ࡱ> a T5bjbjjj ;?b?b->x x 8@<@b8H!H!H!H!"" "k@m@m@m@m@m@m@$NCFz@"""""@H!H!H@***"FH!H!k@*"k@**7|K9H!nV#*O8W@@0@a8~G.$d~G$K9~GK9 ""*"""""@@*"""@""""~G"""""""""x B : REQUIRED DOCUMENTATION FOR SPECIFIC LEARNING DISABILITY (SLD) INITIAL EVALUATION Form ER-2A (Rev. 05/2019) Student Name: ______________________________________ Date of Eligibility Determination: _______________________ The responses to items #1, #2, and #3 under Documentation of Eligibility must be marked Yes" for the student to meet the eligibility criteria for the impairment of Specific Learning Disability (SLD). In addition, these criteria must be documented in at least one of the same area(s) of concern. If any item is marked "No, the student does not meet eligibility criteria for the impairment of SLD. Prompts for additional information must be completed as appropriate. If information is addressed elsewhere in the IEP team evaluation report, reference where the information can be found. DOCUMENTATION OF ELIGIBILITY 1. Insufficient Progress  FORMCHECKBOX  Yes  FORMCHECKBOX  No The student does not make sufficient progress to meet age or grade-level standards following at least two intensive, scientific research-based or evidence-based interventions implemented with adequate fidelity and closely aligned to individual student needs. Check Yes if the student did not make sufficient progress in one or more of the area(s) considered. Check No if the student made sufficient progress in all area(s) considered. Data Used to Support Insufficient Progress Determination Check the area(s) considered and whether the student did or did not make sufficient progress in the chart below. Area(s) Considered Decision Rule The students rate of progress was:Progress Monitoring Data Briefly summarize data collected. Attach supporting data as appropriate. FORMCHECKBOX  Basic Reading Skill  FORMCHECKBOX  The student did not demonstrate sufficient progress  FORMCHECKBOX  The student demonstrated sufficient progress  FORMCHECKBOX  The same or less than same age peers.  FORMCHECKBOX  Greater than same age peers, but will not result in the student reaching the average range of achievement as same age peers in a reasonable period of time.  FORMCHECKBOX  Greater than same age peers, but the intensity of resources necessary to obtain this rate of progress cannot be maintained in general education.  FORMCHECKBOX  Reading Comprehension  FORMCHECKBOX  The student did not demonstrate sufficient progress  FORMCHECKBOX  The student demonstrated sufficient progress  FORMCHECKBOX  The same or less than same age peers.  FORMCHECKBOX  Greater than same age peers, but will not result in the student reaching the average range of achievement as same age peers in a reasonable period of time.  FORMCHECKBOX  Greater than same age peers, but the intensity of resources necessary to obtain this rate of progress cannot be maintained in general education.  FORMCHECKBOX  Reading Fluency Skills  FORMCHECKBOX  The student did not demonstrate sufficient progress  FORMCHECKBOX  The student demonstrated sufficient progress  FORMCHECKBOX  The same or less than same age peers.  FORMCHECKBOX  Greater than same age peers, but will not result in the student reaching the average range of achievement as same age peers in a reasonable period of time.  FORMCHECKBOX  Greater than same age peers, but the intensity of resources necessary to obtain this rate of progress cannot be maintained in general education.  FORMCHECKBOX  Mathematics Calculation  FORMCHECKBOX  The student did not demonstrate sufficient progress  FORMCHECKBOX  The student demonstrated sufficient progress  FORMCHECKBOX  The same or less than same age peers.  FORMCHECKBOX  Greater than same age peers, but will not result in the student reaching the average range of achievement as same age peers in a reasonable period of time.  FORMCHECKBOX  Greater than same age peers, but the intensity of resources necessary to obtain this rate of progress cannot be maintained in general education.  FORMCHECKBOX  Mathematics Problem Solving  FORMCHECKBOX  The student did not demonstrate sufficient progress  FORMCHECKBOX  The student demonstrated sufficient progress  FORMCHECKBOX  The same or less than same age peers.  FORMCHECKBOX  Greater than same age peers, but will not result in the student reaching the average range of achievement as same age peers in a reasonable period of time.  FORMCHECKBOX  Greater than same age peers but the intensity of resources necessary to obtain this rate of progress cannot be maintained in general education.  FORMCHECKBOX  Written Expression  FORMCHECKBOX  The student did not demonstrate sufficient progress  FORMCHECKBOX  The student demonstrated sufficient progress  FORMCHECKBOX  The same or less than same age peers.  FORMCHECKBOX  Greater than same age peers, but will not result in the student reaching the average range of achievement as same age peers in a reasonable period of time.  FORMCHECKBOX  Greater than same age peers but the intensity of resources necessary to obtain this rate of progress cannot be maintained in general education.  FORMCHECKBOX  Oral Expression  FORMCHECKBOX  The student did not demonstrate sufficient progress  FORMCHECKBOX  The student demonstrated sufficient progress  FORMCHECKBOX  The same or less than same age peers.  FORMCHECKBOX  Greater than same age peers, but will not result in the student reaching the average range of achievement as same age peers in a reasonable period of time.  FORMCHECKBOX  Greater than same age peers but the intensity of resources necessary to obtain this rate of progress cannot be maintained in general education.  FORMCHECKBOX  Listening Comprehension  FORMCHECKBOX  The student did not demonstrate sufficient progress  FORMCHECKBOX  The student demonstrated sufficient progress  FORMCHECKBOX  The same or less than same age peers.  FORMCHECKBOX  Greater than same age peers, but will not result in the student reaching the average range of achievement as same age peers in a reasonable period of time.  FORMCHECKBOX  Greater than same age peers but the intensity of resources necessary to obtain this rate of progress cannot be maintained in general education.   FORMCHECKBOX  The instructional strategies used with the student, including intensive intervention, were applied in a manner highly consistent with the design, closely aligned to student need, and culturally appropriate.  FORMCHECKBOX  The students parent(s) were informed about the amount and nature of their childs performance data collected; the general education services provided; progress monitoring data collected; the strategies for increasing their childs rate of learning, including the intensive interventions used; and their right to request an evaluation. Additional Notes (if any): 2. Inadequate Classroom Achievement  FORMCHECKBOX  Yes  FORMCHECKBOX  No The student does not achieve adequately for their age or grade-level after intensive intervention. If Yes, achievement is inadequate in the following area(s) (check all that apply):  FORMCHECKBOX  Oral Expression  FORMCHECKBOX  Basic Reading Skill  FORMCHECKBOX  Mathematics Calculation  FORMCHECKBOX  Listening Comprehension  FORMCHECKBOX  Reading Comprehension  FORMCHECKBOX  Mathematics Problem Solving  FORMCHECKBOX  Written Expression  FORMCHECKBOX  Reading Fluency Skills Data Used to Support Determination: If the 1.25 standard deviation (SD) requirement was not used to make this determination, provide the reason why valid and reliable standard scores could not be attained and document inadequate achievement using other empirical evidence: Additional Notes (if any): 3. Exclusionary Factors as a primary reason DO NOT apply.  FORMCHECKBOX  Yes  FORMCHECKBOX  No Check "Yes" if none of the exclusionary factors are the primary reason for the students inadequate achievement or insufficient progress. Check "No" if the students inadequate achievement or insufficient progress are primarily due to one or more exclusionary factor, and check the factor(s) below. If the students inadequate achievement or insufficient progress is primarily due to one or more exclusionary factor, the student is not a student with a specific learning disability. The student does not meet general education expectations primarily because of (check all that apply):  FORMCHECKBOX  Environmental, cultural, or economic factors  FORMCHECKBOX  Limited English proficiency  FORMCHECKBOX  Lack of appropriate instruction in the identified area(s) of concern: oral expression, listening comprehension, written expression, basic reading skill, reading fluency skills, reading comprehension, mathematics calculation, or mathematics problem solving  FORMCHECKBOX  Other impairment (specify): Additional Considerations (complete whether or not an exclusionary factor applies)The IEP team considered:  FORMCHECKBOX  Data demonstrating, prior to or as part of the evaluation, the student was or was not provided appropriate instruction.  FORMCHECKBOX  Evidence the student received repeated assessments of achievement reflecting student progress.  FORMCHECKBOX  The students parent(s) were informed of such assessments. Additional Notes (if any): ADDITIONAL DOCUMENTATION REQUIRED WHEN STUDENT IS EVALUATED FOR SLD Relevant behavior noted during observations of the student in their learning environment including the regular education classroom and during intensive intervention, and the relationship of that behavior to the students academic functioning. Educationally relevant medical findings  FORMCHECKBOX  Yes, relevant medical findings, (specify):  FORMCHECKBOX  No relevant medical findings. SUMMARY of ELIGIBILITY CRITERIA CONSIDERATION List the area(s) of concern in the box below (e.g., reading fluency, math calculation, and reading comprehension). For each area of concern listed, check Yes or No to indicate. (1) Inadequate classroom achievement, (2) Insufficient progress, and (3) Exclusionary factors as a primary reason DO NOT apply. If all three are checked Yes for at least one area of concern, then the student meets eligibility criteria for SLD. Area(s) of Concern Considered (please list)Insufficient ProgressInadequate Classroom AchievementExclusionary Factors DO NOT apply FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  No FORMCHECKBOX  Yes  FORMCHECKBOX  NoIf there are more areas of concern, add rows to this chart  FORMCHECKBOX  The IEP team decision of whether the child has a specific learning disability was based on information from a variety of sources and not on any single measure or assessment as the sole criterion. Each IEP team participant must sign below and indicate whether they agrees with the conclusions regarding whether or not the child is a child with a specific learning disability. If this does not reflect their conclusions, then that IEP team participant must also attach a statement with their conclusions. 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