St. Lucie Public Schools
Specific Learning Disabilities Multidisciplinary Group Analysis Summary
Student Name:
ID#:
AYP Subgroup(s):
School:
Grade:
Retention History:
Meeting Date ___/___/___
Identified area(s) of Concern:
Please refer to the psycho-educational report dated
____/____/_____ for all observational data, educationally
relevant medical findings, and diagnostic assessment results.
OBSERVATIONAL DATA:
Behavioral observations
Relationship to academic functioning
EDUCATIONALLY RELEVANT MEDICAL FINDINGS
DIAGNOSTIC ASSESSMENT RESULTS
Page _____
Page _____
Page _____
Parent Involvement Checklist (enter pertinent dates)
Parent notification of intervention activities was provided to parent on:
Parent conference(s) was/were held on: ____ /____ /____
Response to Intervention Summary
Instruction/Intervention
Core
(Tier I)
Delivered By
Tier 2 ____ / ____ / _____
____ /____ /____
Tier 3 ____ / ____ / _____
____ / ____ / _____
Duration/Frequency
____ / ____ / ____
Fidelity/Support
+
Response
?
-
Targeted
(Tier II)
Intensive
(Tier III)
Analysis of Response to Intervention Data (Attach all supporting data and graphs)
1. Performance Discrepancy (level or performance pre and post intervention)
Instrument
Date
Student
Class
School
District
2.
Rate of Progress (Attach documentation/graphs)
3.
Statement of need for specialized instruction:
State
AYP grp____
AYP grp ____
AYP grp ____
Specific Learning Disabilities Multidisciplinary Group Analysis Summary
(p.2)
Consideration of Exclusionary Factors Determine whether level of performance and rate of progress are primarily the result of any of the
following. Attach documentation that supports the groups’ conclusion for each.
 Yes  No
Visual, hearing, or motor disability
 Yes  No
Intellectual Disability
 Yes  No
Emotional/Behavioral Disability
 Yes  No
Irregular pattern of attendance or high mobility rate
 Yes  No
Cultural Factors
 Yes  No
Environmental or economic factors
 Yes  No
Classroom behavior
 Yes  No
Limited English Proficiency
Summary of eligibility criteria for a Specific Learning Disability
 Yes  No
Student has been provided intervention and does not achieve adequately for age or does not meet grade-level standards in one
or more of the following areas (Check all that apply):
Basic Reading Skills
Reading fluency skills
Reading Comprehension Written expression
Mathematics calculation Mathematics problem solving Oral Comprehension
Listening Comprehension
 Yes  No
Student does not make adequate progress based on response to intervention.
 Yes  No
The student’s progress is not primarily the result of any of the exclusionary factors or lack of appropriate instruction.
 Yes  No
The student needs interventions that differ significantly in intensity and duration from what can be provided through general
education resources alone.
 Yes  No
All four questions above are answered “YES” and the team has determined that the student demonstrated evidence for specific
learning disability.
This report reflects the conclusion of the following team member(s). If this report does not reflect the conclusion of the member(s), a separate
report must be filed by any team member who is not in agreement.
Title
Printed Name
Signature
Yes (√)
No (√)
ESE Administrator/Designee
School Counselor
School Psychologist
Speech/Language Pathologist
ESE Teacher
General Education Teacher
Parent
Parent
Other
Other
Other
Other
Other
Original: ESE Audit File
Copy to: Parent/Adult Student
XED0079
Rev 7/11/12