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Introduction to EVALUATION

The goal of a special education evaluation is to consider eligibility for special

education and to identify significant barriers to the education of the disabled

child. Regardless of the child’s identified category, or categories, of eligibility, the

law requires that services be provided in all areas of significant educational

impact. Therefore, the evaluation determines not only who gets an IEP, but also

clarifies exactly what areas of need must be addressed in that IEP.

An evaluation is technically defined as “procedures used to determine whether

the student is disabled, and the nature and extent of the special education and

related services that the child needs”. The evaluation must address all areas of

suspected disability for each student. For children with limited English proficiency,

tests and procedures are administered that measure the extent to which the child

has a disability and needs special education, rather than merely measuring the

child’s English language skills. In interpreting evaluation data, the IEP team will

draw on information from a variety of sources, including the parents, and ensure

that all information is documented and carefully considered.

Parents have several key roles in the evaluation process. Parents must be invited

to participate in all decisions that may affect their child’s education. In planning

and completing an evaluation, parents must be informed of any referral of their

child (Form R), and invited to be team members when

• considering a referral for special education evaluation

• determining the evaluation plan (types of assessments to be

completed)

• obtaining consent to evaluate

• completing assessments, including identification of the student’s

strengths and interests, and completion of developmental history and

rating scale measures.

Pressure is sometimes exerted by parents or regular classroom teachers to test,

identify, and provide services to a student who does not technically qualify for

special education. Special education eligibility is not always the panacea for

every student, and special education services cannot be truly effective for

students with documented disabilities if group sizes are significantly increased due

to inappropriate eligibility decisions. We have a statutory responsibility not to label

students as disabled unless they truly meet eligibility requirements and need

specially designed instruction. It is also our responsibility to effectively advocate

for students who truly are disabled, even in the face of parent denial. In each of

these difficult scenarios, you need to rely on your background in special

education and your relationship with the parents and classroom teachers to

negotiate a plan that will benefit each student and preserve a positive

relationship with parents and staff. It is typically very helpful to focus on student

needs and brainstorm ways to meet those needs in order to reach consensus.

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OVERVIEW OF EVALUATION PROCESS Evaluation in educational settings is a process involving far more than the

administration of a given test or tests. Assessment is an evaluative, interpretive

appraisal of objective data, gathered from observations, parent and teacher

interview, records review, work samples, responses to intervention and

standardized tests, which is used to:

� determine a student’s current level of functioning, including the student’s

strengths and weaknesses;

� determine whether a student meets the criteria for a disability

� determine whether a student is in need of special education and related

services;

� provide information for developing an Individualized Education Program

(IEP).

Responsible Assessment Each specialist conducting assessments has the responsibility to assure that

techniques employed are conducted and interpreted in a non-discriminatory

manner drawn from a variety of sources, including the student’s parent(s), using

the criteria below as guidelines:

Assessment instruments are:

� used in accordance with recognized professional standards;

� appropriate for students with impaired intellectual, sensory, physical, or

communicative skills;

� appropriate for student’s age, socio-economic and cultural

background with exceptions noted;

� administered in the student’s primary language;

� administered, if possible, at the school the student attends;

� appropriate and limited to specific areas of concern.

Specialists administering assessment procedures:

� are knowledgeable about local culture, language, and social patterns

and practices;

� have knowledge of the norm group for norm-referenced tests;

� have knowledge of the reliability and validity of any standardized

instruments;

� include in their interpretation of results any degree and type of potential

discrimination of the instruments employed during the assessment

process;

� consider the possibility of bias in assessment whenever results are

significantly different from reports of the student’s functioning in different

settings;

� employ multiple instruments and observations (including parent input) in

order that interpretation and decisions are not based on the results of a

single instrument, test score, observation, or report.

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EVALUATION AND REEVALUATION PLANNING

� The team (including the parent) will review existing evaluation data, including

evaluations and information provided by the parents of the child, current

classroom-based assessment and observations, student responses to

intervention, and teacher and related service providers’ observations. This

must be completed 60 school days from the due date of the 3 year

reevaluation.

� On the basis of that review and input from the child’s parents, the team will

identify what additional data, if any, are needed to complete a

comprehensive evaluation in all areas of concern. If a re-evaluation complete

a Re-evaluation Planning Form to document whether or not further evaluation

is required. (see Overview of Re-Evaluation for further details)

� The Evaluation Planning (IEP) team will assure that assessment tools and

strategies provide relevant information that assists in determining the

educational needs of the child, not just eligibility for special education.

� The assessment will include information related to enabling the child to be

involved in progress in the general curriculum.

� At the time of parent consent for evaluation the Special Education Evaluation

Tools Checklist will be completed which identifies and describes what

assessments will be used in the evaluation. Parent will initial next to each

assessment to be used. This form is to be attached to the Prior Notice and

Consent for Evaluation form and must be presented in the parent’s native

language in addition to the English form for the file.

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INITIAL EVALUATION PROCEDURES

The district is required to have a team conduct a full and individual initial

evaluation before the initial provision of special education and related services to

a child. The initial evaluation shall consist of procedures to determine:

1. Whether the child has a disability; 2. The educational needs of a child with a disability; and 3. The present levels of academic achievement and related

developmental needs.

Required Parent Consent and Input The district shall obtain an informed consent from the parent* prior to conducting

the initial evaluation. A Prior Notice and Consent for Evaluation form will be

completed by the Special Education Case Manager. Parents will be informed of

the areas in which evaluation procedures, assessments and/or tests may be used.

The evaluators may designate tests they intend to use during the evaluation, but

that shall not limit the discretion of evaluators in selecting test instruments that

address areas of concern uncovered during the course of the evaluation. The

Special Education Evaluation Tools Checklist will document what assessments will

be used in the evaluation. Parents will be notified of any changes in the

assessment tools used and a Prior Notice of Special Education Action form will be

completed indicating the changes of assessments. All Prior Notices will be in

parent’s native language (with a copy in English as well). If the parents refuse

consent for the evaluation, the District may continue to pursue an evaluation

through mediation and/or due process procedures. (This would be extremely

unlikely, since the District is prohibited from filing due process to compel a parent

to consent to Prior Notice and Consent for Initial Provision of Special Education

Services.) After the consent is signed by parent, it will be sent along with the

appropriate referral form(s), checklist of tools and Red Zone documentation to the

Office of Student Services Director to be processed.

• Woodburn SD Evaluation Referral Form: to be used for the following

evaluations – Intellectual Disability, Communication Disorder (including the

communication piece for autism, which means both referral forms will need

to be used), Emotional Disturbance, Traumatic Brain Injury, Other Health

Impaired, Specific Learning Disability

• WESD Regional Services Referral Form: to be used for the following

evaluations – Hearing Impairment, Vision Impairment, DeafBlindness,

Orthopedic Impairment and Autism Spectrum Disorder (Communication

portion done by district staff using the Woodburn referral form).

Originals will be sent back to the Learning Specialist. Team is expected to begin

evaluation at time of written consent.

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Several suspected disability areas require medical input. This information is not

only a legal requirement for these suspected disability conditions, but provides

important information in the confirming or denying medical impact upon the

child’s educational performance. A Medical Statement or Health Assessment

form is provided for this purpose. It is essential that parent signature be obtained

for Permission to Release and Obtain Information form, so that the case manager

can obtain this information from the health provider prior to the eligibility meeting.

In an effort to gain systematic information and data from parents contributing to

the evaluation, the Developmental History Form will be distributed to parents at

the time of pre-referral by school SIT team. If it has not been completed then the

case manager should have the SIT complete this data collection tool before

moving forward with Consent for Evaluation. The purpose of this form is to provide

parent input directly into the evaluation, either through written or interview

procedures. This input from parents is an important and required component of

the evaluation.

Required Teacher Input

The IDEA requires input from the student’s regular classroom teacher to address

the impact of the suspected disability on the student’s ability to function in the

general curriculum. Typically, this information should be found in the Red Zone

documentation, if not the Regular Classroom Teacher Checklist is provided as a

resource to document this important information.

Procedures for Evaluating for Specific Learning Disability

For initial evaluations, our district uses a process of Patterns of Strengths and

Weaknesses when evaluating for a Specific Learning Disability. This will be

discussed further in the Eligibility section of this manual.

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INITIAL EVALUATION

SUMMARY OF KEY POINTS…

♦ The evaluation planning team and the other qualified professionals, as appropriate,

shall review existing information and concerns about the child, including:

◊ Evaluations and information provided by the parents;

◊ Current classroom-based assessments and observations;

◊ Teacher observations;

◊ Student Response to Interventions

♦ On the basis of that review, and input from the child’s parents, the IEP will determine

whether the concerns warrant an evaluation and, if so, what measures are needed to

evaluate all areas of concern and determine:

◊ Whether the child meets eligibility requirements in one or more disability categories;

◊ The present levels of academic achievement and related developmental needs of

the child;

◊ Whether the child needs special education and related services;

◊ Whether any accommodations or modifications are needed to meet IEP goals and

◊ To participate, as appropriate, in general curriculum.

♦ If an evaluation has been requested by the parent and the team decides there is no

compelling reason to initiate an evaluation, the team rationale must be carefully

documented and Prior Notice of Special Education Action must be provided to the

parent.

♦ The assessment team shall administer such tests and other evaluation materials as

determined necessary by the evaluation planning team. Assessments will be recorded

on the Special Education Evaluation Tools Checklist. This includes gathering

documentation, such as medical statements, records reviews, and hearing and vision

screenings, to consider whether the student meets ALL eligibility requirements in each

area of concern prior to the eligibility meeting.

♦ Informed consent shall be obtained from the parents prior to conducting an initial

evaluation. An eligibility meeting must be convened within 60 school days* after

consent to evaluate is signed.

♦ Parent signature shall be obtained on the Permission to Obtain and Release

Confidential Information Form whenever medical or other agency information is

essential to a comprehensive evaluation.

♦ The assessment team will gather Developmental History, if not already completed by

the school SIT Team information from the parent, as well as a description of the parents

concerns and the student’s strengths and interests.

♦ The assessment team will gather information from regular education teachers

regarding the student’s ability to progress in the general curriculum (from the Red Zone

Documentation or Regular Education Teacher Checklist)

♦ The 60 school day timeline does not apply if (1) the parent repeatedly fails or refuses to produce the student

for the evaluation, or (2) the student transfers into Woodburn after the consent for evaluation was signed and

prior to the eligibility meeting in another district as long as Woodburn ensures prompt completion of the

evaluation and the parent and district agree to a specific time when the evaluation will be completed (Written Agreement Between Parent and the District: Completion of Evaluation of Transfer Student.)

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OVERVIEW OF REEVALUATION

Reevaluation is conducted at least every three years following the

establishment of initial eligibility, to re-determine eligibility under one or more

disability categories and the student’s need for special education. It may

include administration of standardized tests or checklists, and/or the

collection of data from continuous direct measurement of student progress

or performance and information provided by the parent(s) and classroom

teachers. The process of reevaluations may be conducted:

� Whenever there is the potential for changing a student’s eligibility;

� When a significant change in student performance warrants a reappraisal

of educational or related service needs, including improved academic

and functional performance.

� Every three years for the required formal process to reestablish a student’s

eligibility and to determine if a student continues to need special

education services, unless the parent(s) and district agree that no

reevaluation is needed.

� When a child’s parents or teacher request a reevaluation. (The case

manager must provide Prior Notice of Special Education Action whenever

the team refuses to initiate an evaluation requested by a parent.)

Reevaluations may not occur more frequently than once a year unless the

parent(s) and district agree.

When planning a reevaluation, the IEP team and other qualified professionals, as

appropriate, must determine whether additional data is or is not needed to

determine that the child continues to evidence a disability and to need special

education. A Re-Evaluation Planning Form is provided to assist in this review and

decision making process. Based on this review, the parent and district may agree

that current information provides sufficient data and that new testing is not

needed to complete the reevaluation. This form documents the Written

Agreement between the Parent and District if no further evaluation is required, so

no other documents are needed and the team may move directly to Eligibility

Determination. If further evaluation is required, the team obtains parent consent

for evaluation.

It is typically in the best interests of district assessment personnel and the student

to make the triennial reevaluation as simple and non-repetitive as possible. In

other words, the functional, on-going student progress data, including statewide

and district-wide assessment results, collected during provision of special

education services over the past three years is typically considered more

pertinent and relevant than standardized testing. Given good functional

information to determine continuing eligibility and development of the IEP, then,

the district has a preference for using this information and not conducting an

additional evaluation. If new testing is not needed, the Statement of Eligibility

will be completed using previous testing dates, current dates when previous test

results were reviewed, and the dates recent functional assessments were

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REEVALUATION FLOW CHART

Student is due for triennial reevaluation; IEP team feels the student requires a

reevaluation for programming purposes; not more frequently than once a year.

Evaluation Planning team, including parents, determines which testing, if any, is required

to conduct the reevaluation using the Re-Evaluation Planning Form 60 school days prior to

3 year reevaluation due date.

No testing required Only testing required

does not include

personality or

intelligence testings.

Team determines need

for personality and/or

intelligence testing.

Proceed to Eligibility

Determination Complete Prior Notice and Consent for Evaluation Notice form. Check “To reevaluate”

box.

Complete Prior Notice and Consent for Evaluation Notice form. Check “To reevaluate” box.

Under the title “Consent

for Evaluation” check the

third box under “We

request your consent

because…”.

Under the title “Consent

for Evaluation”, check the

second box in the left

column.

Seek parent consent.

Document three

attempts.

Seek Parent consent.

Document three

attempts.

Complete evaluation

within 60 school days of

consent.

Complete evaluation

within 60 school days of

consent.

If no response in 10

days, conduct evaluation.

The personality and/or

cognitive testing cannot

be conducted without

parent consent.

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If no response in 10 days,

observations, academic

and communication testing

may begin

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OVERVIEW OF STUDENT PROGRESS ASSESSMENT Continuous assessment is an ongoing measurement of actual student functioning and the

recording of behavior and performance relevant to that functioning. The use of such a

system results in the IEP objectives being based on the direct measurement of student

performance. Thus, interventions may be readily changed and the IEP evaluated easily.

Two types of measurement formats are described below and may be helpful for annual

reviews of specific IEP objectives, as well as for gathering data to determine whether a

student might qualify for extended school year services.

1. Performance Measurement is designed to assess how a student’s behavior

changes on a single task over a period of time. Direct observation and

recording of student academic and social behaviors are the essential

ingredients of performance measurement. These behaviors may be measured

and depicted in terms of rate (frequency), accuracy (mastery), duration

(period of time), latency (period before response), or intensity (degree),

dependent upon what is being measured and what decisions need to be

made. A performance measurement system includes seven major steps:

� Selection of an academic or social target behavior;

� Baseline measurement and recording of the target behavior;

� Implementation of an intervention;

� Continuous measurement and recording of the target behavior;

� Display of the data;

� Interpretation and analysis of data on which to base decisions regarding

interventions;

� Implications of changes based on the data;

� Relationship of the data to performance on the general curriculum.

2. Progress Measurement is designed to assess the student’s mastery of a set of

sequenced objectives or tasks. The objectives with a criterion for mastery are

usually linked to a curriculum. Two approaches can be used to implement a

student progress measurement system.

� One approach is the measurement of a student’s progress in a published

curriculum. Progress might be indicated by the number of pages read,

number of unit tests mastered at 80%, etc.

� The other approach concentrates on a task analysis of the target behavior.

For example, the behavior brushing teeth may be broken into ten sub-steps.

In this approach, the teacher would then monitor the number of sub-steps

the student successfully completes in a sequence.

� Relate this progress to the student’s ability to perform general curriculum

tasks in the regular classroom.

Special education students are required to take appropriate statewide and district-wide

assessments. This performance data should be included in any discussion of student

progress, continuing eligibility or IEP development.

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EVALUATING ENGLISH LANGUAGE LEARNERS

On many occasions students with diverse language and cultural backgrounds are

referred for a special education evaluation. Many referrals for students with

diverse language and cultural backgrounds can lead to inappropriate referrals for

special education evaluations. It is important to gather further information

specifically around the diversities present in order to get the most accurate

information possible. It will be important to invite the building bilingual coordinator

into the evaluation process in gathering of information.

In addition to the cumulative file review, intervention log, and parent input the

following information must be gathered before a special education evaluation

can be made:

• Documented record of Language Scores in English and native language

from language assessments - Woodcock Munoz in English and Spanish

(required to happen at the beginning of the SIT Red Zone), and the English

Language Proficiency Assessment (ELPA)

• Work samples in both English and native language. This information

collected will insure a more detailed synopsis of students with diverse

language and cultural backgrounds and lead to more precise interventions

and / or special education evaluation referrals.

• Completed PreReferral Review for Diverse Learners Form (as appropriate)*

• Completed Acculturation Quick Screen (AQS) Form (as appropriate)*

• Completed Sociocultural Resiliency Checklist Form (as appropriate)*

• Completed Classroom Language Interaction Checklist Form (as

appropriate)*

*While not all of these tools are required, they are highly recommended for use

and analysis to determine the specific needs of culturally diverse students.

When evaluating English Language Learners Woodburn School District will ensure

that:

� Tests and other evaluation materials used to assess a student:

� Are selected and administered so as not to be racially or

culturally discriminatory;

� Are provided and administered in the student’s native

language or other mode of communication unless it is clearly

not feasible to do so and;

� Materials and procedures used to assess a student with limited

English proficiency are selected and administered to ensure

that they measure to the extent to which a student has a

disability and needs special education, rather than measuring

the student’s English language skills

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SUMMARIZING EVALUATION

In summary, the term EVALUATION may refer to initial evaluation, reevaluation,

and student progress assessment. Initial evaluation and reevaluation include

the administration of norm-referenced or criterion-referenced standardized or

non-standardized tests and data from continuous assessment and/or direct

observations.

� All evaluations require parental notification and, when testing is needed,

written consent before procedures commence, with the following

exceptions:

• When standardized tests listed under Evaluation Procedures on the

goals and objectives page of the IEP are administered as part of

continuous assessment, parental consent is not required.

• When, after reasonable attempts to gain consent for a reevaluation

have been made, parents have not responded, observations,

academic, and communication testing may proceed.

� Written parental consent is always required prior to administering tests of

intelligence or personality.

� Written parental consent is not required for functional student progress

assessment.

� The Re-Evaluation Planning Form is required when determining whether

further testing is required for a 3-year evaluation. It stands as the Written

Agreement when the team determines that no new testing is needed for a

reevaluation.

� Evaluations must be completed and an eligibility meeting scheduled within

60 school days of obtaining parent consent for the evaluation unless:

• The student attends a new school district after consent is given but

before the evaluation is conducted. (See Transfer section.)

• The parent fails to, or repeatedly refuses to, produce the student for

evaluation.

� Reevaluations must occur at least once every three years, unless the parent

and district agree that the reevaluation is unnecessary. Re-evaluations may

not occur more frequently than once a year, unless the parent and the district

agree otherwise.

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OVERVIEW OF INDEPENDENT EDUCATIONAL EVALUATION (IEE)

SUMMARY OF KEY POINTS…

� The parent has the right to an IEE at public expense if they disagree with an

evaluation conducted by the school district, and comply with district

criteria for IEEs;

� All IEE requests will be referred to the Director of Special Services;

� The Director will provide the parents, on request, information about where

an IEE may be obtained;

� The District may initiate a hearing to show that its evaluation is appropriate.

If the final decision of the hearing is that the evaluation is appropriate, the

parents still have a right to an IEE, but not at public expense;

� The IEE must be considered, by the school, in any decision made regarding

FAPE;

� The IEE results may be presented at a hearing;

� If the hearing officer requests an IEE, the IEE must be at public expense. In

this situation, the requirements of the evaluation must be the same as when

the district initiates an evaluation.

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Criteria for Independent Educational Evaluations Woodburn School District #103

1. Parents of children eligible for services under the Individuals with Disabilities

Education Act (IDEA, at 20 U.S.C.A. 1401, et seq.) are entitled to an

Independent Educational Evaluation (IEE) of their child if the parent

disagrees with an evaluation obtained by Cascade School District. 34

C.F.R. 300.502(b). The IEE must be requested within six months of the

completion of the district’s evaluation. All such requests shall be referred to

the Director of Special Services.

2. An IEE is defined as an evaluation conducted by a qualified examiner who

is not employed by the school district responsible for the education of the

child in question. 34 C.F.R. 300.502(a)(3)(I).

3. Parents may obtain an IEE at the expense of the school district or at their

own expense. As stated above, the right to request an IEE is dependent

upon a parent’s disagreement with an existing evaluation performed by

the District. If Woodburn School District has not performed its own

evaluation in a particular area of disability, the parent does not have a

right to an IEE with respect to that area until after the District performs an

assessment in that disability area. Only one IEE may be funded for each

evaluation obtained by the District. In addition, parents may be asked to

explain what areas of the District’s assessment they disagree with, but are

not required to answer specifically as a pre-condition to District funding of

the IEE.

4. If Woodburn wishes to deny a request for a district-funded IEE, it must

initiate a special education due process hearing within a reasonable time

to show that the evaluation objected to by the parent is appropriate. If the

final decision of the proceeding is that the district evaluation is appropriate,

the parents still have a right to an IEE, but not at district expense. 34 C.F.R.

300.502(b)(2)(I) & (b)(3).

5. The results of an IEE, whether funded by the parents or the District, shall be

considered by the IEP Team within 30 school days of receipt of the IEE

report, in any decision made with respect to the provision of a free

appropriate public education to the child, and may be presented as

evidence at a special education due process hearing regarding that child.

34 C.F.R. 300.502(c)(1). The fact that an IEP Team reviews and considers an

IEE, however, does not automatically render Woodburn School District

liable for the costs of such evaluation.

6. If a special education hearing officer requests an IEE as part of a hearing,

the evaluation must be funded by the school district. 34 C.F.R. 300.502(d).

7. Without unnecessary delay after the request for a district-funded IEE is

received, the Director of Special Services will provide the parents with a list

of 3-5 professionals qualified to perform the IEE. Parents do

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not have to choose any of the listed professionals. If they choose to have

the IEE performed by a professional outside the district-approved list, the

criteria specified below in paragraph 8 will apply. Arrangements for the IEE

will be undertaken by the District.

8. Whenever an IEE is to be funded by the school district, the criteria under

which the evaluation is to be obtained must be the same as the criteria

which the district uses when it initiates an evaluation itself. 34 C.F.R.

300.502(e). The following criteria shall be applied to parent-requested IEEs

at school district expense:

a. The district limits the travel distance to obtain an IEE to the general local

geographic area (not more than 100 miles from the district).

b. The district will only pay a reasonably comparable rate for IEEs (not

more than 30% above the average cost of comparable district-initiated

evaluations.)

c. The qualifications of the evaluators chosen to perform IEEs must

comport with the qualifications required of evaluators chosen by the

district for district-initiated evaluations, in accordance with all

applicable Federal regulations, state laws, and state regulations.

For example, qualified evaluators must

• be a Licensed psychologist, psychiatrist, speech/language

pathologist, or special education teacher;

• have previous experience evaluating students of similar ages and

with similar concerns; and

• be able to provide evaluation that addresses all Oregon

Department of Education required criteria for special education

eligibility.

9. If a parent obtains an IEE that does not comply with the above criteria, the

district may refuse to reimburse the parent for the costs of the IEE. This result

may be avoided if the parent contacts the Director of Special Services prior

to obtaining an IEE, and allows the district to undertake the necessary

arrangements to perform the IEE in accordance with these criteria.

10. An IEE that does not comply with all criteria set forth above will only be

funded by the district if the parent is able to show the district that

extraordinary or unique circumstances exist that call for an exception to be

made. A final decision in such a situation shall be made by the district on a

case-by-case basis, in light of the child’s existing evaluation data and other

relevant information.

11. If approved, payment for the evaluation will be made directly to the

independent evaluator, following receipt of the evaluation report. The

independent evaluator must agree to provide an original typed report to

the District within thirty (30) calendar days from the date that the IEE is

approved by the District, unless the evaluator and the District agree

otherwise due to unusually compelling circumstances.

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12. Assessment protocols must be made available for District review,

and the report must contain original signatures, as well as the titles of all

assessment personnel involved in the evaluation. The report must

also comply with all requirements of state and Federal regulations (the

District will provide assistance with these matters, as necessary). An

agreement by an independent evaluator to perform an IEE obligates the

evaluator to comply with these requirements, which shall be

communicated to the evaluator prior to the IEE appointment date. The

District may deny payment for an IEE report that does not meet the above

requirements.

13. District funding of an IEE may also include reasonable related costs, such as

transportation costs at the District rate, upon approval of the District. If

necessary, the District may provide funds for these expenses prior to the IEE

appointment(s), or the District can reimburse these expenses after the

appointment(s).

14. A District agreement to waive a portion of the above requirements or

criteria in any particular case should not be interpreted to mean that the

District will not impose that requirement or criterion in other or subsequent

cases.

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Prior Notice about Evaluation/Consent for Evaluatio n

Dear Date Student Name: has been referred for an evaluation. The Team is proposing the following: � To evaluate your child. � To reevaluate your child.

� Based on a review of existing information, no additional evaluation data are needed to determine if your child is or continues to be eligible for special education services or to determine your child’s educational needs.

Reason: Reason: If you disagree, you may request an assessment.

This proposal is based on the following evaluation procedures, tests, records or reports: Other options we considered were: We decided against these options because: Any other factors considered by the team: Sincerely, __________________ Name/Title Phone Parents of a child with a disability have protection under the procedural safeguards. For a copy of the procedural safeguards or assistance in understanding this information, please contact the person named above.

Consent for Evaluation We request your consent because: � This is an initial evaluation and will be used to determine whether your child is a child with a disability

and to determine special education needs. � This evaluation will include intelligence or personality testing.

� This is a reevaluation and will be used to decide your child’s continued eligibility and/or education needs. (Except for tests of intelligence and personality, if you do not respond to a request for written consent for a reevaluation, that evaluation may be conducted without your consent.)

We plan to use the following evaluation procedure(s ), assessments and/or test(s):

If the evaluation includes release of student educational records requiring parental consent, the “Records Release Form(s),” dated _______________, identifies the records to be released and to whom.

---------------------------------------------------------------------------------------------------------------------------- � I give my consent for the evaluation or re-evaluation. I understand my consent is voluntary and may be revoked for any evaluation or reevaluation that has not yet been conducted. � I refuse consent for the evaluation. Signature (Parent/Guardian/Surrogate Parent) Date (mm/dd/yyyy)

� For initial evaluations, a copy of the Notice of Procedural Safeguards has been given to the parent.

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Prior Notice about Evaluation /Consent for Evaluation This form is used to:

• Provide written notice and document written parent consent (or refusal) for an initial evaluation or reevaluation.

• Provide written notice to the parent that the team determined that no additional

evaluation data is necessary to determine that the child continues to be eligible for special education services or to determine the student’s special education needs, and to inform the parent that the parent may request an assessment.

• Obtain and document parent consent for an evaluation that will include individual

personality or intelligence testing;

• Tell the parent in writing what evaluation procedures, assessments or tests will be used.

• Citations: 20 USC § 1414 and 1415(b); 34 CFR 300.300, 300.302 and 300.503; OAR 581-015-2090, 2095and 2310.

Directions:

1. Enter the month, day, and year the form is completed.

2. Enter the name of the parent, guardian, or surrogate parent.

3. Enter the child’s name.

4. Indicate the intent of the team (to evaluate, reevaluate, or not to complete further testing), and indicate the reason(s) for this action.

5. Describe any screening, evaluation procedures, tests, records and reports used to make

this decision.

6. Describe any other options that the team considered prior to this action.

7. Explain why the options were rejected.

8. Describe any other factors relevant to the decision.

9. Sign and date the notice part of the form.

10. In the consent box, check the relevant boxes indicating the type of evaluation planned.

11. List and describe the specific evaluation procedures, assessments or tests the team plans to use, or describe the type of tests to be used (may attach a separate sheet with this information).

12. If the evaluation includes release of records requiring parent consent, attach “Records

Release Form(s)” that identifies the records to be released, and to whom. Enter the date of the release form on the consent form as a cross-reference.

13. Ask the parent to check the appropriate box, and sign and date the form.

Note: If the parent signs refusal or refuses to respond in writing at all, document the district’s reasonable attempts to get parent co nsent, such as detailed records of phone calls, correspondence (including emails), mee tings, home visits, etc.

a. For an initial evaluation or reevaluation, if the parent refuses consent, the district may

not conduct the evaluation. b. For a reevaluation, if the parent does not respond after the district’s reasonable

attempts to get consent, the district may conduct the evaluation as long as it does not include intelligence test or test of personality.

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14. For initial evaluations, give the parent a copy of the Notice of Procedural Safeguards (parent’s rights booklet) and check the box that you have done so.

WOODBURN SCHOOL DISTRICT Special Education Evaluation Tools

Checklist When an assessment for determining eligibility for Special Education services is desired, please:

1. Write, “See Attached Checklist” on the Consent of Evaluation Form. 2. Check the box next to all of the assessment(s) tools from this list that will be used. 3. If an assessment will include a measure or procedure that is not on this checklist,

write the name of the Assessment as well as a brief description of what it measures beside “OTHER” at the end of the appropriate section.

4. Have the parent initial each blank next to assessment(s) that are checked. 5. Have parent sign Consent. 6. Attach Consent and assessment checklist to referral form and send to District Office. 7. Give a copy to parent of the checklist with a copy of consent.

Student Name: _________________________________ Date: ___________________________ Evaluation Procedures:

_____ Developmental and Mental Health: Information provided by parents from questionnaires.

_____ Educational File Review: All documents in the student’s educational file will be reviewed.

_____ Observations: Observation(s) of the student at school, at home, or another setting to assess needs.

_____ Parent Interview: An interview with parents by one or more specialists to facilitate the evaluation.

_____ Student Interview: An interview with student by one or more specialists to facilitate the evaluation.

_____ Teacher Questionnaire: Information provided by teacher(s) about student’s work and behavior.

_____ Work Samples: Samples of student classroom work will be reviewed. Academic Achievement and Perceptual Skill Assessments:

_____ Batería Woodcock-Muñoz Aprovechamiento-Third Edition: Spanish academic reading, writing, &

math assessments. _____ Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI):

Developmental measure of visual motor integration.

_____ Jordan Left-Right Reversal Test-Revised (JLRRT-R): Assesses reversals of letters, numbers, words,

and detects visual reversal problems in children 5-12 years old. _____ Kaufman Tests of Educational Achievement – Second Edition (KTEA-II):

Measures academic skills. _____ Test of Auditory Processing Skills, Revised (TAPS-R): Measures auditory

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_____ Test of Early Math Ability - Third Edition (TEMA-3) : Assesses early math skills of 3-7 year olds.

_____ Test of Early Reading Ability - Third Edition (TERA -3): Assesses early reading skills of 3-9 year olds.

_____ Test of Written Language - Third Edition (TOWL-3): Assessment of writing skills for children.

_____ Test of Early Written Language (TEWL): Assessment of early writing skills for children ages 3-7.

_____ Test of Written Spelling- Second Edition (TWS-II): Assessment of spelling. _____ Wechsler Individual Achievement Test (WIAT II): Academic assessment of

reading, math, writing, spelling, listening comprehension and oral expression.

_____ Woodcock Johnson Tests of Achievement, Third Edition (WJ–III): Academic reading, writing & math

assessments. _____ Woodcock Munoz Language Survey (WMLS): Overall measure of

cognitive-academic language proficiency (CALP) usually administered in both English and Spanish.

_____ Other: (list test name) ________________________________________________________________

Adaptive Behavior Assessments:

_____ Adaptive Behavior Assessment System, Second Edition (ABAS-II): Assesses adaptive behavior.

_____ Other: (list test name) ________________________________________________________________

Autism Spectrum Disorder and/or Asperger’s Disorder Assessments: _____ Asperger’s Syndrome Diagnostic Scale (ASDS): Measure designed to

identify individuals’ ages 5-18 who manifest characteristics of Asperger’s Syndrome.

_____ Autism Diagnostic Observation Schedule (ADOS): Semi-structured assessment designed to

identify individuals with autism or other pervasive developmental disorders. _____ Australian Scale for Asperger’s Syndrome: Questionnaire designed to

identify behaviors and abilities indicative of Asperger’s Syndrome during primary school years.

_____ GiIliam Autism Rating Scale (GARS): Behavioral checklist to identify persons with autism.

_____ GiIliam Asperger’s Disorder Scale (GADS): Behavioral checklist used in the diagnosis of Asperger’s.

_____ Social Cues Questionnaire: Informal interview that elicits responses about non-verbal social and

environmental information in school settings. _____ School Assessment Rating Scale (SARS): An Australian scale used to

identify behaviors and abilities consistent with Asperger’s Syndrome in primary school aged

children. _____ School Social Skills Rating Scale: Assesses school related skills which are

based on student behavior. _____ Social Interaction Checklist-Elementary: Rating of elementary school age

student social interactions. _____ Social Interaction Checklist-Secondary: Rating of secondary school age

student social interactions.

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Student Communication Rating Form: Rating of student communication, based on student behavior.

_____ The High Functioning Autism Spectrum Screening Questionnaire (ASSQ): A measure of social and

behavioral impairment in children from age 4 to adulthood. _____ Other: (list test name)

____________________________________________________________ Behavior / Attention / Emotion / Personality Assessments:

_____ AD/HD Rating Scale: Rating scale used to assess inattention, hyperactivity, and impulsivity.

_____ Behavior Assessment System for Children Second Edition (BASC-II): Behavior rating scale that

assesses emotional, social, and behavioral functioning. _____ Informal Behavior Checklist: Informal checklist of common classroom

problems. _____ Parenting Relationship Questionnaire (PRQ): Assessment of the parent

child relationship. _____ Projective Drawings: Student drawings that may indicate developmental

skills, interests or concerns. _____ Sentence Completion: Open ended sentences completed by the student in an

interview. _____ Other: (list test name)

________________________________________________________________ Cognitive Ability Assessments:

_____ Batería Woodcock-Muñoz Pruebas de Habilidad Cognitiva-Third Edition: Spanish language

cognitive measure that assesses a variety of processing skills. _____ Bilingual Verbal Abilities Test (BVAT): Assessment of language skills in

English, Russian & Spanish. _____ Comprehensive Test of Nonverbal Intelligence (CTONI): Cognitive

assessment that minimizes expressive and receptive use of language during testing.

_____ Differential Ability Scales – Second Edition (DAS-II) : Comprehensive assessment of cognitive

abilities for children ages 2-17 years. _____ Kaufman Assessment Battery for Children II (KABC-II ): Intelligence test

designed to accomplish culturally fair assessment for children 3-18 years old.

_____ Leiter International Performance Scale-Revised (Leiter-R): Nonverbal intelligence measure that

emphasizes fluid intelligence. _____ Universal Non-Verbal Intelligence Test (UNIT): Nonverbal intelligence test

for children ages 5-17. _____ Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV ):

Intelligence test that calculates verbal, performance and full-scale IQ scores for children age 6 to 16 years.

_____ Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV ): Intelligence test that calculates

verbal, performance and full-scale IQ scores for persons age 16 and older.

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Woodcock-Johnson Tests of Cognitive Abilities Third Edition (WJ–III; cognitive): Cognitive

scales that assess a variety of processing skills. _____ Other: (list test name)

______________________________________________ Speech and Language Assessments:

_____ Boehm Test of Basic Concepts, Third Edition (Boehm-III): A test designed to assess the child’s

understanding of basic concepts. _____ Bracken Basic Concept Scale (BBCS): A test designed to assess a child’s

ability to understand descriptions of basic concepts.

_____ Clinical Evaluation of Language Fundamentals, Third/Fourth Edition (CELF-3/4): Comprehensive

measure of understanding and expression of language skills. _____ Comprehensive Assessment of Spoken Language (CASL): Measures

knowledge and use of words, word combinations, grammar, complex language and language for

social situations. _____ Comprehensive Receptive and Expressive Vocabulary Test (CREVT):

Evaluates receptive and expressive oral vocabulary.

_____ Expressive One Word Picture Vocabulary Test (EOWPVT): Measures single word expressive

vocabulary. _____ Expressive One Word Picture Vocabulary Test - bilingual: Measures

bilingual (Spanish/English) single word expressive vocabulary.

_____ Goldman-Fristoe Test of Articulation (GFTA): Measures a child’s ability to use sounds in words and

connected speech. _____ Language Processing Test, Revised (LPT-R): Measures a child’s ability to

attach meaning to language and effectively formulate responses

_____ Lindamood Auditory Conceptualization Test (LAC): Measures phonemic awareness.

_____ Montgomery Assessment of Vocabulary Acquisition (MAVA): Measures a child’s listening and

speaking vocabulary. _____ Oral and Written Language Scales (OWLS): Overall assessment of a child’s

oral expression and listening comprehension.

_____ Peabody Picture Vocabulary Test, Third Edition (PPVT–III): Assesses understanding of vocabulary.

_____ Photo Articulation Test, Third Edition (PAT-III): Measures articulation in single words and speech.

_____ Preschool Language Scale, Third Edition (PLS-3): Assesses understanding and expressive use of

language. _____ Receptive One Word Picture Vocabulary Test, Third Edition (ROWPVT-

III): Measures single word understanding of vocabulary.

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_____ Receptive One Word Picture Vocabulary Test, bilingual: Measures bilingual (Spanish/English single

word understanding of vocabulary. _____ Spanish Articulation Measure (SAM): Measures articulation of single words

in Spanish. _____ Spanish Test for Assessing Morphologic Production (STAMP): Evaluates

grammar skills. _____ Structured Photographic Articulation Test – featuring Dudsberry (SPAT-

D): Assesses single word articulation skills.

_____ Structured Photographic Expressive Language Test, 2nd Edition (SPELT-II): Assesses syntax skills.

_____ Stuttering Severity Instrument, Third Edition (SSI-3): Evaluates fluency of speech.

_____ Test of Auditory Comprehension (TACL): Assesses understanding of language.

_____ Test for Examining Expressive Morphology, (TEEM): Evaluates grammar skills.

_____ Test of Language Development-Intermediate, Third Edition (TOLD-I:3): Overall assessment of

understanding and use of language. _____ Test of Language Development-Primary, Third Edition (TOLD-P:3):

Overall assessment of understanding and use language.

_____ Test of Problem Solving-Adolescent (TOPS-Adolescent): Measures critical thinking and reasoning

skills in children12-17 years old. _____ Test of Problem Solving, Third Edition (TOPS-3): Measures five thinking

tasks that require problem solving and reasoning.

_____ Wiig Assessment of Basic Concepts (WABC): Assesses use and understanding of basic concepts.

_____ Wilson Voice Assessment: Measures vocal characteristics of pitch, quality, intensity and resonance.

_____ Woodcock Language Proficiency Battery, Revised (WLPB-R): Comprehensive assessment of oral

language abilities, reading and written language. _____ Word Test, Revised: Measures expressive vocabulary and semantics. _____ Other: (list test name)

_________________________________________________________

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Request for Regional Services and/or Evaluation for Eligibility

���� New Referral

���� Move-in-Referral

SSID # District Student ID:

Student Name: Date of Birth: Attending School: Attending District: Resident School: Resident District: Grade: Age: Gender: Primary Language: Parent/Guardian: Address: Phone: Cell Phone: Email: Primary Eligibility: Secondary Code 1: Secondary Code 2: Secondary Code 3: Case Manager: Email: Phone: Date Parent Consent Signed: Eligibility meeting to be held on or prior to: Current IEP: � NO � Yes - Date: Current IEP Annual Review Due Date: Request for WESD Evaluations :

� Audiological Evaluation � Augmentative Communication/Assistive

Technology � Autism Spectrum Disorder

Communication Evaluation to be completed by: ________________________________________

� Functional Vision Evaluation (please send eye examination report with referral)

� Occupational Therapy � Physical Therapy

For OT or PT evaluation, please list current diagnosis, if applicable: __________________________________

� Traumatic Brain Injury

Request for WESD Regional Services :

� Augmentative Communication/Assistive Technology

� Autism Spectrum Disorder Services

� Deaf/Hard of Hearing Services

� OT- Motor Services � PT- Motor Services � Traumatic Brain Injury � Vision Services � Other- provide detailed

explanation

Please submit referral and any accompanying documen tation to: Special Education Director or delegate

Referral Authorized By:

Phone:

Date:

Reason for Referral/Additional Information:

The Case Manager is responsible for providing student file information and

Consent to Evaluate to the Regional Specialist.

Office use only WESD Evaluator Assigned: Assigned By: Date:

WESD Evaluator Assigned: Assigned By: Date:

WESD Evaluator Assigned: Assigned By: Date:

WESD Evaluator Assigned: Assigned By: Date:

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Supporting Documents

Autism Spectrum Disorder Services The following is to be completed by the district and must accompany a Referral for eligibility determination: □Copy of the signed Consent for Evaluation for: -Behavorial observations -File review -ASD Rating Scale -Developmental Profile -Team/Parent Interviews □Copies of any prior assessments that led to this referral such as: communication Disorder evaluation, psychological report, autism screening checklist, IFSP/IEP, observation notes, etc. For students who have moved into the district with a current ASD eligibility (82), the following should be attached to the referral: □Eligibility Statement □Signed Medical Statement □Current IFSP/IEP □Current communication evaluation report □Psycho educational report, if available □Developmental Profile □Medical Statement or Health Assessment □Documentation of behavioral observations □Autism Behavior Checklist

Deaf/Hard of Hearing Services

The following is to be completed by the district and must accompany a Referral for eligibility determination: □Copy of the signed Consent for Evaluation for: -Classroom observation -File review -Observation/Questionnaire forms □Two failed hearing screenings OR a current audiological assessment OR wearing hearing aids, i.e. move-in from another district, etc. The following is to be completed prior to the initial eligibility meeting (this can be obtained by the district or our office): □Physician’s Statement For students who have moved into the district with a current HI eligibility (20), the following should be attached to the referral: □Eligibility Statement □Signed Medical Statement □Current IFSP/IEP □Current Audiological Evaluation Report

Vision Services The following is to be completed by the district and must accompany a Referral for eligibility determination: □Copy of the signed Consent for Evaluation for: -Classroom observation -Functional Vision Assessment □Copy of an Eye Report from an ophthalmologist or optometrist For students who have moved into the district with a current VI eligibility (40), the following should be attached to the referral: □Eligibility Statement □Signed Eye Report from an ophthalmologist or optometrist □Signed Functional Vision Report □Current IFSP/IEP

Orthopedic Services The following is to be completed by the district and must accompany a Referral for eligibility determination: □Copy of the signed Consent for Evaluation for: -Classroom observation -File review -EI/ECSE Age: PDMS-2; OREST School Age: Functional Motor Assessment; OREST -Feeding Evaluation (if applicable) -Sensory Evaluation (if applicable) For students who have moved into the district with a current OI eligibility, the following should be attached to the referral: □copy of the signed Consent for Evaluation □Signed Physician’s Statement or medical report which includes diagnosis with physician’s signature □Current IFSP/IEP (services can be added when eligible) □Statement of Eligibility-Orthopedic Impairment (70)

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