Word format - Graves County Schools

Graves County Schools
Planning form for Initial and Re-evaluation of Orthopedically Impaired
Do not use this form for folder review.
Student name __________________________ Date of birth ___________ Age _____
Parent name and address ________________________________________________
School _________________________ Teacher ___________________ Grade ______
Initial evaluations must have all of the following data:
_____ TAT data including:
Scientific researched based interventions (specific to the disability strategies with multiple pre/post assessments
before and after interventions in all problem areas) documented/dated from multiple sources
Data collected (grades, attendance, behavior logs, CTBS, KCCT if available)
Team recommendations in summary form from TAT meeting
_____ Screening results summarized
_____ Referral packet including:
Committee must have an educationally relevant Medical Statement with disability listed specific to the academic
problem student is experiencing before referring.
Referral with suspected disability stated
Permission to evaluate
Evaluation planning form with suspected disability stated
Social and developmental history
Re-Evaluations need only the data listed below:
Person responsible
____ Vision and hearing screening (current within a year)
School nurse/SLP
____ Previous assessment info if not completed in district
Special Ed. Staff
____ Updated social and developmental history (if re-eval)
Parent interview in ARC
____ Language evaluation (if applicable)
____ Behavior Observation (2) (any academic area of concern)
Special Ed. Staff
____ Adaptive Behavior Scale (choose 1) ABAS-2 or SIB-R
____ Individual academic achievement test(s)
School Psychometrist
____ Learning Styles Inventory (if not already completed)
____ Vocational Inventory (14 years and older)
____ Transition Assessments (interviews, surveys, interest inventories) Teacher
(14 years or older)
____ Other evaluations as needed (OT, PT, Intelligence)
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