August 2013
Edgefield County School District
Office of Exceptional Children
Evaluation/Reevaluation Plan and Prior Written Notice
Student’s Full Name _____________________________________ Date ________________________
Is the student currently receiving special education services? __________________________________
I. Review of existing information – Listed below is each evaluation procedure, assessment, record, or report this
team has reviewed and used in determining whether additional information is necessary.
___ English proficiency
___ Grades
___ Work samples
___ Local and state assessments
___ Classroom-based assessments
___ Attendance record
___ Educational history
___ Demographic, developmental, medical history
___ Medical records
___ Vision screening
___ Hearing screening
___ Speech-language screening
___ Discipline record
___ Behavior log/Anecdotal records
___ Functional behavior assessment
___ Observations
___ Interviews
___ Documentation of interventions
___ 504 Plan
___ Individualized Education Program
___ Individualized Family Service Plan
___ Existing evaluations
___ Other parental input_________________________________________________________________
_____________________________________________________________________________________
___ Other_____________________________________________________________________________
___ Other_____________________________________________________________________________
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August 2013
II. Determination of need for additional information - After reviewing existing information, team members
have determined that: (check only one)
(a) Additional information is needed in order to determine the child’s educational needs and whether the
child is a child with a disability (Initial Eval to be done)
(b) Additional information is needed; the IEP Team believes the student continues to meet eligibility for the
current disability and does not suspect an additional disability. (??)
(c) Additional information is needed in order to determine (Reeval to be done)
- if the student continues to have a disability or to need special education and/or related services and/or
- the present levels of performance and educational needs of the student and/or
- if any additions or modifications to special education and/or related services are needed to enable the student
to meet the annual goals set forth in the IEP and to participate, as appropriate, in the general curriculum.
(d) No additional information is needed. The student continues to have a disability and needs special
education and/or related services. (No reeval needed, continue current placement)
(e) No additional information is needed. The student continues to have a disability but no longer needs
special education and/or related services. (No reeval needed; discontinue special and related services)
(f) The student has attained an optimal level of proficiency in the Speech Language Program and is being
dismissed. (No reeval needed; speech dismissal)
If (a), (b) or (c) is checked, proceed to Section III (Prior Written Notice of the Evaluation/Reevaluation).
III. Description/explanation of proposed action – The school district proposes to conduct an individual
evaluation/reevaluation of this student. The purpose of the evaluation is: (PWN Description of the action proposed
& why)
to determine the child’s educational needs and whether the child is a child with a disability (Initial Eval)
to gather additional information; the IEP Team believes the student continues to meet eligibility for the
current disability and does not suspect an additional disability. (Must be a reason it’s on Aiken County form??)
to determine (Reeval to be done)
if the student continues to have a disability or to need special education and/or related services and/or
the present levels of performance and educational needs of the student and/or
if any additions or modifications to special education and/or related services are needed to enable the
student to meet the annual goals set forth in the IEP and to participate, as appropriate, in the general
curriculum.
IV. Description of any other actions or choices the team considered and the reasons why those choices were
rejected: (PWN Options considered)
(e.g. The team considered not evaluating/reevaluating. Student is currently identified as a student with
Developmental Delay. More information is needed to determine if more age appropriate disability is present.)
___________________________________________________________________________________________
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August 2013
V. Description of other reasons why the school district proposes to conduct an evaluation: (PWN Description of
other factors)
___________________________________________________________________________________________
___________________________________________________________________________________________
VI. Additional Information Needed / Evaluation Plan (PWN Description of evaluation procedure)
Need
Evaluation Component / Area of Evaluation
Title of Team Member
Responsible for
Obtaining
School Records:
Demographic, health, developmental
and education history
Documentation or assessment of English language proficiency:
Medical records:
Parent/Caregiver
Psychologist
Existing evaluations:
Observation:
Classroom Observation
Interview:
Psychologist
Vision Screening
Hearing Screening
Speech-language screening
Documentation of academic interventions and results of progress monitoring:
Functional behavioral assessment (determining what causes or maintains a
behavior)
Behavior log/Anecdotal records:
Documentation of behavioral interventions and results of progress monitoring:
Comprehensive developmental evaluation(cognition, communication, motor,
activities of daily living, social/emotional maturity)
Intelligence assessment(problem solving and processing)
Adaptive behavior assessment (personal and functional skills necessary for
independence)
Behavior rating scales (social, emotional, behavioral functioning):
Personality measure
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Speech Therapist
Psychologist
Psychologist
Psychologist
August 2013
Preacademic, academic, or functional academic achievement OR
developmental skills assessment Areas: __Preacademic skills, __Functional
academic skills, __Developmental skills assessment, __Oral expression, __Listening
comprehension, __Written expression, __Basic reading skills, __Reading fluency skills,
__Reading comprehension, __Mathematics calculation, __Mathematics problem
solving, __Other:
Autism rating scale
Written report of audiological evaluation
Medical history documenting chronic middle ear infection
Receptive and expressive communication skills in preferred mode
Written report of visual examination
Functional vision (use of vision in environment)
Literacy media and braille skills
Vision specific skills (developmental vision skills )
Functional communication (communication skills in the school setting)
Oral peripheral examination (structure and function of mouth)
Articulation (production of sounds)
Language (receptive, expressive, social)
Speech fluency (rhythm, rate, fluency)
Voice (pitch, intensity, quality, resonance)
Language pragmatics (language in social situations)
Documentation of physical functioning (for TBI)
Behavior assessment (for TBI)
Visual motor skills
Assessment of language processing and use, memory, attention, reasoning,
abstract thinking , judgment, problem-solving skills, auditory perception, visual
perception (for TBI)
Fine motor skills (small muscle movements)
Sensory functioning (processing information from the environment taken in by
the senses)
Self-care skills
Gross motor skills
Assessment of communication, adaptive, and social skills to determine need for
applied behavior therapy or social behavior therapy
Hearing teacher
Vision teacher
Vision teacher
Vision teacher
Speech therapist
Speech therapist
Speech therapist
Speech therapist
Speech therapist
Speech therapist
Speech therapist
Psychologist and
Speech therapist
Occupational therapist
Occupational therapist
Occupational therapist
Physical therapist
VII. Evaluation Schedule (check only one)
This is an initial evaluation and will be completed within 60 days of receipt of written parental consent to
evaluate.
This is an evaluation for transition from Part C to Part B and will be completed prior to the child’s third
birthday.
This is a reevaluation. The team has decided that the evaluation will be completed by _________________.
Date
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August 2013
VIII. Special Notices to the Parent / Guardian / Student (if age of majority):
1. You have the right to present other information to be considered by the team in planning the evaluation
and/or determining eligibility for special education.
2. If you would like a further explanation or description of the evaluation components, please contact the Office
of Exceptional Children at 803-275-4601.
TEAM MEMBERS
Signature
Position
Date
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Distribution:
Original - District office
Copies - Parent/legal guardian/adult student, all team members who will be actively participating in gathering
evaluation components
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