, behavior and/or communication problems that interfered with the student’s performance and/or learning.
Yes
No (“NO” indicates inappropriate identification under IDEA. Student should not be found eligibible.)

Did the child participate in a Response to Intervention (SBIT) process?
Yes (Attach strategies and data collected to this report)
No – EXPLAIN WHY:
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Please note any other essential deliberations here:
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ELIGIBILITY DETERMINATION

CONSIDERATIONS
Did the Eligibility Team ensure that no single procedure was used as the criterion for determining whether the student was a child with a disability?
 Yes
No (“NO” indicates inappropriate identification under IDEA. Student should not be found eligibible.)

A group of qualified professionals and the parent(s) of the student determined that the student was a child with a disability.

Yes - the student was found eligible and parent is in agreement.
No - the student was found ineligible or the student was found
eligible but the parent disagrees with the outcome of the eligibility meeting.

At the time of the initiation of the evaluation it was determined by an IEP Team to be sufficiently comprehensive to identify all of the student’s needs for special education and related services.
 Yes
No (“NO” indicates inappropriate identification under IDEA. Student should not be found eligibible.)

The student was assessed in all areas related to the suspected disability.
 Yes
No (“NO” indicates inappropriate identification under IDEA. Student should not be found eligibible.)

The student is eligible for special education services under the following categories (if none, clear out any remaining categories):

 

Disabilities: optional

Primary

 

Secondary

 

Third