Revised 10/17/07
The following elements are required for each section of initial LD Eligibility Reports. If information is missing, or questions are unanswered, the team is not ready to make an eligibility determination.
Section 1: Background Information

Reason for the referral (state areas of concern and disability/disabilities suspected)

Previous testing

History in special programs (special education, Title I,
ELL)

Parent concerns and perspective, including background of disabilities, especially in areas related to current difficulties
Section 2: Students who qualify for special education as having learning disabilities have very low skills relative to expectations for the student’s age, or relative to the student’s progress toward Oregon achievement.
Source(s)

Cumulative file

Individual Problem Solving Worksheet

Report cards

Developmental history
Source(s)

Review of existing information including teacher collected work samples

List Oregon Assessment of Knowledge & Skills
(OAKS) scores, both current and historical

List all DIBELS subtest scores (both current and
Required in area of concern (K-3)
Reading

DIBELS


Phonics Inventory
WIAT-II: Listening Comprehension historical) o o
Insert DIBELS or IDEL tables (at end of checklist)
Summarize actual growth to expected growth and
Math

CBMs

WIAT-II: Numerical Operations &
 o student scores to average scores
List individual achievement test results in standard scores by subtest
Include standard scores for tests given in the past
Mathematics Reasoning
Writing

Writing and/or Spelling CBMs

WIAT-II: Written Expression or o For any subtests with SS below 90, describe the TOWL-III specific skill deficits that contribute to the low score o List classroom assessment scores and curriculum Optional in area of concern (K-3)
 based measures (includes pre- and post-tests, math and writing CBMs)
Analyze historical data.
Reading

WIAT-II: Pseudoword Decoding,
Word Reading, Reading
- Have scores always been low? Comprehension o If not, a learning disability is unlikely. Writing
- Are scores relatively low? o If not, get one more piece of information about the

WIAT-II: Spelling o Has the student had intensive assistance to maintain skills at that level?
Required in area of concern (4-5)
Reading achievement tests consistent? 
DIBELS

WIAT-II: Reading Comprehension skills in question.
 o Confirm results with reports from teachers, which must be consistent.
If inconsistent results are reported, decide which is
Math

CBMs

WIAT-II: Numerical Operations &

Revised 10/17/07 valid and justify the decision. o Consider the demands of each assessment
(content, speed, fluency) o Lower scores may be considered valid if they reflect performance on a test that is more comprehensive or involves more complex demands than other assessments used.

Finish with a summary statement about the stude nt’s low skills. o Describe the student’s academic weaknesses. o Note if the significant skill deficits combine with strengths to form a pattern of achievement that has been demonstrated to be associated with an LD subgroup. Strengths should be informally assessed by reviewing report cards and work samples. If gathered information is inconclusive, conduct curriculum based measures in potential areas of strength.
1) Reading Disability: Word Recognition o Weaknesses: phonological processing, spelling o Strengths: math computation, spatial and motor skills
2) Reading Disability: Fluency o Weaknesses: fluency o Strengths: word recognition
3) Reading Disability: Comprehension o Weaknesses: vocabulary, receptive language, working memory, attention o Strengths: phonological processing
4) Math Disability o Weaknesses: math computation, attention, working memory, motor and spatial skills o Strengths: word recognition, spelling, vocabulary
5) Written Expression Disability o Weaknesses: handwriting, spelling, composition o Strengths: math computation
Mathematics Reasoning
Writing

Writing and/or Spelling CBMs

WIAT-II: Written Expression or
TOWL-III

Two scored writing samples using
Oregon rubric
Optional in area of concern (4-5)
Reading

WIAT-II: Listening Comprehension
Writing

WIAT-II: Spelling
Required in area of concern (6-12)
Reading

CBMs

WIAT-II: Pseudoword Decoding,
Word Reading, Reading
Comprehension
Math

CBMs

WIAT-II: Numerical Operations &
Mathematics Reasoning
Writing

Writing and/or Spelling CBMs

WIAT-II: Written Expression or
TOWL-III

Two scored writing samples using
Oregon rubric
Optional in area of concern (6-12)
Writing

WIAT-II: Spelling

Cumulative file

Individual Problem Solving Worksheet

Report cards

Work samples

Teacher reports

State/District Assessment Results

Individual Achievement Test Results

Revised 10/17/07
Section 3: Students with learning disabilities have academic skill deficits that are resistant to wellplanned and implemented research based interventions that were designed to increase the child’s rate of learning.

State what the baseline skill level was (a number), and how that relates to the general population.

State what the interventions were and the basis upon which they were chosen. Include: o Specific curriculum/method used o How much time per day o Length of intervention o Group size o Level and type of reinforcement used o If needed, additional behavior interventions
 Describe the student’s response to the intervention
(progress monitoring data, including the measure and frequency). o How does this relate to the general population? o How does this relate to progress of intervention cohort?

Does this progress support a picture of a skill deficit that is resistant to instruction?
Section 4: The student’s academic performance and behavior were observed in a regular classroom setting.

Observation must occur in area of concern

Note relevant behavior and its relationship to academic functioning
Section 5: The student has been provided the opportunity to learn the skills.

Document the level of instructional stability throughout the student’s educational experience o Mobility (# of schools attended) o Attendance (over the years) o Reason(s) for excessive absences o Cumulative effect of absences (“Missed 20 days per year for 4 year, equating to one semester missed”)

Describe key characteristics of the core instruction the student has received in area of concern o Research based? Mention specific curricula, if known. o Has the student received instruction in phonemic awareness, phonics, fluency, comprehension and vocabulary? o Amount/intensity? o Training of instructor (certified? IA?) o Size of group
Source(s)

Progress monitoring data

Student Intervention Profile

Information from interventionist
Source(s)

Observation data
Source(s)

Cumulative file

Individual Problem Solving Worksheet

Student Intervention Profile

Developmental history

Report cards

Teacher interviews

Revised 10/17/07
Section 6: The student does not have another disability or sensory problem.

Report results of current vision and hearing screenings.

Report historical difficulties with vision and hearing as reported by parent (infections, tubes, surgeries)

Have there ever been suspicions of other disabilities?
Consider: o Attention-Deficit/Hyperactivity Disorder o Autism Spectrum Disorder o Other Health Impairment o Communication o Emotional Disturbance o Mental Retardation

Report results of evaluations done regarding any areas of concern raised at the time of referral or during the evaluation. This is the place to explain, if you decided not to assess those areas, why you didn’t.

This is the section to report results of functional behavior assessments, Conners scales, language assessments, etc.

If an IQ test was given, this is the place to note statistically unusual performance.
Section 7:
The student’s problem is not the result of cultural factors or environmental or economic disadvantage.
 Describe the student’s school history starting with preschool.

Describe pertinent information about family literacy levels.
 Describe pertinent information about the family’s social history that could account for stressors, such as: o Frequent moves o Homelessness o Divorce o Unemployment o Extended illnesses or deaths in the family
Section 8: The student’s problem is not the result of limited English proficiency.
 Identify the student’s primary and secondary languages.

Report current levels of: o Primary Language Oral Proficiency o Primary Language Writing Proficiency o Primary Language Reading Proficiency o English Oral Proficiency o English Writing Proficiency o English Reading Proficiency o Acculturation Screening Results

How many years has the student lived in the US?
And

What is the home language?
And
Source(s)

Cumulative file

Individual Problem Solving Worksheet

Developmental History

Report cards

Teacher interviews

Assessment results

Minutes of Evaluation Planning

Medical Statement
Source(s)

Cumulative file

Individual Problem Solving Worksheet

Developmental History
Source(s)

Cumulative file

Individual Problem Solving Worksheet

Parent Interview

LAS scores

Acculturation Screening

Revised 10/17/07
 What is the parents’ literacy proficiency?
And

What is a typical academic profile for a student with this language and family history?
Section 9: Is there sufficient evidence to support the conclusion that this student is eligible for special education as a student with a learning disability?
 This is the place that the “basis for determination” is stated clearly. o Does the student have low skills? o Has the student made slow progress despite intensive intervention? o Have all exclusionary factors been ruled out? o Note if the significant skill deficits combine with strengths to form a pattern of achievement that has been demonstrated to be associated with an LD subgroup.
Source(s)

Every component of the report in sections 1-8.

Discussion of the team.
Reading
Benchmark
Student
Score
3rd
204
4th
211
5th
218
6th
222
7th
227
8th
231
10th
236
Percentile
Math
Benchmark
Student
Score
205 212 218 221 226 230 236
Percentile
Writing
Benchmark 32-39 40-49 40-49
Student
Score
ISF
LNF
PSF
NWF
K-Winter
Score %ile Benchmark
13
25
27
18
K-Spring
Score %ile Benchmark
N/A
40
35
25

Revised 10/17/07
LNF
PSF
NWF
ORF
1st-Fall
Score %ile Benchmark
37
35
24
N/A
1st-Winter
Score %ile Benchmark
N/A
35
50
20
1st-Spring
Score %ile Benchmark
N/A
35
50
40
NWF
ORF
2nd-Fall
Score %ile Benchmark
50
44
2nd-Winter
Score %ile Benchmark
N/A
68
2nd-Spring
Score %ile Benchmark
N/A
90
ORF
3rd-Fall
Score %ile Benchmark
77
3rd-Winter
Score %ile Benchmark
92
3rd-Spring
Score %ile Benchmark
110
ORF
4th-Fall
Score %ile Benchmark
93
4th-Winter
Score %ile Benchmark
105
4th-Spring
Score %ile Benchmark
118
ORF
5th-Fall
Score %ile Benchmark
104
5th-Winter
Score %ile Benchmark
115
K-Fall
Score %ile Benchmark
K-Winter
Score %ile Benchmark
LNF
(FNL) 6
5th-Spring
Score
25
K-Spring
Score
%ile Benchmark
124
%ile Benchmark
40
PSF
(FSF)
NWF
(FPS)
15
N/A
30
20
50
35

Revised 10/17/07
1st-Fall
Score %ile Benchmark
1st-
Winter
Score %ile Benchmark
1st-
Spring
Score %ile Benchmark
LNF
(FNL)
PSF
(PSF)
NWF
(FPS)
ORF
(FLO)
35
50
35
N/A
N/A
50
70
20
N/A
50
90
40
NWF
(FPS)
ORF
(FLO)
2nd-
Fall
Score %ile Benchmark
2nd-
Winter
Score %ile Benchmark
2nd-
Spring
Score %ile Benchmark
90
35
N/A
50
N/A
65
ORF
(FLO)
3rd-Fall
Score %ile Benchmark
3rd-
Winter
Score %ile Benchmark
3rd-
Spring
Score %ile Benchmark
60 70 85