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SPECIFIC LEARNING DISABILITY ELIGIBILITY SUMMARY
Using a Pattern of Strengths and Weaknesses (PSW) Model
Ventura County SELPA IEP
Student Name : .Click
here to enter text.
D.O.B.:Click
here to enter a date.
Meeting Date: Click
here to enter a date.
DIRECTIONS: For use by Ventura County SELPA approved RtI2 PSW pilot programs, to be used the first time a student is assessed for consideration as
having a specific learning disability.
1.
Yes
No
The student did not make sufficient progress in one or more of the following areas identified below based on the student’s response to standards and research-based instruction and
intervention (R t I 2 ) as documented by ongoing progress monitoring at reasonable intervals:
2.
Yes
reading comprehension
oral expression
mathematics reasoning/problem solving
basic reading skills
listening comprehension
mathematics calculation
reading fluency skills
written expression
No The student has not achieved adequately (assessed at 10th percentile or below) to meet state standards in one or more areas, when provided with learning experiences and instruction appropriate for
the student’s age and/or grade level standards:
Standardized Academic Achievement Test Administered:Click
Subtest:
3.
Yes
No
Click here to enter text.
here to enter text.
Standard Score: Click here to enter text.
Percentile Rank:Click
here to enter text.
The student exhibits a pattern of strengths and weaknesses in performance, achievement or both, relative to the student’s age, state approved grade level standards, or intellectual
development:
Psychological processing measures indicating average ability:
Test/Subtest:
Click here to enter text.
Standard Score:Click
here to enter text.
Percentile Rank: Click
(>25th percentile)
here to enter text.
Percentile Rank: Click
(<10th percentile)
here to enter text.
Psychological processing measures related to the academic weakness:
Test/Subtest:
Click here to enter text.
Standard Score:
Click here to enter text.
4. If standardized tests do not reveal a pattern of strengths and weaknesses, do other data sources reveal this pattern?)
Yes
No (If yes, attach the Collective Team Report form.)
5. If any of the items below (A-G) are checked “Yes,” the student may not be identified as having a specific learning disability.
A.
B.
C.
D.
E.
F.
G.
Lack of progress is due primarily to limited school experience or poor school attendance.
Lack of progress is due primarily to environmental or cultural difference or economic disadvantage.
Lack of progress is due primarily to intellectual disabilities or emotional disturbance.
Lack of progress is due primarily to a visual, hearing, or motor disability.
Lack of progress can be corrected through other regular or categorical services offered within the regular instructional program.
Lack of progress is due to limited English proficiency.
Lack of progress is due to lack of appropriate instruction in reading and/or math.
The IEP team concludes that the student meets eligibility for Specific Learning Disability under the Pattern of Strengths and Weaknesses model.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
No
Signatures on this IEP signify agreement with the findings with respect to eligibility under Specific Learning Disability, unless a minority opinion is attached.
March 2011