16 DART for Bilingual LD 2015 - Sharepoint
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This page is completed by the campus and comes from the referral packet. REFERRAL SOURCE: SPRING BRANCH INDEPENDENT SCHOOL DISTRICT Student Support Committee Referral Information Student: _____ DOB: ID#: ____ Grade: ____ Date: _________ School: _____________Teacher & Subject/Period: _____________________________ Conference Period: _____________ Identify the skill area in which the student is experiencing difficulty: READING: Phonics/Decoding Reading Fluency Vocabulary Reading Comprehension MATH: Math Computation Math Concepts WRITING: Writing Content Writing Mechanics SPEECH/LANGUAGE: Articulation Listening Comprehension Oral Expression Voice Fluency (stuttering) BEHAVIOR: Specific concern (i.e. off task, physical aggression) _________________________________________ OTHER: Specific concern (attendance, handwriting, etc) ____________________________________________ Describe the Current Problem: ________________________________________________________________________________________ Describe the Student’s Strengths: _____________________________________________________________________ Is this student currently receiving any special programs services? ____ Yes ___Bilingual ___ESL Home Language Survey: ___ Dyslexia English ____ No ___Other: __________________ *If student is receiving Special Education Services contact Diag. Spanish Other:___________ Is the student identified as Limited English Proficient? _______ Has this student received tutoring or intervention out of school for the academic deficit? YESNO If Yes, Describe: _____________________________________________________________________________________ Attendance/Continuity of Instruction: No. of Districts attended ______ No. of Schools attended _____ Private School: YES Attended School Outside TX? YES NO Where: _________________ Days Absent (this year) ______ Days Tardy (this year) ______ NO Name:__________ Home School? YESNO When? _____________ Has student been retained? No Yes: Grade:__________ Please explain any attendance or schooling situations that may impact learning: ___________________________________ Vision/Hearing/Health: Vision: Pass Does the student wear glasses? YES Fail Hearing: Pass Fail NO Identify any difficulties in Vision, Hearing, or Health that impact learning: __________________________________________ Environmental and Cultural Factors: Identify factors unique to this student’s environment that may impact learning: _____________________________________ Emotional/Behavioral Factors: Number of discipline referrals ________ Behavior Contract YES NO Identify any emotional or behavioral characteristics that may impact learning:______________________________________ 2/2015 Differentiated Classroom Practices Please indicate instructional strategies used in your classroom to help this student be more successful. DRA Level: _____, Subject EDL ________ Current Grade Language of Instruction Reading Language Arts Oral Language Writing Spelling Math Science Social Studies Conduct Please bring the referral folder with updated: Local and State Assessments Data printed from Eduphoria (including STAAR, RPTE, TELPAS), Work Samples showing area of strength and weakness, Anecdotal Records, PAPI, SRI, etc. Section IC: NORM-REFERENCED ACADEMIC ACHIEVEMENT DATA If using another achievement test, cut and paste appropriate chart. The Woodcock-Johnson-IV Tests of Oral Language: ENGLISH Standard Score Percentile Rank SPANISH ORAL Language Lenguaje ORAL Picture Vocabulary Oral Comprehension Vocabulario sobre dibujos Comprensión oral LISTENING COMPREHENSION Understanding Directions COMPRENSIÓN AUDITIVA Oral Comprehension Comprensión de indicaciones Comprensión oral ORAL LANGUAGE (Extended) LENGUAJE ORAL (Extendido) Standard Score Percentile Rank Cognitive Academic Language Proficiency Cognitive Academic Language Proficiency (CALP) levels describe how the student performs on language tasks when compared with others of the same age or grade. ENGLISH ORAL EXPRESSION LISTENING COMPREHENSION ORAL LANGUAGE (Extended) 2/2015 CALP Score Description Fluent Fluent SPANISH EXPRESIÓN ORAL COMPRENSIÓN AUDITIVA Fluent LENGUAJE ORAL (Extendido) CALP Score Description Fluent Fluent Fluent The Woodcock-Johnson-IV Tests of Oral Language and The Batería Woodcock-Muñoz pruebas de aprovechamiento – III were administered with the following results: WJ-IV Standard Score BASIC READING SKILLS Letter-Word Identification Identificación de letras y palabras Word Attack Análisis de palabras READING COMPREHENSION READING COMPREHENSION-EXTENDED Passage Comprehension Comprensión de textos Reading Recall Reading Vocabulary Vocabulario de lectura MATH CALCULATION SKILLS Calculation Cálculo Math Fact Fluency Fluidez en matemáticas MATH REASONING Applied Problems Problemas aplicados Number Matrices WRITTEN EXPRESSION Writing Samples Muestras de redacción Sentence Writing Fluency Fluidez en la escritura Reading Fluency Oral Reading Sentence Reading Fluency Writing Related Subtest Spelling Spelling of Sounds Phoneme-Grapheme Knowledge (Orthography) Word Attack Spelling of Sounds 2/2015 Bateria III Percentile Rank Standard Score Percentile Rank SECTION II: The data in this section will determine if the student demonstrates a pattern of cognitive strengths/assets and weaknesses/deficits. Consult your Cross Battery Book for subtests that will help you confirm a weakness when scores are not cohesive. Must have a second subtest in the same narrow ability as the low score. Test in a third narrow ability only when there is no other subtest to confirm the weakness. Test Name Cognitive Processing Area Standard Score Percentile Rank COMPREHENSION-KNOWLEDGE (Gc) WJ IV Bateria III General Verbal Information (KO) General Information Informacion General General Information WJ IV Bateria III Lexical Knowledge (VL) Oral Vocabulary Comprensión verbal Verbal Comprehension Test Name Cognitive Processing Area Standard Score Percentile Rank Standard Score Percentile Rank LONG-TERM RETRIEVAL (Glr) WJ IV Batería III WJ IV Batería III Batería III Test Name Associative Memory (MA) Visual-Auditory Learning Aprendizaje visual-auditivo Visual-Auditory Learning Meaningful Memory (MM) Story Recall (No comparable subtest in this narrow ability) Naming Facility (NA) Rapid Picture Naming (If needed for Basic Reading) Cognitive Processing Area VISUAL PROCESSING (Gv) (VISUAL-SPATIAL THINKING) WJ IV Batería III WJ IV Batería III Batería III 2/2015 Visual Memory (MV) Picture Recognition Reconocimiento de dibujos Picture Recognition Visualization (Vz) Visualization (No comparable subtest in this narrow ability) Spatial Relations (SR) Relaciones espaciales Spatial Relations Test Name Cognitive Processing Area Standard Score Percentile Rank AUDITORY PROCESSING (Ga) Phonetic Coding (PC) WJ IV Phonological Processing WJ IV Nonword Repetition Batería III TAPS Integración de sonidos Sound Blending Palabras Incompletas Incomplete Words Phonological Index TAPS Word Discrimination TAPS Phonological Segmentation TAPS Phonological Blending Batería III Test Name Cognitive Processing Area Standard Score Percentile Rank Standard Score Percentile Rank Standard Score Percentile Rank FLUID REASONING (Gf) WJ IV Batería III WJ IV Batería III Batería III Test Name Induction (I) Concept Formation Formación de conceptos Concept Formation Quantitative Reasoning (RQ) Number Series (No comparable subtest in this narrow ability) General Sequential Reasoning (RG) Análisis-Sintesis Analysis-Synthesis Cognitive Processing Area COGNITIVE PROCESSING SPEED (Gs) Perceptual Speed (P) WJ IV Letter-Pattern Matching WJ IV Pair Cancellation Batería III Pareo visual Visual Matching Pareo Cancelación Pair Cancellation Batería III Test Name Cognitive Processing Area SHORT-TERM WORKING MEMORY Working Memory (GWM) WJ IV Verbal Attention WJ IV Numbers Reversed Batería III Inversión de números Numbers Reversed Memory Span (MS) Batería III 2/2015 Memoria para palabras Memory for Words New Cross Battery pages including the WJ IV will help you see if there is an empirical relationship between the cognitive deficit and the achievement deficit. Bring these pages to DART ** Attach the optional worksheet pages for the specific area of eligibility to show the cognitive link to achievement. 2/2015 THIS SECTION IS TO BE COMPLETED AT THE REVIEW TEAM MEETING. Review of Information YES NO The student is able to satisfactorily meet age or state-approved grade-level standards. Low/failing grades in : reading writing math ELA Benchmarks not met : reading writing math ELA STAAR assessments failed: reading writing math DRA _________ science social studies ELA EDL ____________ SECTION V: DECISION Based on the data presented in this worksheet, the review team concludes that: YES NO Data is sufficient to determine LD in the area of: READING: MATH: WRITING: LANGUAGE: Basic Reading Skills (Decoding) Reading Fluency Math Calculation Math Problem Solving Written Expression Listening Comprehension Oral Expression Reading Comprehension YES NO Data is not sufficient to determine LD and the following additional data need to be collected: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ YES NO Data is sufficient to determine that an LD condition is not present: Does the student display a general/global cognitive weakness: YESNO or the absence of cognitive deficits: YESNO Evaluation Specialist for Case Presentation:______________________________ Date:__________________ Review Team Members: Name Position _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ 2/2015
