1
EXCEPTIONAL EDUCATION
ASSESSMENT AND
ELIGIBILITY PROCEDURES
HENRICO COUNTY PUBLIC SCHOOLS
Department of Exceptional Education
and Support Services
Revised June 2012
2
TABLE OF CONTENTS
INTRODUCTION ...........................................................................................................................1
BEFORE THE ELIGIBILITY MEETING ......................................................................................2
AT THE ELIGIBILITY MEETING ................................................................................................3
AFTER THE ELIGIBILITY MEETING.........................................................................................5
QUESTIONS AND ANSWERS ABOUT ELIGIBILITY ..............................................................6
OPERATIONAL CRITERIA WORKSHEETS
Autism ................................................................................................................................18
Deaf-Blindness ...................................................................................................................22
Developmental Delay.........................................................................................................24
Emotional Disability ..........................................................................................................25
Hearing Impairment ...........................................................................................................27
Intellectual Disability .........................................................................................................28
Multiple Disabilities...........................................................................................................29
Orthopedic Impairment ......................................................................................................30
Other Health Impairment ...................................................................................................31
Attention Deficit/Hyperactivity Disorder ..........................................................................32
Specific Learning Disability ..............................................................................................33
Speech or Language Impairment .......................................................................................35
Traumatic Brain Injury ......................................................................................................36
Visual Impairment .............................................................................................................37
QUALITY MEETING GUIDELINES ..........................................................................................38
APPENDIX
A. Federal Definitions
3
INTRODUCTION
A student may receive special education services when a multidisciplinary team
determines that the student: 1) is considered to have a disability under federal and state laws and
regulations governing special education, and 2) due to that disability, requires specially designed
instruction to meet his/her unique needs. In Henrico County Public Schools, this decision is
made at the school level by an Eligibility Group.
Under federal laws and regulations, the child’s parent participates as a group member
during the eligibility process. School personnel will work closely with the parent to explain the
decision-making process. It is our goal to help parents feel comfortable with the procedure and
become active participants in the meeting.
In addition to the parents, the Eligibility Group consists of qualified professionals.
Contributing members of the Eligibility Group are: administrator/designee, school psychologist,
school social worker, general education and special education teachers, the parent(s), and other
school personnel contributing components to the eligibility consideration. If a child meets the
criteria for Speech/Language Impaired as the primary disability, the Eligibility Group is
composed of the administrator/designee, speech/language pathologist, the student’s teacher, and
the parent. Other staff members may be present to contribute to the consensus determination.
This booklet is designed to assist Eligibility Group members in making clear and
consistent decisions. It is recommended that administrators/designees review this booklet to
ensure that the correct procedures are followed.
4
BEFORE THE ELIGIBILITY MEETING
A.
SCHEDULE THE ELIGIBILITY MEETING
Most schools hold eligibility meetings on a specific day of the week according to the
schedules of the psychologist and social worker assigned to the building. With this in
mind, contact the parent to identify a mutually convenient date and time. Inform them that
copies of the reports to be presented at the meeting will be available for review two days
prior to the meeting. Collaborate with school staff about possible meeting dates. Confirm
the date by mailing notice of the eligibility meeting to the parent.
B.
NOTIFY SCHOOL-BASED STAFF
Notify school staff.
C.
COLLECT REPORTS FOR REVIEW
Reports to be presented must be typed and placed in the student education record no later
than two business days prior to the eligibility meeting so the parents may have access to the
reports. Each professional conducting an assessment or completing a report is responsible
for submitting the report in a timely manner.
5
AT THE ELIGIBILITY MEETING
A.
SETTING THE STAGE
The eligibility chair will welcome the participants and introduce group members, stating
their roles and their relationships to the student. The eligibility chair will state the purpose
of the meeting and provide a brief description of the proceedings. The eligibility chair will
present a summary of the background information and the reason for the evaluation.
B.
PRESENTATION OF REPORTS
Each evaluation team member will present a summary of his/her report to the group.
Highlights of the summary will be recorded on the Eligibility Group Summary of
Deliberations. A written copy of the evaluation reports must be provided to the parent(s).
C.
PARENTS PROVIDE INFORMATION
After reports are presented, the eligibility chair will ask the parent(s) if there are any
questions or any additional information they would like the group to consider.
D.
DECISION-MAKING PROCESS
The eligibility chair will review the decision-making process used in Henrico County
Public Schools. Group members are asked which disabilities they would like the group to
consider. The Operational Criteria Worksheets are selected from the file/notebook.
E.
OPERATIONAL CRITERIA WORKSHEETS ADDRESSED
Each Operational Criteria Worksheet is considered separately. The eligibility chair reads
the definition of the disability. The eligibility chair ensures that the required reports have
been obtained. The eligibility chair reads each criteria aloud. The group discusses each
item and comes to a consensus. It is not necessary for the group to come to complete
agreement on each item. Dissenting opinions are noted on the Eligibility Group Summary
of Deliberations with an explanation. (See F. and G.)
F.
CHILD DETERMINED ELIGIBLE FOR SPECIAL EDUCATION
Based on the information in the Operational Criteria Worksheets, the Eligibility Group
identifies the presence of a disability that requires special education. If there is
disagreement among group members, each member’s opinion is taken and an effort is made
to reach consensus. Using language contained in the Operational Criteria Worksheets, a
written summary that consists of the basis for the group’s eligibility decision is composed.
Members of the Eligibility Group sign the Eligibility Minutes form indicating that they
agree or disagree with the decision. If any member disagrees with the consensus of the
group, he/she must write a statement of explanation presenting that member’s conclusions.
A child may be determined to have more than one disability, based on Operational Criteria
Worksheets.
G.
CHILD DETERMINED INELIGIBLE FOR SPECIAL EDUCATION
Based on the information in the Operational Criteria Worksheets, the group may find a
child ineligible for special education. If there is disagreement among group members, each
member’s opinion is taken and an effort is made to reach consensus. If a child is found
6
ineligible, the group is required to make recommendations for further programming.
One of the recommendations may be a referral to the child study or intervention teams;
additional recommendations will be case and child specific. Implement Response to
Intervention process to continue assessing the effectiveness of interventions in general
education. The Essential Deliberations statement is composed. Members of the Eligibility
Group sign the form indicating their agreement or disagreement with the decision. If a
member disagrees with the consensus of the group, he/she must write a statement of
dissent. This statement may be written on the dissent page.
H.
DISAGREEMENT OF PARENT
If the parent expresses disagreement with the group’s decision, the eligibility chair
indicates the section entitled “Impartial Due Process Hearing” in the procedural safeguards
document. The eligibility chair describes the mediation and due process activities and
informs the parent how to access each one. The notice of the proposed action is provided
to the parents with a copy of their procedural safeguards. If mediation is selected by
parents, they may access more information on this subject through the Virginia Department
of Education website. (http//www.pen.k12.va.us/VDOE/dueproc/) If mediation or a due
process hearing is requested by the parents, the Director of Exceptional Education should
receive a letter from the parents. It is critical at this time to be sure that the eligibility
group informs parents that support for their child will be implemented in academic and/or
behavioral areas, no matter what the decision of the eligibility group is.
I.
DISTRIBUTION OF PAPERWORK
The parent receives the signed copy of the Eligibility Minutes, the Procedural Safeguards
document, and the Prior Written Notice. The Prior Written Notice may be completed after
the meeting in more complex cases and when parents and school are not in agreement.
Parents should receive the Prior Written Notice as soon as possible. If applicable, the
parent also receives a copy of the LD Addendum and a copy of the Conclusions of
Dissenting Members. The eligibility chair ensures that the parent has no additional
questions or concerns.
7
AFTER THE ELIGIBILITY MEETING
A.
IF PARENT DID NOT ATTEND MEETING
Mail a copy of the above-described paperwork to the student’s home. Call them to inform
them of the group’s decision and respond to any questions they might have. Let them
know that you will be sending documents in the mail. This is also a good time to
schedule the IEP meeting if the child has been found eligible or the child study/
intervention team meeting if the student is ineligible for special education.
B.
STUDENT FOUND INELIGIBLE
If the student has been found ineligible for special education, review the Essential
Deliberations and check the recommendations made by the Eligibility Group. Take action
as necessary. Students who are found ineligible for special education may be referred to
the child study/intervention team to develop an appropriate child study plan.
C.
STUDENT FOUND ELIGIBLE
If the student was found eligible for special education services, schedule the IEP meeting to
occur within thirty (30) calendar days of the eligibility meeting. Review the Essential
Deliberations statement for IEP recommendations and related services to be considered.
Ensure the presence of the appropriate related service provider(s) at the meeting.
8
QUESTIONS AND ANSWERS ABOUT ELIGIBILITY
RESPONSE TO INTERVENTION
What role does RtI play in eligibility decisions?
The expectation is that eligibility groups will help determine if specialized instruction is
needed by applying the response to intervention process. This includes goal setting,
progress monitoring, and use of research-based interventions.
What is the timeline for continuing to use an intervention before determining that a special
education evaluation is needed? Is there a maximum time that a student can be involved in
a RtI process?
Decisions about the duration, type(s), and number of interventions must be based on an
individual student’s performance data; therefore, there is no prescribed length of time for
intervention implementation. Sufficient time must be provided to a) determine if the
intervention is working and b) “close the gap” between the performance of the target
student and peers or benchmark expectations when effective interventions have been
documented. The greater the gap, the more time will be needed to bring the target
student into the range of expected performance. The team must consider each individual
student’s needs and use data from frequent progress monitoring and other sources to
determine the length of time to implement interventions and plan revisions to
interventions accordingly. School teams should use standardized databased decision
rules rather than prescribed timelines to evaluate student outcomes. Other factors to
consider include:
•
The student’s baseline performance level,
•
The student’s prior history of effective interventions,
•
The stability of the student in the current school and instructional environment
(e.g., student attendance/absences, disciplinary removals from class, student mobility),
and
•
The intensity of the interventions.
Can parents request an evaluation while their child is involved in an RtI process?
The right for parents to request a special education evaluation at any time has not
changed, nor have the requirements associated with the district’s response to such a
request. Therefore, parents can request a special education evaluation at any time prior
to, during, or following their child’s involvement in an RtI process. If the district agrees
that the student may be a student with a disability requiring special education and related
services, then it must provide notice of the intent to conduct an evaluation, obtain written
parental consent, and complete the evaluation. If the district does not agree that a special
education evaluation is warranted, a written notice must be provided to the parents that
informs them of this decision and explains the reasons why it has been determined an
evaluation is not indicated. The parent can challenge the district’s decision by requesting
mediation and/or a due process hearing to resolve the dispute over the student’s need for
an evaluation.
To determine special education eligibility, existing data collected during the RtI process
will be used as an important source of evaluation information. The school eligibility
team, which includes a student’s parents, will determine if these data are sufficient to
9
determine eligibility or if additional evaluation data are needed. During this process, any
interventions the student has been receiving should continue to be provided.
How do you decide what’s good evidence-based instruction?
Start with the documentation provided by school staff of the instruction, interventions
and data on the student’s progress to date. Ask for information on how the various
approaches and strategies were selected, and their relationship to district guidance and
scientifically-based practice.
GENERAL QUESTIONS:
What does “adversely affects educational performance” mean?
An adverse effect on educational performance can incorporate all aspects of the child’s
functioning at school, including educational performance as measured by grades or
achievement test scores. It can also be manifested through behavioral difficulties at school;
and impaired or inappropriate social relations; impaired work skills, such as being
disorganized, tardy, having trouble getting to work on time and difficulty with following
the rules. Schools are required to address the effects of a child’s disability in all areas of
functioning, including academic, social/emotional, cognitive, communication, vocational,
and independent living skills.
What part do private evaluations play in eligibility consideration?
Henrico County Public Schools has the right to complete the evaluation of the child and
the responsibility to review private evaluations. Private evaluations should be viewed as
supplemental to components completed by school personnel.
In interpreting evaluation data for the purpose of determining if a child has a disability
and determining the educational needs of the child, the Eligibility Group shall: (a) draw
upon information from a variety of sources, including aptitude and achievement tests,
parent input, teacher recommendations, physical condition, social or cultural background,
and adaptive behavior; and (b) ensure that information from all these sources is
documented and carefully considered.
When the Eligibility Group determines that information is not sufficient to make an
eligibility decision, what do they do?
The group must either not find the student eligible (initial eligibility) or maintain current
eligibility. A re-evaluation may then be initiated and eligibility determined based on new
evaluative reports. If a selected component is determined to not be essential to the
eligibility decision, complete the eligibility meeting based on available information.
Can we find a student eligible based on oral information given during the meeting when
this information is not included in written form?
All available information, written and oral, should be used in making eligibility
decisions. Written documentation should always be present. For example, a student with
a health impairment (other than ADHD) must have the health impairment documented by
a physician. This documentation is necessary, even when the parent may have given
verbal information pertaining to the health impairment in the social history or shared
medical information during the eligibility meeting.
10
What is meant by “current” evaluation?
An evaluation may be considered current if it was completed within the 12 months (6
months for preschool) prior to the eligibility meeting. Any current report deemed
relevant can be used when making an eligibility decision with the exception of a hearing
test, which must be administered within the 65-day time frame allowed for the eligibility
process.
What assessment components should be used for re-evaluation?
Minimally, the educational component (to include standardized achievement testing)
should be updated. Questions or concerns about student progress may justify the need for
additional evaluative components. The group should refer to the Student Planning
Worksheet and previous evaluations.
Can a report be updated?
Yes. The decision to update rather than readminister an assessment component is an
individual professional decision. When the professional updates a report, he/she is
accepting that report as a current reflection of the student’s performance/ability. If the
decision is made to update, NEW information must be added (for example, the
psychologist who decides not to readminister a cognitive abilities test but who does
conduct an interview or a classroom observation).
Does the Eligibility Group decide if a student is eligible to receive related services?
With the exception of speech/language, vision, and hearing services, the IEP Team
determines whether or not a related service is required in a student’s IEP based upon
review of the goals and objectives, appropriate assessment reports, and local guidelines
for provision of related services. However, the Eligibility Group may review the related
service evaluation, document the results on the Eligibility Minutes Summary form, and
recommend that the service be considered by the IEP Team.
What do I tell parents about mediation and due process?
Both mediation and due process are avenues parents may pursue if they are in
disagreement with any decision regarding evaluation, identification, or placement of their
child in special education. Due process may be initiated by the parent contacting the
Executive Director of Exceptional Education or the Virginia Department of Education.
Mediation may be initiated by the parent writing a letter to the Executive Director of
Exceptional Education that states the reason for disagreement. An explanation of
mediation and due process is in the procedural safeguards document, which will be given
to the parent at any meeting involving special education.
Copies of forms for requesting mediation or due process are available from the VDOE’s
Office of Dispute Resolution and Administration website:
http://www.pen.k12.va.us/VDOE/dueproc/.
What assessment components should be used for re-evaluation?
The educational evaluation (to include standardized achievement testing) and the
observation should be minimally completed. Questions or concerns about student
11
progress may justify the need for additional evaluative components. The group should
refer to the Student Planning Worksheet and previous evaluations.
When an evaluation is initiated at a child study meeting and the team suspects a child has
fine motor issues, can an occupational therapy (OT) assessment be selected as an evaluative
component?
No. OT is a related service to the IEP, and an OT assessment can only be initiated at an
IEP meeting. However, an occupational therapist may be invited to a child study
meeting, and may offer suggestions for teacher and parent to address fine motor
concerns. The OT may also observe the student in the classroom and offer additional
recommendations for home and school assistance.
If an IEP team determines that a student has made progress on an IEP, no further IEP
goals are needed, and the student no longer requires special education services, how should
the student be terminated from special education services?
A full evaluation is needed, an eligibility meeting is held, and if the consensus is that the
student is no longer eligible, with parental written consent, the student is then exited from
special education.
What should the IEP team do if a parent wants their child out of special education
immediately and will not consent to any re-evaluations?
Parents have the right to refuse special education services. The parent should notify
HCPS in writing that they want their child removed from special education and refuse
special education services. This means ALL services, if a parent disagrees with level of
services or specific services only then the team should utilize the standard dispute
resolution. If a parent removes their child from special education services HCPS retains
the right to disagree and file a due process if we believe special education is necessary for
FAPE.
AUTISM:
Do you have to have a medical diagnosis of autism?
No. We consider autism an educational label, not a medical diagnosis. A medical
diagnosis of autism or a Pervasive Developmental Disorder (PDD), however, may
provide supportive data in making an eligibility decision. If there is no medical
documentation of autism, there must be sufficient documentation in the reports to support
the determination. This will include observations, reports from school personnel, and
behavioral checklists.
Under the autism criteria for Step 4, “documentation of an adverse effect on educational
performance,” does this include those students who only have significant social skill
deficits?
Yes.
DEVELOPMENTAL DELAY:
When a child is approaching his or her seventh birthday, does he/she need to go back to
eligibility even if it has not been three years since the last evaluation?
12
Yes. All children who have been identified as Developmentally Delayed must be reevaluated and go through the eligibility process to determine a categorical disability and
the need for continued special education.
Can you give a categorical designation to a child before the age of seven?
Absolutely! A categorical designation is required if the child clearly meets the criteria.
EMOTIONAL DISABILITY:
When an emotional disability is suspected, besides evaluative components, what else should
be done?
Best practice recommends that in most cases a functional behavior assessment and
behavior plan be implemented prior to eligibility meeting.
Can a student be socially maladjusted and still have an emotional disability?
Yes. A student with an emotional disability may present with significant problems in
behavior. A severely depressed student, for example, may well act out in ways that
violate norms of behavior in school – smoking, fighting, abusing substances, verbally
abusing others, etc. However, the student may not be found eligible solely on the basis of
social maladjustment. In order to be eligible under Emotional Disability (or any
disability category), the student must meet the applicable criteria.
Can a student be drug involved and be identified as emotionally disabled?
Yes. However, substance abuse, by itself, is not an emotional disability. The Eligibility
Group must investigate if the characteristics of emotional disability were present before
the onset of the substance abuse.
If a student was hospitalized for psychiatric reasons, does he/she automatically qualify for
ED services?
No. Students may be hospitalized for psychiatric reasons, which may or may not qualify
them for ED services. Severe behavior problems often precipitate psychiatric
hospitalizations for students who would not qualify for ED services. Moreover, a
psychiatric diagnosis does not necessarily qualify a student for ED services. The
Eligibility Group must carefully examine the data presented in order to determine if the
diagnosis creates an adverse educational impact.
Can a very young child be identified as a child with emotional disability?
Yes. The data must clearly support the determination that the child has an emotional
disability; however, such an identification will be a rare occurrence.
HEARING IMPAIRMENT:
Do we need to have a current audiological assessment to determine eligibility for hearing
impairment?
A current audiological assessment for an initial evaluation should occur within 65 days.
Can a student be both hearing impaired and learning disabled?
13
Yes, but it is a rare occurrence. The data must clearly show that the specific learning
disability is not caused by the hearing impairment and the Essential Deliberations
statement must provide strong evidence that the hearing impairment is not exclusionary
for a learning disability.
INTELLECTUAL DISABILITY:
What are areas of adaptive behavior?
Adaptive behavior skills are those that help us to function in nonacademic activities.
Areas of adaptive behavior will vary according to the instrument used for measurement.
They may include self-care, communication, daily living skills, social skills, selfdirection, health, safety, and leisure.
Do we need formal measures of adaptive behavior or can we use descriptions of behavior
found in a social history or teacher narrative?
At least one formal measure must be reported. It is also useful to gather evidence for
deficits in adaptive behavior from one or more reliable independent sources (i.e., teacher
education reports; educational, developmental, and medical evaluations).
Can a student be found eligible as intellectually disabled (ID) with standard scores in
academics above the ID range?
Students can be found eligible as ID with some achievement scores above the ID range.
(ID range is two or more standard deviations below the mean, i.e., a standard score of 70
or less.) High splinter skills should not negate the preponderance of evidence supporting
the ID identification.
Can a student be found eligible as intellectually disabled with standard scores in adaptive
behavior above the ID range?
It is expected that students being considered for ID have composite scores two or more
standard deviations below the mean (i.e., a standard score of 70 or less). However, all
available information should be considered in making a determination of ID.
Do ID students with standard scores of 40 or less who also have physical impairments,
emotional issues, etc., need to be given additional eligibility identifications?
No. Typically, these students require no additional identifications.
What happened to the Severe Disability category?
The Severe Disability category no longer exists separately. Students with standard scores
of 40 or less are now identified as having an intellectual disability.
MULTIPLE DISABILITIES:
What is meant by “multiple disabilities”?
A student with multiple disabilities will meet the criteria for at least two disability
categories. The educational impact of these concomitant impairments will be so severe
that they cannot be accommodated in a special education program solely for one of the
impairments. In the rare cases when a student is found eligible for multiple
14
disabilities without ID, the Eligibility Group must provide a clear statement for this
position.
ORTHOPEDIC IMPAIRMENT:
Does an OI student automatically receive occupational and physical therapy?
No. OI students qualify for OT and PT in the same way as any other student receiving
special education services. The students must go through the referral and evaluation
process, and it is the responsibility of the IEP team to consider whether these services are
required to support the special education program.
Can a student have cerebral palsy and not be found eligible for services?
Yes. As a student with OI, there has to be educational impact. There are students with
CP who do not require special education services.
Does a student with OI have to exhibit a severe discrepancy between ability and
achievement to determine educational impact?
No. The impact of physical disability may not be reflected on standardized testing. In
some cases, the student will be impacted in the area of fine-motor skills, production of
class work, or in organizational skills. The Eligibility Group needs to refer to all data,
particularly the teacher education reports, to obtain data relevant to the educational
impact.
OTHER HEALTH IMPAIRMENT:
Are students with ADHD automatically considered eligible under OHI?
No. ADHD may be considered under OHI. The student must first meet the Henrico
County criteria as a student with ADHD. Then, the nature of the attentional deficit and
its impact on educational performance must be considered. Eligibility Groups must
review the modifications/accommodations to the general education environment that
have been made.
If ADHD is suspected, besides evaluative components, what else is needed for the eligibility
meeting?
Goals from the child study team addressing issues at school related to ADHD should be
developed with interventions, progress monitoring, and data to show effects of plan. For
example, what is the intervention plan for poor sustained attention?
Are children with a neurological impairment automatically considered eligible under OHI?
No. It depends on the nature of the impairment and its educational impact.
SPECIFIC LEARNING DISABILITY:
May teams determine when to use the ability/achievement discrepancy as part of SLD
criteria?
No. HCPS is no longer using ability/achievement discrepancy as part of the SLD criteria.
15
If a student initially identified as having a SLD that interferes with reading, then later
presents concerns in math, do we need to initiate a formal re-evaluation or could the IEP
committee add math goals to the plan?
This student should be referred to the child study team to write an intervention plan to
address math. The response to intervention process would be initiated to determine if the
student is progressing in math with additional support from general education. If math
progress is noted, no further action related to special education would be needed. If there
is a lack of math progress based on goal setting, documented progress monitoring, and
various levels of intervention, this data would be shared with the IEP team to determine if
a math goal should be added to the IEP.
Can a VI, HI, or otherwise disabled student be considered SLD?
Students with other disabilities may be considered for SLD, but exclusionary criteria
must be considered. To qualify for SLD, the academic deficit cannot be caused by a
visual, hearing, or motor disability; intellectual disability; emotional disability; or
environmental, cultural, or economic disadvantage.
If a student is not found eligible for Exceptional Education services will he be able to
continue receiving RtI support?
Yes.
I do interventions in the classroom all the time such as proximity seating, small group for
reading, and reading aloud tests but my student is still not successful and earning poor
grades. Isn’t this evidence enough that he is not responding to intervention and needs an
IEP?
No, in a Response to Intervention model a student must receive evidence-based
interventions targeting specific areas of academic weakness. RtI requires implementation
of an aim line, goal, and at least bi-weekly progress monitoring toward a goal. Proximity
seating, small group for reading, reading aloud tests, etc. are accommodations or best
teaching practices and are not evidence based interventions and would not be applicable
in determining whether a child has a SLD using a RtI model.
Can a student qualify for special education as a student with a learning disability if (s)he
has participated in Tier II and/or Tier III interventions and has met or almost met his/her
goals at the time of progress monitoring, but the student’s achievement is still below grade
level?
If the student is demonstrating the ability to make significant progress toward goals, that
may not support identification as a student with a disability and the committee should
carefully consider whether other factors may have impacted learning or achievement test
performance prior to making an eligibility decision.
How much consideration should be given to the student’s attendance/tardiness at school
when making eligibility determinations? If the student is frequently tardy and misses the
whole class instruction that is provided in a particular subject area (i.e.reading), but is
present in order to receive individual interventions, is that not sufficient to document lack
of growth that may be indicative of a disability?
Tier II and Tier III interventions are intended to be provided in addition to core
instruction. If the student is missing out on the Tier I instruction the teacher is providing
16
to the entire class, then Tier II and Tier III interventions are simply make-up for what was
missed. That would be insufficient in order to determine that the student has a disability.
What if the student is always present for the Tier II and/or Tier III interventions, but
his/her inattention and hyperactivity do not allow him/her to benefit from the instruction?
Can Specific Learning Disability be considered as a primary disability when the student
demonstrates a lack of growth in the area of intervention?
If the student’s attention and hyperactivity appear to be interfering with the student’s
learning and the benefit of interventions, the team may choose to consider the category of
Other Health Impairment for ADHD, rather than Specific Learning Disability.
If a student is performing below grade level but is making progress does this count as
expected progress? Additionally, how do we determine goals for students reading
significantly below grade level? For example, if I have a 5th grade student who is reading
on a 2nd grade level and has progressed to a 3rd grade level, can that student qualify
because they are still not on grade level?
Benchmarks and progress monitoring should generally match the intervention level. So
if a 5th-grade student receives a supplemental reading fluency intervention using grade 2
texts, the school would use grade 2 reading fluency benchmarks and progress-monitoring
measures to track student growth and to determine when the student has reached mastery
at this off-level intervention point. It is also recommended that the school occasionally
(e.g., once per month) assess an off-level student using benchmarks and progressmonitoring measures from his or her enrolled grade level as a means to assess the
student’s abilities relative to same-grade peers. If an off-level student is tracked using
only unrealistically difficult progress-monitoring measures from his or her enrolled-grade
level, any actual evidence of student progress may be masked by the challenging nature
of the assessment materials. This intervention assessment mismatch could lead the
school erroneously to judge the student a “nonresponder” to an off-level intervention
when in fact the student is actually making substantial academic progress. (taken from
interventioncentral)
My student received an intervention for reading fluency but eligibility/educational testing
revealed very low scores on reading comprehension. Can the reading comprehension score
be “evidence” for SLD criteria?
The student must receive interventions in the area where a disability is suspected.
REFERENCES
-Adroin & Christ (2008) Evaluating Curriculum-Based Measurement Slope Estimates Using
Data from Triannual Universal Screenings. School Psychology Review, 37 (1), 109-125.
-Fuchs (2003) “Assessing Intervention Responsiveness” Conceptual and Technical Issues.
Learning Disabilities Research & Practice, 18 (3), 172-186
-NASP article “Response to Instruction in the Identification of Learning Disabilities: A guide
from School Teams”
-National Research Center for Learning Disabilities website
17
-Vaughn (2003, December) How Many Tiers are Needed for Responsive to Intervention to
Achieve Acceptable Performance Outcome? Paper presented at the National Center on Learning
Disabilities Responsiveness-to-Intervention Symposium, Kansas
TRAUMATIC BRAIN INJURY:
Is a student with a brain tumor eligible under TBI?
No. A brain tumor is considered a health impairment.
Is a student with severe brain damage eligible under TBI?
A traumatic brain injury must be caused by an external physical force. If the brain
damage was caused by an external force, e.g., a gunshot wound or blow to the head, then
the student could be considered for TBI.
How current does the brain injury have to be to be considered for TBI?
An injury that occurs anytime after the period immediately following birth can be
considered for TBI if the injury meets the requirements of the definition.
Does the injury have to be permanent?
No. There are degrees of recovery from a traumatic brain injury.
SECTION 504:
When and how do we consider Section 504 eligibility?
Section 504 eligibility should always be considered after a student is found ineligible for
special education under IDEIA. An eligibility group may consider Section 504 eligibility
alone when the impairment is solely a medically based disability with accommodations
for the student as the main need. The eligibility group should carefully consider the
Section 504 eligibility flow chart that is included in this manual.
To determine eligibility for Section 504, the eligibility group must determine that there is
a physical or mental impairment that substantially limits the student’s performance in a
major life activity. An impairment that is episodic or in remission is a disability if it
would substantially limit a major life activity when active. Be sure to identify the
specific physical or mental impairment and write it in the summary of deliberations
statement in the eligibility minutes.
The determination of whether an impairment substantially limits a major life activity
shall be made without regard to the ameliorative effects of mitigating measures. These
include medication, medical supplies, equipment or appliance, low-vision devices,
prosthetics including limbs and devices, and hearing aids and cochlear implants or other
implantable hearing devices, mobility devices, or oxygen therapy equipment and
supplies. Ordinary eyeglasses and contact lenses are not included in this provision.
The definition of a person with a disability contains the addition of reading,
concentrating, thinking, communicating, bending, lifting, standing, sleeping, and eating
as “major life activities,” along with the established major life activities of learning,
working, breathing, speaking, walking, hearing, seeing, performing manual tasks, and
caring for oneself. The term “major life activity” also includes the operation of a major
18
bodily function. This definition of disability does not apply to impairments that are
transitory (actual or expected duration of six months or less) and minor.
In the summary of deliberations statement, also include how the physical or mental
impairment substantially limits or impacts the major life activity.
17
ELIGIBILITY DECISION PROCESS CHART
Child Study or Intervention Team Plan
NO –– Provide IDEIA Procedural
Safeguards
IDEIA
Does the child study or eligibility team
suspect the child has a disability under
IDEIA?
YES
Conduct IDEIA evaluation
If not IDEIA eligible
SECTION 504
Child Study or Intervention Team Plan
NO –– Provide 504 Procedural
Safeguards
NO –– Provide 504 Procedural
Safeguards
NO –– Provide 504 Procedural
Safeguards
YES –– Provide 504 Procedural
Safeguards
NO –– Provide 504 Procedural
Safeguards
Does the child study team suspect a
physical or mental impairment that
substantially limits a major life activity?
Does the student have a physical or
mental impairment?
YES
504 Evaluation
YES
YES
Does the impairment affect a
major life activity?
NO
Do cultural, environmental or economic
factors cancel out potential limitations of a
major life activity?
YES
Does the impairment substantially
limit a major life activity?
Write 504 plan and provide Section 504
procedural safeguards.
20
Name:
D.O.B.
Autism Worksheet
School:
AGE:
Meeting Date:
GRADE:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Autism. Review the definition, consider the items below, and note any additional
information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
STEP 2.
STEP 3.
DEFINITION: "Autism" means a developmental disability significantly affecting verbal and nonverbal
communication and social interaction, generally evident before age three that adversely affects a child's
educational performance. Other characteristics often associated with autism are engagement in repetitive
activities and stereotyped movements, resistance to environmental change or change in daily routines, and
unusual responses to sensory experiences. Autism does not apply if a child's educational performance is
adversely affected primarily because the child has an emotional disturbance. A child who manifests the
characteristics of autism after age three could be identified as having autism if the criteria in this definition are
satisfied.
There is documentation of any of the Pervasive Developmental Disorders, also referenced as autism spectrum disorder,
such as Autistic Disorder, Asperger's Disorder, Rhett's Disorder, Childhood Disintegrative Disorder, Pervasive
Developmental Disorder – Not Otherwise Specified including Atypical Autism as indicated in diagnostic references.
Characteristics of Autism: (see criteria worksheets)
□ Children with Asperger's Disorder demonstrate the following characteristics:
 Impairments in social interaction, such as marked impairment in the use of multiple nonverbal behaviors such as
eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction; failure to develop peer
relationships appropriate to developmental level; a lack of spontaneous seeking to share enjoyment, interests, or
achievements with other people (i.e., by a lack of showing, bringing, or pointing out objects of interest); or lack of
social or emotional reciprocity are noted; and
 Restricted, repetitive and stereotyped patterns of behavior, interests, and activities such as encompassing
preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or
focus, apparently inflexible adherence to specific, nonfunctional routines or rituals, stereotyped and repetitive motor
mannerisms, persistent preoccupation with parts of objects.
□ Children with Autistic Disorder demonstrate impairments in:
 Social interaction; and
 Restricted, repetitive, and stereotyped patterns of behavior as listed above; and
 Impairments in communication, such as delay in, or total lack of, the development of spoken language (not
accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime).
In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with
others, stereotyped and repetitive use of language or idiosyncratic language, or lack of varied, spontaneous makebelieve play or social imitative play appropriate to developmental level is noted.
□ Children with Pervasive Developmental Disorder - Not Otherwise Specified or Atypical Autism may display
any of the characteristics listed above without displaying all of the characteristics associated with either Asperger's
Disorder or Autistic Disorder.
□ Other (Describe):
AND
The child's educational performance is not adversely affected primarily because the child has an emotional disturbance.
AND
STEP 4.
STEP 5.
There is documentation of an adverse effect on educational performance due to one or more documented characteristics
of autism.
List and/or describe:
AND
Due to the identified Autism, the student needs specially designed instruction.
21
CRITERIA FOR AUTISM
DSM-IV-TR
A.
A total of six (or more) items from 1), 2), and 3), with at least two from 1) and one each from
2) and 3):
1)
Qualitative impairment in social interaction, as manifested by at least two of the
following:
a)
b)
c)
d)
2)
Qualitative impairments in communication, as manifested by at least one of the
following:
a)
b)
c)
d)
3)
Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye
gaze, facial expression, body posture, and gestures to regulate social interaction
Failure to develop peer relationships appropriate to developmental level
A lack of spontaneous seeking to share enjoyment, interests, or achievements with
other people (e.g., by a lack of showing, bringing, or pointing out objects of interest)
Lack of social or emotional reciprocity
Delay in, or total lack of, the development of spoken language (not accompanied by
an attempt to compensate through alternative modes of communication, such as
gesture or mime)
In individuals with adequate speech, marked impairment in the ability to initiate or
sustain a conversation with others
Stereotyped and repetitive use of language or idiosyncratic language
Lack of varied, spontaneous make-believe play or social imitative play appropriate
to developmental level
Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as
manifested by at least one of the following:
a)
b)
c)
d)
Encompassing preoccupation with one or more stereotyped and restricted patterns of
interest that is abnormal either in intensity or focus
Apparently inflexible adherence to specific, nonfunctional routines or rituals
Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or
twisting, or complex whole-body movements)
Persistent preoccupation with parts of objects
B.
Delays or abnormal functioning in at least one of the following areas, with onset prior to age
three years: (1) social interaction, (2) language as used in social communication, or (3)
symbolic or imaginative play.
C.
The disturbance is not better accounted for by Rett’s Disorder or Childhood Disintegrative
Disorder.
22
DSM-IV-TR

Diagnostic criteria for 299.10 Childhood Disintegrative Disorder
A.
Apparently normal development for at least the first 2 years after birth as manifested by the presence
of age-appropriate verbal and nonverbal communication, social relationships, play, and adaptive
behavior.
B.
Clinically significant loss of previously acquired skills (before age 10 years) in at least two of the
following areas:
(1)
(2)
(3)
(4)
(5)
C.
Abnormalities of functioning in at least two of the following areas:
(1)
(2)
(3)
D.

Expressive or receptive language
Social skills or adaptive behavior
Bowel or bladder control
Play
Motor skills
Qualitative impairment in social interaction (e.g., impairment in nonverbal behaviors, failure to
develop peer relationships, lack of social or emotional reciprocity)
Qualitative impairments in communication (e.g., delay or lack of spoken language, inability to
initiate or sustain a conversation, stereotyped and repetitive use of language, lack of varied
make-believe play)
Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, including
motor stereotypes and mannerisms
The disturbance is not better accounted for by another specific Pervasive Developmental Disorder or
by Schizophrenia.
Diagnostic criteria for 299.80 Rett’s Disorder
A.
All of the following:
(1)
(2)
(3)
B.
Apparently normal prenatal and perinatal development
Apparently normal psychomotor development through the first 5 months after birth
Normal head circumference at birth
Onset of all of the following after the period of normal development:
(1)
(2)
(3)
(4)
(5)
Deceleration of head growth between ages 5 and 58 months
Loss of previously acquired purposeful hand skills between ages 5 and 30 months with the
subsequent development of stereotyped hand movements (e.g., hand wringing or hand washing)
Loss of social engagement early in the course (although often social interaction develops later)
Appearance of poorly coordinated gait or trunk movements
Severely impaired expressive and receptive language development with severe psychomotor
retardation
23

Diagnostic criteria for 299.80 Asperger’s Disorder
A.
Qualitative impairment in social interaction, as manifested by at least two of the following:
(1)
(2)
(3)
(4)
B.
Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at
least one of the following:
(1)
(2)
(3)
(4)

Marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial
expression, body postures, and gestures to regulate social interaction.
Failure to develop peer relationships appropriate to developmental level
A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
(e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
Lack of social or emotional reciprocity
Encompassing preoccupation with one or more stereotyped and restricted patterns of interest
that is abnormal either in intensity or focus
Apparently inflexible adherence to specific, nonfunctional routines or rituals
Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or
complex whole-body movements)
Persistent preoccupation with parts of objects
C.
The disturbance causes clinically significant impairment in social, occupational, or other important
areas of functioning.
D.
There is no clinically significant delay in language (e.g., single words used by age 2 years,
communicative phrases used by age 3 years).
E.
There is no clinically significant delay in cognitive development or in the development of ageappropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the
environment in childhood.
F.
Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.
299.80 Pervasive Developmental Disorder Not Otherwise Specified (Including
Atypical Autism)
This category should be used when there is a severe and pervasive impairment in the development of
reciprocal social interaction or verbal and nonverbal communication skills, or when stereotyped behavior,
interests, and activities are present, but the criteria are not met for a specific Pervasive Developmental
Disorder, Schizophrenia, Schizotypal Personality Disorder, or Avoidant Personality Disorder. For example,
this category includes “atypical autism” - presentations that do not meet the criteria for Autistic Disorder
because of late age at onset, atypical symptomatology, or subthreshold symptomatology, or all of these.
24
Deaf-blindness Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Deaf-blindness. Review the definition, consider the items below, and note any additional
information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
STEP 2.
DEFINITION: "Deaf-blindness" means simultaneous hearing and visual impairments, the combination of
which causes such severe communication and other developmental and educational needs that they cannot
be accommodated in special education programs solely for children with deafness or children with blindness.
There is documentation of Deaf-blindness.
Complete and attach:
 Visual Impairment including Blindness Worksheet
 Deafness or Hearing Impairment Worksheet
AND
STEP 3.
The combination of the hearing and visual impairments causes such severe communication and other developmental and
educational needs that cannot be accommodated in special education programs solely for children with deafness or
children with blindness.
25
Deafness Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Deafness. Review the definition, consider the items below, and note any additional
information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
STEP 2.
DEFINITION: "Deafness" means a hearing impairment that is so severe that the child is impaired in
processing linguistic information through hearing, with or without amplification that adversely affects the
child's educational performance.
There is documentation of Deafness.
The child has (check all that apply):
□ a bilateral hearing loss (sensorineural, or mixed conductive and sensorineural),
□ a fluctuating or a permanent hearing loss,
□ documented auditory dyssynchrony (auditory neuropathy), and/or cortical deafness
Describe:
AND
There is documentation of an adverse effect on educational performance due to the Deafness.
List and/or describe:
STEP 3.
AND
STEP 4.
Due to the identified Deafness, the student needs specially designed instruction.
26
Developmental Delay Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Developmental Delay. Review the definition, consider the items below, and note any
additional information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
DEFINITION: "Developmental Delay" means a disability affecting a child ages two by September 30 through six,
inclusive: (34 CFR 300.8(b); 34 CFR 300.306(b))
1. (i) Who is experiencing developmental delays, as measured by appropriate diagnostic instruments and
procedures, in one or more of the following areas: physical development, cognitive development,
communication development, social or emotional development, or adaptive development, or (ii) who has an
established physical or mental condition that has a high probability of resulting in developmental delay;
2. The delay(s) is not primarily a result of cultural factors, environmental or economic disadvantage, or limited
English proficiency; and
3. The presence of one or more documented characteristics of the delay has an adverse effect on educational
performance and makes it necessary for the student to have specially designed instruction to access and make
progress in the general educational activities for this age group.
STEP 2.
The child will be two by September 30 of the current school year through six, inclusive.
AND
There is documentation of a Developmental Delay, (a standard score of 70 or below) as measured by appropriate
diagnostic instruments and procedures, in one or more of the following areas (check all that apply):
□ P ysical Development
□
STEP 3.
Social
or
Development
Emotional
□ Cognitive Development
□ Communication Development,
□ Adaptive Development
□ Established Physical or Mental Condition that
has a high probability of resulting in
developmental delay;
List and/or describe:
AND
STEP 4.
The delay(s) is not primarily a result of cultural factors, environmental or economic disadvantage, or limited English
proficiency.
AND
The presence of one or more documented characteristics of the delay has an adverse effect on educational performance
and makes it necessary for the student to have specially designed instruction to access and make progress in the general
educational activities for this age group.
STEP 5.
List and/or describe:
27
Emotional Disability Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with Disabilities in
Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered for eligibility under the
category of Emotional Disability. Review the definition, consider the items below, and note any additional information. Attach this worksheet to
the Eligibility Summary Form and include any necessary documentation.
STEP 1.
STEP 2.
DEFINITION: "Emotional Disability" means a condition exhibiting one or more of the following characteristics over a
long period of time and to a marked degree that adversely affects a child's educational performance: (34 CFR 300.8(c)(4))
1. An inability to learn that cannot be explained by intellectual, sensory, or health factors;
2. An inability to build or maintain satisfactory interpersonal relationships with peers and teachers as shown by
reports and information from multiple sources. Provide time frame for unsatisfactory peer and teacher
relationships. Consider factors such as the inability to get along, feelings of isolation, withdrawal behavior,
avoidance of communication, inappropriate fear of teachers and/or students (not an exclusive list).
Describe: __________________________________________________________________________________
__________________________________________________________________________________________
3. Inappropriate types of behavior or feelings under normal circumstances as shown by reports and information
from multiple sources. Consider behaviors such as anxiety, attention issues, excessive crying, curling up in a
fetal position, hiding under furniture, paranoia, persecution, verbal and/or physical attacks on others for no
apparent reason (not an exclusive list). Describe: __________________________________________________
__________________________________________________________________________________________
4. A general pervasive mood of unhappiness or depression, as shown by reports and information from multiple
sources and as seen in more than one setting. Provide time frame for evidence of unhappiness or depression,
such as changes in eating and/or sleeping patterns, persistent disobedience, low frustration tolerance, mood
swings, self-destructive behavior, suicidal ideation, and underachievement (not an exclusive list).
Describe: _________________________________________________________________________________
__________________________________________________________________________________________
5. A tendency to develop physical symptoms or fears associated with personal or school problems as confirmed
by reports from multiple sources. Provide time frame for physical symptoms such as stomachaches or headaches
related to school, school refusal, and high rate of absenteeism (not an exclusive list). Describe:
Emotional disability includes schizophrenia. The term does not apply to children who are socially maladjusted*, unless it
is determined that they have an emotional disability as defined in the Virginia Regulations. *(See ED/Social
Maladjustment checklist)
There is documentation of an Emotional Disability.
One or more of the following characteristics, exhibited over a long period of time and to a marked degree (check all that
apply):
□ An inability to learn that cannot be explained by intellectual, sensory, or health factors;
□ An inability to build or maintain satisfactory interpersonal relationships with peers and teachers as
□ Inappropriate types of behavior or feelings under normal circumstances;
□ A general pervasive mood of unhappiness or depression; or
□ A tendency to develop physical symptoms or fears associated with personal or school problems.
AND
There is documentation of an adverse effect on educational performance due to one or more documented characteristics of
an Emotional Disability.
STEP 3.
List and/or describe:
AND
STEP 4.
Due to the Emotional Disability, the student needs specially designed instruction.
28
ED OR SOCIALLY MALADJUSTED CHECKLIST
Complete this checklist as a team. At least seven items in column A required.
You may check both or neither under characteristic.
Column A
Characteristic
Emotional Disability
Conscience development
Self-critical; poor self-esteem;
feelings of guilt
Reality orientation
Withdraws into fantasy; naïve;
gullible
Adaptive behavior
Consistently poor
Aggression
Uncontrolled verbal or physical
aggression towards self or others
Bullying
Victim or perpetrator due to poor
social judgment
Anxiety
Tense; fearful; hypervigilant;
paranoid, suspicious
Depression
Persistent mood of sadness or
irritability with disturbance in
functioning across environments
Peer relations
School behavior
Locus of control
Issues of trust
Attitude toward authority
Rationality
Ignored or rejected; withdrawn;
unable to form and maintain
satisfactory age peer relationships
Inconsistent compliance, response
to structure, situations,
relationships, and achievement
Maintains external locus of
control; therefore, manipulated by
environment
Wants to trust; feels insecure; can
develop relationships
Unable to comply consistently
Unable to correctly identify a
problem and articulate its causes
or solutions
Column B
Social Maladjustment
Egocentric; lack of empathy; little
remorse
Able to manipulate situations for
gain; streetwise
Situationally dependent
Purposeful, premeditated
aggression towards others
Threatens and intimidates for
social or material gain
Indifferent; sullen; appears
relaxed
Sadness related to consequences
of actions and adjustment to life
circumstances, e.g., depressed
because he/she got caught
Accepted socially; outgoing;
friends the same age or older
Controls and manipulates
circumstances and relationships
for personal gain
Maintains internal locus of
control; able to manipulate the
environment
Does not trust those outside of
close circle of friends and family
Compliance based on personal
agenda
Dismisses ownership of a
problem; lacks personal
responsibility for actions
*According to the Diagnostic and Statistical Manual Fourth Edition (DSM-IV-TR), a student with a conduct disorder (social maladjustment)
displays a persistent pattern of behavior characterized by violating the rights of others and not following age-appropriate behavioral norms or
rules. Behaviors include: A. Threatening or aggressive behavior toward people and animals, B. destruction of property, C. deceitfulness or
theft, and D. serious violations of rules. Most or all behaviors will be manifested for the past twelve months, and at least one will be present
for the last six months. Social/academic functioning will be markedly impaired. Such students may have little concern for others and may
lack appropriate feelings of guilt or remorse.
29
Hearing Impairment Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Hearing Impairment. Review the definition, consider the items below, and note any
additional information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
STEP 2.
DEFINITION: "Hearing impairment" means an impairment in hearing in one or both ears, with or without
amplification, whether permanent or fluctuating, that adversely affects a child's educational performance but
that is not included under the definition of deafness contained in the Virginia Regulations.
There is documentation of a Hearing Impairment.
Characteristics include (check all that apply):
□ unilateral hearing loss (conductive, sensorineural, or mixed), or
□ bilateral hearing loss (conductive, sensorineural, or mixed), or
□ a fluctuating or permanent hearing loss, and/or
□ auditory dyssynchrony (auditory neuropathy)
□ other:__________________________________________________________
List and/or describe:
AND
STEP 3.
The hearing loss results in qualitative impairments in communication/educational performance.
AND
There is documentation of an adverse effect on educational performance due to the Hearing Impairment.
STEP 4.
List and/or describe:
AND
STEP 5.
Due to the identified Hearing Impairment, the student needs specially designed instruction.
30
Intellectual Disabilities Worksheet
Name:
D.O.B.
School:
Age:
Meeting date
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Intellectual Disability. Review the definition, consider the items below, and note any
additional information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
DEFINITION: "Intellectual disability" means significantly sub average general intellectual functioning, existing
concurrently with deficits in adaptive behavior and manifested during the developmental period that adversely
affects a child's educational performance.
Significant limitations in adaptive behavior and intellectual functioning (must be present concurrently):
□ At least 2.0 standard deviations below the mean, on an individually administered, standardized measure of intellectual
functioning with consideration given to the standard error of measurement for the assessment.
Standardized instrument used: ______________________
Score/Results:______________________
STEP 2.
□ Significantly impaired adaptive behavior, at least 2.0 standard deviations below the mean on an individual
standardized instrument of adaptive behavior.
The following skills represent the three areas of adaptive behavior:
Conceptual Skills - language and literacy, money, time, and number concepts; and self-direction
Social Skills - interpersonal skills, social responsibility, self-esteem, gullibility, social problem solving, and
the ability to follow rules, obey laws, and avoid being victimized
Practical Skills – activities of daily living, occupational skills, healthcare, travel/transportation,
schedules/routines, safety, use of money, use of the telephone
Standardized instrument used: ______________________
Composite Score/Results:______________________
□ There is a developmental history (birth through 18) that indicates significant impairment in intellectual functioning
and a current demonstration of a significant impairment is present. Age at Identification:_________________
AND
STEP 3.
There is documentation of an adverse effect on educational performance due to the documented characteristics of an
intellectual disability.
List and/or describe:
AND
STEP 4.
Due to the intellectual disability, the student needs specially designed instruction.
31
Multiple Disabilities Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Multiple Disabilities. Review the definition, consider the items below, and note any
additional information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
STEP 2.
DEFINITION: "Multiple disabilities" means simultaneous impairments (such as intellectual disability
with blindness, intellectual disability with orthopedic impairment), the combination of which causes such
severe educational needs that they cannot be accommodated in special education programs solely for one of
the impairments. The term does not include deaf-blindness.
There is documentation of multiple disabilities. Simultaneous impairments (such as intellectual disability with blindness,
intellectual disability with orthopedic impairment) are present and individual specific disability worksheets are attached.
List disability worksheets completed: _________________________________________
AND
There is documentation that the combination of impairments causes such severe educational needs that they cannot be
accommodated in special education programs solely for one of the impairments.
STEP 3.
List and/or describe:
AND
STEP 4.
The student does not have Deaf-blindness.
32
Orthopedic Impairment Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Orthopedic Impairment. Review the definition, consider the items below, and note any
additional information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
STEP 2.
DEFINITION: “Orthopedic Impairment” means a severe orthopedic impairment that adversely affects a child’s
educational performance. The term includes impairments caused by congenital anomaly, impairments caused
by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g. cerebral
palsy, amputations, and fractures or burns that cause contractures).
There is documentation of an Orthopedic Impairment (check all that apply):
□ Congenital anomaly
□ Impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.)
□ Impairments from other causes
List and/or describe:
AND
There is documentation of an adverse effect on educational performance due to the Orthopedic Impairment.
STEP 3.
List and/or describe:
AND
STEP 4.
Due to the identified Orthopedic Impairment, the student needs specially designed instruction.
33
Other Health Impairment Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Other Health Impairment. Review the definition, consider the items below, and note any
additional information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
DEFINITION “Other Health Impairment" means having limited strength, vitality or alertness, including a
heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational
environment, that is due to chronic or acute health problems such as asthma, attention deficit disorder or
attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning,
leukemia, nephritis, rheumatic fever, and sickle cell anemia and Tourette syndrome that adversely affects a
child’s educational performance.
There is documentation of an Other Health Impairment. The effect of the Other Health Impairment limits are
identified and impacts the students in the area of (check all that apply):
□ Strength
□ Vitality
□ Alertness (including heightened alertness to environmental stimuli, that results in limited alertness with respect
to the educational environment)
Indicate chronic or acute health condition:
□ Attention deficit disorder or attention deficit hyperactivity disorder (see criteria worksheet)
□ Asthma
□ Leukemia
□ Diabetes
□ Nephritis
□ Epilepsy
□ Rheumatic fever
STEP 2.
□ Heart condition
□ Sickle cell anemia
□ Hemophilia
□ Tourette syndrome
□ Lead poisoning
□ Other (describe):
List and/or describe:
AND
There is documentation of an adverse effect on educational performance due to one or more documented characteristics of
the Other Health Impairment.
STEP 3.
List and/or describe:
AND
STEP 4.
Due to the identified Other Health Impairment, the student needs specially designed instruction.
34
Name:
School:
Completed by:
DOB
Date:
(please print)
ATTENTION DEFICIT/HYPERACTIVITY DISORDER IDENTIFICATION WORKSHEET
CRITERIA. A Student with AD/HD will meet all the following criteria. For each criterion indicate yes or
no.
_____ A. Either (1) or (2):
1. six (or more) of the following symptoms of inattention have persisted for at least 6 months to
a degree that is maladaptive and inconsistent with developmental level:
Inattention
 a. often fails to give close attention to details or makes careless mistakes in schoolwork,
work, or other activities
 b. often has difficulty sustaining attention in tasks or play activities
 c. often does not seem to listen when spoken to directly
 d. often does not follow through on instructions and fails to finish schoolwork, chores, or
duties in the workplace (not due to oppositional behavior or failure to understand
instructions)
 e. often has difficulty organizing tasks and activities
 f. often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
(such as schoolwork or homework)
 g. often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils,
books, or tools)
 h. is often easily distracted by extraneous stimuli
 i. is often forgetful in daily activities
2. six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at
least 6 months to a
degree that is maladaptive and inconsistent with developmental level:
Hyperactivity
 a. often fidgets with hands or feet or squirms in seat
 b. often leaves seat in classroom or in other situations in which remaining seated is expected
 c. often runs about or climbs excessively in situations in which it is inappropriate (in
adolescents or adults, may be limited to subjective feelings of restlessness)
 d. often has difficulty playing or engaging in leisure activities quietly
 e. is often “on the go” or often acts as is “driven by a motor”
 f. often talks excessively
Impulsivity
 g. often blurts out answers before questions have been completed
 h. often has difficulty awaiting turn
 i. often interrupts or intrudes on others (e.g., butts into conversations or games)
_____ B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before
age 7 years.
_____ C. Some impairment from the symptoms is present in two or more settings (e.g., at school [or work]
and at home).
_____ D. There must be clear evidence of clinically significant impairment in social, academic, or
occupational functioning.
_____ E. The symptoms do not occur exclusively during the course of a Pervasive Developmental Disorder,
Schizophrenia, or other Psychotic Disorder and are not better accounted for by another mental
disorder (e.g., Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality
Disorder).
35
Specific Learning Disability Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children
with Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being
considered for eligibility under the category of Specific Learning Disability. Review the definition, consider the items below,
and note any additional information. Attach this worksheet to the Eligibility Summary Form and include any necessary
documentation.
STEP 1.
DEFINITION: “Specific Learning Disability” means a disorder in one or more of the basic psychological
processes involved in understanding or in using language, spoken or written, that may manifest itself in the
imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations, including such
conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental
aphasia. Specific learning disability does not include learning problems that are primarily the result of visual,
hearing, or motor disabilities; of intellectual disabilities; of emotional disabilities; of environmental, cultural, or
economic disadvantage.
AND
Criteria
A child with a specific learning disability who requires special education and related services will meet ALL of the
following criteria. In interpreting evaluation data, the committee must document and carefully consider information from
a variety of sources. For each criterion indicate Yes or No and provide additional information where indicated.
STEP 2.
Yes
No
The student’s learning problems are not primarily the result of: 1. a visual, hearing, or motor impairment, 2. an
intellectual disability, 3. an emotional disability, 4. cultural factors, an environmental or economic disadvantage, or
5. limited English proficiency.
AND
STEP 3.
Underachievement
The student does not achieve adequately for the student’s age or to meet Virginia-approved grade-level standards in one or
more of the following areas, when provided with learning experiences and instruction appropriate for the student’s age or
Virginia-approved grade-level standards. Consider a pattern of underachievement across norm-referenced achievement
tests (e.g., WJ-III, WIAT-III, KTEA-III) criterion-referenced tests (e.g., SOLs, DRAs, PALs), classroom performance,
curriculum-based measurements, and response to intervention. (check all that apply):
Yes
No
□ Reading comprehension
□ Oral Expression
□ Basic reading skills
□ Listening comprehension
□ Reading fluency skills
□ Mathematical calculations
□ Written expression
□ Mathematical problem solving
Comment:
AND
36
Yes
No
Data of Instruction and Assessment
The underachievement of the child suspected of having a specific learning disability is not due to lack of appropriate
instruction in reading, math, or written expression. The committee considered:
STEP 4.
□ Data that demonstrated that prior to, or as part of, the referral process, the child was provided appropriate Tier II/
research-based instruction in general education settings, delivered by qualified personnel; and
□ Data-based documentation that repeated assessments of achievement at reasonable intervals, reflecting that formal
assessment of student progress during instruction was compiled and reviewed. Check all that were considered:
□ Child Study or Intervention Team Plan(s)
□ Response to Intervention
□ Phonological Awareness & Literacy Screening (PALS)
□ Other: ______________________________
□ Developmental Reading Assessment (DRA)
□ Running Records
□ Curriculum-Based Measures
Identify interventions as well as dates and durations:
AND
Yes
No
Evaluation outcomes (check all that apply):
The student exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative to
age, Virginia-approved grade-level standards, or intellectual development that is determined by the group to
be relevant to the identification of a specific learning disability, using appropriate assessments. In identifying
a pattern of strengths and weaknesses, the following criteria must be met:
Yes
No
1) The child has a deficit (at least one standard deviation) in one or more cognitive abilities/processes (broad or narrow)
below what is expected for the child’s age, and the cognitive deficit(s) exists within a pattern of significantly higher
abilities.
STEP 5.
Comment:
Yes
No
2) The identified cognitive deficit(s) is related (empirically or logically) to the underachievement, if identified above.
Identify areas of underachievement that are related to cognitive deficit:
AND
Yes
No
There is documentation of an adverse effect on educational performance due to one or more documented characteristics of
a specific learning disability.
STEP 6.
List and/or describe:
AND
STEP 7.
Yes
No
The student needs specially designed instruction.
37
Speech-Language Impairment Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Speech-Language Impairment. Review the definition, consider the items below, and note
any additional information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
STEP 2.
DEFINITION: “Speech-Language Impairment” means a communication disorder, such as dysfluency
(stuttering), impaired articulation, expressive or receptive language impairment or a voice impairment that
adversely affects a child’s educational performance.
There is documentation of a significant discrepancy from typical communication skills in one of the areas below (check all
that apply):
□ Fluency
□ Receptive or expressive language
□ Articulation
□ Voice
List and/or describe:
AND
STEP 3.
The student does not demonstrate Limited English Proficiency (LEP) and/or is not a speaker of a sociocultural dialect that
is the primary reason for the speech-language impairment.
AND
There is documentation of an adverse effect on educational performance due to one or more documented characteristics of
Speech-Language Impairment.
STEP 4.
List and/or describe:
AND
STEP 5.
Due to the identified Speech-Language Impairment, the student needs specially designed instruction.
38
Traumatic Brain Injury Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Traumatic Brain Injury. Review the definition, consider the items below, and note any
additional information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
DEFINITION: "Traumatic Brain Injury" means an acquired injury to the brain caused by an external physical
force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely
affects a child's educational performance. Traumatic brain injury applies to open or closed head injuries
resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning;
abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psychosocial behavior;
physical functions; information processing; and speech. Traumatic brain injury does not apply to brain injuries
that are congenital or degenerative, or to brain injuries induced by birth trauma.
There is documentation of a Traumatic Brain Injury.
STEP 2.
List and/or describe:
AND
STEP 3.
There is documentation of impairments in one or more areas including (check all that apply):
Cognition
Language
Memory
Attention
Reasoning
Abstract thinking
Judgment
Problem-solving
Speech
Psychosocial behavior
Physical functions Information processing
Sensory
Perceptual
Motor abilities
List and/or describe:
AND
STEP 4.
The brain injury is not congenital, degenerative, or induced by birth trauma. (34 CFR 300.8(c)(12))
AND
There is documentation of an adverse effect on educational performance due to one or more documented characteristics of
traumatic brain injury.
STEP 5.
List and/or describe:
AND
Due to the identified Traumatic Brain Injury, the student needs specially designed instruction.
39
40
Visual Impairment including Blindness Worksheet
Name:
D.O.B.
School:
Age:
Meeting Date:
Grade:
In application of the Virginia Department of Education’s Regulations Governing Special Education Programs for Children with
Disabilities in Virginia, this worksheet shall assist the eligibility group in applying criteria for students who are being considered
for eligibility under the category of Visual Impairment. Review the definition, consider the items below, and note any additional
information. Attach this worksheet to the Eligibility Summary Form and include any necessary documentation.
STEP 1.
DEFINITION: “Visual Impairment including Blindness” means an impairment in vision that, even with
correction, adversely affects a child’s educational performance. The term includes both partial sight and
blindness.
There is documentation of a visual impairment and the child demonstrates the characteristics of blindness or visual
impairment (check all that apply):
 A child with blindness has (check all that apply):
□ Visual acuity in the better eye with best possible correction of 20/200 or less at distance or near; or
□ Visual field restriction in the better eye of remaining visual field of 20 degrees or less.
STEP 2.
 A child with a visual impairment demonstrates the following (check all that apply):
□ Visual acuity better than 20/200 but worse than 20/70 at distance and/or near; or
□ Visual field restriction in the better eye of remaining visual field of 70 degrees or less but better than 20 degrees.
List and/or describe:
AND/OR
STEP 3.
The child has any of the conditions, which may in the future, have an adverse effect on educational performance, or a
functional vision loss where field and acuity deficits alone may not meet the aforementioned criteria (check all that apply).
□ Oculomotor apraxia
□ Cortical visual impairment
□ A progressive loss of vision
□ Other:__________________________
List and/or describe:
AND
There is documentation of an adverse effect on educational performance due to the visual impairment.
STEP 4.
List and/or describe:
AND
STEP 5.
Due to the identified visual impairment, the student needs specially designed instruction.
41
QUALITY MEETING GUIDELINES
1.
Participants are punctual.
2.
Meetings start at the specified time.
3.
Meetings are uninterrupted.
4.
Participants listen actively.
5.
There are no one-to-one or side meetings.
6.
There is active participation.
7.
Participants respect the agenda.
8.
There is freedom to check process and ground rules.
9.
Participants are willing to reach consensus.
“Although I may not agree with the team’s decision, I can support it because it has
been reached through a fair and open process that has considered my point of view.”
10. Participants share responsibility for team’s progress.
11. Timekeeping is observed.
42
QUALITY MEETING GUIDELINES (continued)
Quality meeting guidelines describe agreements that team members can make to conduct meetings in a
courteous and business-like way in order to save time and add to the productivity of the team.
It is useful to post these guidelines at meetings, to review them from time to time and to renew the
agreement to observe them.
Team members will respect the time of others by arriving
promptly at the appointed time and place of the meeting.
To accommodate team members’ busy schedules and
Meetings start at the specified
make sure the meeting concludes on time, meetings will
time.
begin promptly at the specified time, whether or not all
team members are present.
To avoid disrupting group processes and delaying the
Meetings are uninterrupted.
conclusion of the meeting, team members will make
whatever arrangements are necessary so as not to be
interrupted during the meeting.
Team members will pay close attention so that they can
Participants listen actively.
receive the information being presented, mentally process
it, and formulate responses to the questions asked and
issues raised.
All team members will participate in the same meeting.
There are no one-to-one or side
There will be no one-to-one conversations or side
meetings.
meetings; questions, ideas, and thoughts will be shared
with the group.
Team members will use appropriate interactive skills to
There is active participation.
participate actively in the group processes: initiating,
reacting, and clarifying.
In order to complete the business at hand and conclude
Participants respect the agenda.
the meeting on time, the group should adhere to the
agenda. In the event that additional issues arise that the
group must deal with, then the agenda needs to be revised
and the time reallocated.
There is freedom to check process Each team member shares responsibility for keeping the
meeting on track and, therefore, should not hesitate to
and ground rules.
call for a process check or a review of the ground rules.
Participants are punctual.
43
QUALITY MEETING GUIDELINES (continued)
Participants are willing to reach
consensus.
The quality consensus model does not require unanimous
agreement. The quality model calls for the consideration
of everyone’s opinion in a fair and open process.
Consensus is reached when all team members agree that
they can willingly support the team’s decision. In other
words, consensus has been achieved when each team
member either agrees wholeheartedly with the team or
can sincerely make the following statement:
“Although I may not agree with the team’s decision, I
can support it because it has been reached through a fair
and open process that has considered my point of view.”
Participants share responsibility
for team’s progress.
Timekeeping is observed.
In the event that one or more team members cannot agree
to support the decision, consensus has not been reached
and the process will continue until a decision is reached
that all parties can support. Sometimes that “supportable
decision” will be to select an alternative method for
reaching a final agreement or to postpone the final
decision.
Each team member bears individual responsibility for
contributing actively to a positive group process that
supports the team efforts to complete specified tasks
and/or achieve agreed-upon goals.
To accommodate team members’ busy schedules and
conclude the meeting on time, while at the same time
making sure that all agenda items are addressed,
timekeeping must be initiated and observed.