Española Public Schools
Special Education Department
Española, New Mexico 87532
Consent For Special Education Evaluation
Student’s Name:
Date of Birth:
Student Number:
School:
Written Prior Notice for Free Appropriate Public Education
We are proposing to evaluate/re-evaluate this student to determine if he/she has a disability that adversely affects education
performance and requires special education and related services under the Individuals with disabilities Education Act (IDEA). We
are proposing this evaluation because there are concerns about the student’s educational progress. Although there may have
been interventions implemented, concerns about his/her progress continue. These concerns form the basis of this decision. You
have protection under the Procedural Safeguards, a copy of which is included in this notice. If you have any questions regarding
this notice or your Procedural Safeguards, contact the Special Education Director at 505-367-3321.
Your child was referred for a Special Education evaluation for the following reason:
Student Assistance Team (SAT)
3-Year Re-Evaluation
IEP Team meeting
Other
One or more professionals, specializing in diagnosis, will select and administer specific tests and evaluation procedures
related to the areas of concern. These procedures may include but are not limited to measures of the following. An
explanation of each type of assessment is on the back.
Cognitive
Academics
Math
Written Language
OT
Reading
RT
SLP:
Articulation
Fluency
Voice
Language
Receptive Language
Psychological
Expressive
Assistive Technology/AAC
PT
Other
I hereby certify that I have been advised of and have received a copy of “Parent and Child Rights in
Special Education.” I hereby certify that the possible assessments administered were explained to me.
_____ I agree to have my child undergo an individual evaluation to determine initial or continued eligibility for
Special Education Services.
_____ I do not agree to have my child undergo an individual evaluation.
_______________________________________
Parent Signature
__________________________________
Date
_______________________________________
Diagnostician/Evaluator/Witness
__________________________________
Date
EPS CONSENT FOR EVALUATION
Revised 10/2014
Following a discussion with school personnel acquainted with my child, I authorize the use of
school educational diagnosis to aid in the planning and to assist in the guidance of my child. I
understand that this evaluation may include administration of the following assessments:
 Standard Educational Diagnostic Battery – the standard educational diagnostic
battery includes a cognitive and an achievement assessment. Depending on the
results of the assessment, the diagnostician might determine that additional
assessments are needed to determine the extent of the disability and supports
needed to access the classroom curriculum. The assessments are conducted by a
licensed diagnostician and might include:
 Cognitive tests —designed to measure learning ability or intellectual
capacity (IQ), learning and thinking skills associated with mental ability,
processing and memory speed, short-term memory, and other abilities that
impact schooling.
 Achievement assessments —assesses present levels in reading, math,
language, etc., mastery of skills and knowledge acquired in school,
 Assessments to determine if dyslexia exists
 Visual-motor integration tests—checks coordination, balance, eye
movement, eye-to- hand coordination, form recognition, and visual memory
 Classroom observation—a trained professional observes behavior in natural
settings and records or classifies each behavior objectively as it occurs
 Adaptive behavior assessment— assesses the student’s level of selfsufficiency and social responsibility in a number of domains, including (a)
independent functioning, (b) physical development, (c) economic activity,
(d) language development, (e) numbers and time, (f) vocational activity, (g)
self-direction, (h) responsibility, and (i) socialization.
 Behavior and psychological assessment—tests how the child feels, reacts, and
adapts to different social environments and situations; assesses social skills.
 Auditory processing—checks speed and accuracy of processing what is heard,
ability to recall detail and order, and association of sounds and symbols.
 Speech and language assessment—assesses symbolic communication in speech,
language, or hearing, including articulation disorder, language disorder, and voice
disorder.
 OT evaluation—assesses the ability to use and manipulate small muscle groups,
primarily the hands, which affect activities such as drawing and writing
 PT evaluation— assesses the ability to use and manipulate large muscles that affect
activities such running and throwing; assesses body control, balance, and
coordination
 Audiology evaluation— determines the presence and/or degree of hearing loss and
the selection and fitting of hearing aids
 Functional Vision Assessment (FVA) – determines the presence and/or degree of
visual loss and the need for vision supports
 Assistive Technology/AAC – determines the need for technology devices to support
the student access classroom instruction and/or communication support
 (other)____________________________________________________________________________
Parent Signature: ______________________________________ Date: _______________________
EPS CONSENT FOR EVALUATION
Revised 10/2014