Autism Eligibility Checklist
I.
Evaluations and Assessments
All 5 questions below MUST be answered yes as required by state criteria.
1. Yes or No - Was a comprehensive psychological evaluation completed that included assessment of intellectual
functioning and adaptive behavior?
2. Yes or No – Was an educational evaluation completed to include an assessment of educational performance
and current functioning levels?
3. Yes or No – Was a communication evaluation completed to include assessment of verbal and non-verbal
communication, prosody, and pragmatic language utilizing both formal and informal measures?
4. Yes or No – Were behavioral evaluations completed to include assessment of social interaction and
participation, peer and adult interactions, capacity to relate to others, stereotypical behaviors, resistance to
change, atypical responses to sensory stimuli, persistent preoccupation with or attachment to objects or other
behaviors often associated with autism?
5. Yes or No – Was the developmental history assessed to include developmental differences and delays and age
of onset, which is typically before the age of three?
II. Eligibility
All 3 questions/characteristics below MUST be answered yes as required by state criteria.
1. Yes or No – Developmental Rates and Sequences – Does the student exhibit delays, arrests, and or
inconsistencies in the acquisition of motor, sensory, social, cognitive, or communication skills?
a. Indicate which area or areas the student has delays, arrests, or inconsistencies – motor, sensory, social,
cognitive, or communication skills? _____________________________
2. Yes or No - Social Interaction and Participation – Does the student display difficulties and/or idiosyncratic
differences in interacting with people and participating in events?
3. Yes or No – Communication (verbal and/or non-verbal) – Does the student display a basic deficit in the
capacity to use verbal language for social communication, both receptively and expressively?
* Other areas that may be affected but NOT required for eligibility
a. Yes or No – Sensory processing – Does the student exhibit unusual, repetitive, or unconventional
responses to sensory stimuli of any kind?
b. Yes or No – Repertoire of activities and interests – Does the student engage in repetitive activities and/or
display marked distress over changes, insist on following routines and a have a persistent preoccupation
with or attachment to objects?
III. Other Considerations:
1. Yes or No – Does the student have emotional disturbance that should be considered as a determinant factor
impacting the student’s educational performance?
a. If yes, the student MAY NOT eligible for Autism.
2. Yes or No – Are there exclusionary factors that need to be considered prior to eligibility determination?
a. If yes, the student MAY NOT be eligible for Autism.
IV. Educational Performance (academic, behavioral, and functional)
1. Yes or No – Does the disability adversely affect the educational performance, and specially designed instruction
is needed?
a) If yes, indicate how the educational performance is adversely affected - ________________________
__________________________________________________________________________________
b) If no, the student is NOT eligible for Autism
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