Albemarle County Public Schools

ALBEMARLE COUNTY PUBLIC SCHOOLS

DEPARTMENT OF SPECIAL SERVICES

401 McINTIRE ROAD

CHARLOTTESVILLE, VIRGINIA 22902

(434) 296-5885

ELIGIBILITY SUMMARY ADDENDUM

FOR IDENTIFICATION OF AN EMOTIONAL DISABILITY

Name : Date :

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 due to one or more documented characteristics of an emotional disability.

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;

3. Inappropriate types of behavior or feelings under normal circumstances;

4. A general pervasive mood of unhappiness or depression; or

5. A tendency to develop physical symptoms or fears associated with personal or school problems.

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 this section.

CRITERIA

I. This student is exhibiting a condition upon psychological evaluation Yes No
with one or more of the following characteristics (indicated below):

Characteristic #1 Exhibited

An inability to learn, not explained by intellectual, sensory or health factors

(Support characteristic #1 by citing example(s) that best describe(s) referred child.)

Characteristic #2 Exhibited

An inability to build or maintain satisfactory relationships with peers and teachers

(Support characteristic #2 by citing example(s) that best describe(s) referred child)

Characteristic #3 Exhibited

Inappropriate types of behaviors or feelings under normal circumstances

(Support characteristic #3 by citing example(s) that best describe(s) referred child)

Characteristic #4 Exhibited

A general pervasive mood of unhappiness or depression

(Support characteristic #4 by citing example(s) that best describe(s) referred child)

Characteristic #5 Exhibited

A tendency to develop physical symptoms or fears associated with personal
or school problems.

(Support characteristic #4 by citing example(s) that best describe(s) referred child)

II. These conditions are necessary for eligibility.
Yes No

A. Long period of time (6 months or more)……………………………………………..

B. To a marked degree (Obvious to multiple observers across multiple school settings…..

III. There is an adverse educational impact on the student’s Yes No
educational performance:
The committee must provide evidence of adverse educational impact on the child’s educational performance directly related to the characteristics of the condition noted in Section I.
Please cite the data, sources and describe the findings.
Characteristic #1:
Characteristic #2:
Characteristic #3:
Characteristic #4:
Characteristic #5:

NOTE:

IV. RESULT

If ALL of the conditions above are “Yes”, this student meets the Federal, State and Local definition of this particular disability category. It is the “first prong” of the three step eligibility process.

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