Referral For Spanish Evaluations
Aurora Public Schools
Do we have permission to test? Choose an item.

{MANDATORY PRIOR TO REFERRAL}
 Far Vision & Hearing:

These screenings need to be updated within the most recent 12 months before conducting any formal/standardized assessments. If
the hearing screening was not passed, do a sound booth assessment before conducting any formal/standardized assessments.
Far vision screening date: Click here to enter a date. Results: Choose an item. Needs far vision aid: Choose an item.
Hearing screening date: Click here to enter a date. Results: Choose an item. Needs hearing aid: Choose an item.
 Near Vision:
It should be screened at least one time in a student’s academic career before conducting any formal/standardized assessments. (In
APS, all first graders are routinely screened for near vision acuity.) If the school team has any concerns about a student (squinting,
holding materials extremely close, complaints, or other unusual observations) the school nurse should be notified and should
provide further evaluation before the school team conducts formal/standardized assessments.
Near vision screening date: Click here to enter a date. Results: Choose an item. Needs near vision aid: Choose an item.
 WIDA ACCESS most recent language proficiency levels:
The cutoff for bilingual referrals is level 4 or under for Oral Language composite.
Listening: Choose an item. Speaking: Choose an item. Reading: Choose an item. Writing: Choose an item.
Oral Language: Choose an item. Comprehension: Choose an item. Literacy: Choose an item.
Overall: Choose an item.
{If the student is in Kinder, provide ACCESS Placement scores: Click here to enter text.}
 RtI/IST Process:
How many weeks of ACHIEVEMENT RtI/IST have been completed? Choose an item.
How many weeks of BEHAVIOR RtI/IST have been completed? Choose an item.
Student’s and school team’s identifiable information:
Student: Click here to enter text.
Grade: Choose an item.
DOB: Click here to enter a date.
School: Choose an item.
Classroom teacher: Click here to enter text.
Provide the following daily time-frames in order to help us scheduling: At what time do these occur?
School: Click here to enter text. Lunch/Recess: Click here to enter text.
Specials: Click here to enter text. ELD Block: Click here to enter text.
School Nurse: Click here to enter text. Case manager: Click here to enter text. Title: Choose an item.
Person referring: Click here to enter text. Title: Choose an item. Phone # and/or Ext.: Click here to enter text.
Current SpEd label (if any) = Primary: Choose an item. Secondary: Click here to enter text.
Current placement (LRE or Program): Choose an item.
SpEd services currently receiving:
Speech-Language
Math services
Audiology
OT
Reading services
Hearing services
PT
Writing services
Mental Health
Oral expression
Vision services
Listening comprehension
Adaptive PE
Assistive Technology
Suspected dominant language: Choose an item. Home language: Choose an item.
Years of US education: Choose an item. Choose an item.
How does this student’s achievement compare to other ELLs?: Choose an item.
Referral and Meeting details:
Type of referral: Choose an item.
How many weeks before the IST/IEP meeting date was the referral sent (please, estimate)?: Choose an item.
IST/IEP meeting - Date: Click here to enter a date. Time: Click here to enter text.Choose an item.
Bilingual service/s requested:
SLP 
Parent/Guardian interview (please, explain):
Click here to enter text.
Articulation
Receptive language
Language sample
Fluency
Expressive language
Functional Communication Skills
PSYC. 
Parent/Guardian interview (please, explain):
Language dominance
Adaptive (V-II or ABAS-II)
Speech-language Screening
Click here to enter text.
Socio-emotional (BASC-2)
Cognitive
Achievement
Observation
Reason/s for bilingual evaluation referral:
Rule out ID
Rule out SLD
Rule out SLI
Updating data
Incomplete record
Questioning current label
Questioning former scores
Parental request
Limited progress during RtI
Rule out SED
Direct Placement not accepted
Change disability
Assess Speech/Language
Discern ELL issue vs. True disability
Other (specify):
Click here to enter text.
If you want to add additional information in order to help us during the bilingual assessment and team consultation
process, we invite you to write it here: Click here to enter text.
Send to BILINGUAL ASSESSMENT TEAM via email: Office at Paris Elementary (Phone): 303-341-1702 x 23425
*Lynn Padilla, M.A. (Speech-Language Pathologist) lrpadilla@aps.k12.co.us
*Cameran M. Jewell, M.S., Ed.S. (School Psychologist) cmjewell@aps.k12.co.us
BILINGUAL TEAM USE ONLY
Date received by bilingual professional: Click here to enter a date.
Case/Meeting Details:
 Referral continued as a case
 Referral ended up as Consultation/Education only
IST/IEP Meeting attendance:  Yes  No
How many IST/IEP meetings did you attend for this case?: Choose an item.
Student’s Language Use:  Not Evaluated (Mark if not assessed during current school year by any bilingual professional.)
 Spanish Receptive Language Dominant
 Spanish Expressive Language Dominant
 English Receptive Language Dominant
 English Expressive Language Dominant
 No Receptive Language Dominance
 No Expressive Language Dominance
IST/IEP Meeting results:
 Continue in GenEd (student was not staffed-in)
 Student Staffed-In
 Continue Current RtI
 Student Referred for SpEd Evaluation
 Student Staffed-Out
 Start Additional RtI
 Student Referred for Additional Testing
 Add Secondary Disability
 Start Behavior RtI
 Continue Current SpEd Services
 Changed Disability
 Start Achievement RtI
 Add Some SpEd Services
 Changed Placement
 Eliminate Some SpEd Services
 Increase SpEd Services’ Time
 Other (explain): __________________________________________________________________________________________
Bilingual SLP assessment tools used:
 CELF-4 Spanish (Ages 5-8)
 ROWPVT Spanish-Bilingual
 PPVT
 CELF-4 Spanish (Ages 9-21)
 EOWPVT Spanish-Bilingual
 SAM
 CELF-P-2 Spanish
 SLAP Language
 GFTA
 PLS-5 Screener
 SLAP Articulation Measure
 EVT-2
 PLS-5 Articulation Screener
 Language Sample Analysis
 TOLD
 PLS-5 Bilingual
 Speech-Language Screening
 Language Dominance Screening
 Parent/Guardian Interview
 Parent/Guardian Bilingual Questionnaire  Other (explain): ________________
Bilingual PSYC. assessment tools used:
 Language Dominance Screening
 BRIEF
 SB-5
 WM-III-COG
 Parent/Guardian Lang.Dom.Q.
 KABC-II
 Bayley-III
 WJ-III-COG
 WMLS-R NU
 DAS-II-Spanish
 TPBA
 WM-III-ACH
 Vineland-II
 WISC-IV-Spanish
 HELP
 BASC-2
 ABAS-II
 WISC-IV-English
 Parent/Guardian Interview
 Observation
 Other (explain): _________________