[SCHOOL LETTERHEAD]
EDUCATIONAL ASSESSMENT REPORT
Student Name:
Date of Birth:
School:
Grade:
County/State:
Student’s Native Language:
Student ID#
Chronological Age: yrs. mos.
Date(s) of Assessment:
Date of Report:
Examiner:
Purpose:
This assessment is being conducted as a part of the legally mandated process to be followed
when (determining/confirming) whether a student is educationally disabled and eligible for
special education services.
The assessment information included in this report contributes to the (initial identification
process/reevaluation) of (student).
Written authorization for this assessment has been given by (name of parent/guardian) on (date).
Reason for Referral:
(Student) was referred for (assessment/reassessment) to (identify/confirm) current learning
behaviors that are negatively affecting (student’s) progress in (state specifically indicated
academic areas).
For initial identification, the school IEP team’s hypothesis and the date of the screening meeting
should be reported here.
For reevaluation, diagnostic questions or concerns to be addressed in the reevaluation should be
noted.
Background Information:
Document information that may be affecting the student’s ability to make academic progress.
Include dates where applicable.
 If the student was born in a country other than the US, comment on that history
 School history- schools attended, attendance patterns, pattern of academic performance,
report card information, summary of past teacher reports/ comments
 Previous program adjustments- prior referrals, prior additional services and/or
interventions received
 Summary of current classroom performance including behavior
 Social/Emotional factors (if reported), significant life experiences/traumas
 Health information-significant developmental data, medical issues, vision and hearing
results, medications
Observation:
An observation of (student) was done for the purposes of (screening/review) for
(eligibility/reconsideration of a disability) by (person and position) on (date) for (length of time
of observation). The observer stated (summarize main points) or (a copy of this current
observation is attached).
Assessment Information and Analysis:
Formal Assessment
The Woodcock-Johnson III - Tests of Achievement is an individually administered achievement
test that measures a student’s academic performance in relation to their peer group based on age.
Each cluster is composed of subtests that provide diagnostic information and give insight into a
student’s strengths and weaknesses in reading, mathematics, and writing and important related
skills.
Reading:
Letter-Word Identification
This subtest measures a student's word identification skills. Initial items require a student to
identify individual letters in bold type. The majority of items require a student to read words of
increasing difficulty in isolation (words are in list form rather than in context).
(Student) scored a standard score of ______, which is in the _________range of achievement as
compared to age peers.
Discuss Analysis of Performance- insert analysis for this subtest
Analyze the student’s performance. Include information on student’s strengths/needs/ challenges. Include patterns of
style, objective observational data and give examples without divulging test items. Take note of approach to task,
wait time, method of organization, pattern of responses, willingness to risk, subvocalizations, etc.
Passage Comprehension
This sub-test measures a student’s understanding of written text. Initial items measure a
student’s ability to match a rebus (picture symbol) with an actual picture. The next set of items
requires students to match a short phrase to the appropriate picture when given three choices.
The majority of items require a student to supply a missing word to sentences and then
paragraphs of increasing complexity.
(Student) scored a standard score of ______, which is in the _________range of achievement as
compared to age peers.
Discuss Analysis of Performance- insert analysis for this subtest
Analyze the student’s performance. Include information on student’s strengths/needs/ challenges. Include patterns of
style, objective observational data and give examples without divulging test items. Take note of approach to task,
wait time, method of organization, pattern of responses, willingness to risk, subvocalizations, etc.
Word Attack
This sub-test measures a student’s ability to apply phonic/decoding skills to unfamiliar words.
The initial items require a student to produce sounds for a small set of single letters. The
majority of items require students to pronounce nonsense words of increasing complexity.
(Student) scored a standard score of ______, which is in the _________range of achievement as
compared to age peers.
Discuss Analysis of Performance- insert analysis for this subtest
Analyze the student’s performance. Include information on student’s strengths/needs/ challenges. Include patterns of
style, objective observational data and give examples without divulging test items. Take note of approach to task,
wait time, method of organization, pattern of responses, willingness to risk, subvocalizations, etc.
Reading Vocabulary
This sub-test measures a student’s ability to provide synonyms and antonyms and to complete
analogies. All items are presented in increasing difficulty.
(Student) scored a standard score of ______, which is in the _________range of achievement as
compared to age peers.
Discuss Analysis of Performance- insert analysis for this subtest
Analyze the student’s performance. Include information on student’s strengths/needs/ challenges. Include patterns of
style, objective observational data and give examples without divulging test items. Take note of approach to task,
wait time, method of organization, pattern of responses, willingness to risk, subvocalizations, etc.
Mathematics:
Calculation
This sub-test measures a student’s ability to perform paper and pencil math computations. Items
range from writing numbers through numerical operations (addition, subtraction, multiplication,
division), as well as, geometric, trigonometric, logarithmic, and calculus operations if
appropriate.
(Student) scored a standard score of ______, which is in the _________range of achievement as
compared to age peers.
Discuss Analysis of Performance- insert analysis for this subtest
Analyze the student’s performance. Include information on student’s strengths/needs/ challenges. Include patterns of
style, objective observational data and give examples without divulging test items. Take note of approach to task,
wait time, method of organization, pattern of responses, willingness to risk, subvocalizations, etc.
Applied Problems
This sub-test measures a student’s ability to analyze and solve math problems. Initial items
require application of simple number concepts. The majority of items require a student to listen
to the problem, recognize the mathematical procedure that must be followed, and perform the
appropriate calculations.
(Student) scored a standard score of ______, which is in the _________range of achievement as
compared to age peers.
Discuss Analysis of Performance- insert analysis for this subtest
Analyze the student’s performance. Include information on student’s strengths/needs/ challenges. Include patterns of
style, objective observational data and give examples without divulging test items. Take note of approach to task,
wait time, method of organization, pattern of responses, willingness to risk, subvocalizations, etc.
Quantitative Concepts
This sub-test measures a student’s knowledge of mathematical concepts, symbols and
vocabulary, as well as, the ability to understand number patterns. Quantitative Concepts is
comprised of two sub-tests: Concepts and Number Series.
(Student) scored a standard score of ______, which is in the _________range of achievement as
compared to age peers.
Discuss Analysis of Performance- insert analysis for this subtest
Analyze the student’s performance. Include information on student’s strengths/needs/ challenges. Include patterns of
style, objective observational data and give examples without divulging test items. Take note of approach to task,
wait time, method of organization, pattern of responses, willingness to risk, subvocalizations, etc.
Written Expression:
Writing Fluency
This sub-test measures a student’s ability formulate and write sentences quickly. Students are
given a set of three prompt words for each item and must construct as many sentences as
possible within a seven-minute time limit.
(Student) scored a standard score of ______, which is in the _________range of achievement as
compared to age peers.
Discuss Analysis of Performance- insert analysis for this subtest
Analyze the student’s performance. Include information on student’s strengths/needs/ challenges. Include patterns of
style, objective observational data and give examples without divulging test items. Take note of approach to task,
wait time, method of organization, pattern of responses, willingness to risk, subvocalizations, etc.
Writing Samples
This sub-test measures a student’s ability to write sentences given a verbal and picture cue.
Initial items require students to complete sentences. The next set of items requires students to
write a sentence that complies with teacher directions. Final items require more complex
sentence construction and carry more difficult task demands. Items on this sub-test are scored
for the quality of expression. Students are not penalized for errors in capitalization, punctuation,
and spelling. Written expression is measured at the single sentence level.
(Student) scored a standard score of ______, which is in the _________range of achievement as
compared to age peers.
Discuss Analysis of Performance- insert analysis for this subtest
Analyze the student’s performance. Include information on student’s strengths/needs/ challenges. Include patterns of
style, objective observational data and give examples without divulging test items. Take note of approach to task,
wait time, method of organization, pattern of responses, willingness to risk, subvocalizations, etc.
Subtest
Standard Score
Description
range of achievement
Letter Word Identification
Passage Comprehension
Word Attack
Reading Vocabulary
Calculation
Applied Problems
Quantitative Concepts
Writing Fluency
Writing Samples
Validity Statement:
The Woodcock-Johnson Tests of Achievement – III (WJ-III) is judged to be an appropriate
measure for use with (this student). The (cultural/linguistic) characteristics of this student are
appropriately represented in the normative sample. The publishers document adequate validity
of the tests and the items are judged to represent significant overlap between content and MCPS
curriculum. (Student’s) test performance was considered to be an accurate reflection of
(student’s) aptitude and/or achievement.
Informal Assessment
Record complete name of test (no abbreviations) and the date(s) the instrument was
administered. Provide data points indicating level of achievement
Discuss Analysis of Performance- insert analysis for each data point
Analyze the student’s performance. Include information on student’s strengths/needs/ challenges. Include patterns of
style, objective observational data and give examples without divulging test items. Take note of approach to task,
wait time, method of organization, pattern of responses, willingness to risk, subvocalizations, etc.
Summary and Recommendations
Summarize
In the area of reading,
In the area of mathematics,
In the area of written language,
Based on the results of this assessment the following recommendations may be beneficial:
Include specific recommendations regarding instructional approaches, modifications, and/or
strategies that the assessment data suggest that may be effective with this student. It should not
include a definitive statement identifying a disability. That decision is the responsibility of a team
of qualified professionals.
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Under the guidelines of the Individuals with Disabilities Act (IDEA), Amendments of 2004, PL
105-17 and the Code of Maryland Regulations 13A.05.01, the determination or confirmation of a
disability must be made by a committee of qualified professionals and the parents or guardians of
the student at IEP team meeting. Additionally, information which addresses the effects of the
disability on school achievement and performance must be documented.
If the team and the parents confirm the existence of an educational disability, they will then
determine whether this student needs special education and related services.
signature
Typed Name of Examiner
Typed Title of Examiner
Attachments:
Classroom Observation
Copy to:
Confidential file
Parent/Guardian