Graves County Schools
Planning form for Initial and Re-evaluation of Orthopedically Impaired
Do not use this form for folder review.
Student name __________________________ Date of birth ___________ Age _____
Parent name and address ________________________________________________
School _________________________ Teacher ___________________ Grade ______
Initial evaluations must have all of the following data:
_____ TAT data including:

Scientific researched based interventions (specific to the disability strategies with multiple pre/post assessments
before and after interventions in all problem areas) documented/dated from multiple sources

Data collected (grades, attendance, behavior logs, CTBS, KCCT if available)

Team recommendations in summary form from TAT meeting
_____ Screening results summarized
_____ Referral packet including:

Committee must have an educationally relevant Medical Statement with disability listed specific to the academic
problem student is experiencing before referring.

Referral with suspected disability stated

Permission to evaluate

Evaluation planning form with suspected disability stated

Social and developmental history
Re-Evaluations need only the data listed below:
Date
Evaluation
Person responsible
____ Vision and hearing screening (current within a year)
School nurse/SLP
____ Previous assessment info if not completed in district
Special Ed. Staff
____ Updated social and developmental history (if re-eval)
Parent interview in ARC
____ Language evaluation (if applicable)
SLP
____ Behavior Observation (2) (any academic area of concern)
Special Ed. Staff
____ Adaptive Behavior Scale (choose 1) ABAS-2 or SIB-R
Teacher
____ Individual academic achievement test(s)
School Psychometrist
____ Learning Styles Inventory (if not already completed)
____ Vocational Inventory (14 years and older)
Teacher
____ Transition Assessments (interviews, surveys, interest inventories) Teacher
(14 years or older)
____ Other evaluations as needed (OT, PT, Intelligence)