CHARLES COUNTY PUBLIC SCHOOLSDEPARTMENT OF SPECIAL EDUCATION
Developmental Delay Eligibility Checklist
Name of Student: / Date of Birth:School: / Date of Eligibility Determination:
☐Y☐N / 1. / The student is at least three (3) years old and has not exceeded his/her kindergarten year,
AND
☐Y ☐N / 2. / ☐ The student shows a 25% or greater delay in one (1) of the five developmental areas listed below, as measured and verified by appropriate diagnostic instruments and procedures (Check all that apply).
☐Cognition ☐ Physical ☐ Communication ☐ Adaptive behavior
☐Social development
OR ☐ The student shows atypical developmental or behavior demonstrated by abnormal quality of performance and function in one or more of the five developmental areas listed above which interferes with current development and is likely to result in subsequent delay even when diagnostic instruments and procedures do not document a 25% or greater delay
OR☐The student has a diagnosed physical or mental condition which has a high probability of resulting in a developmental delay, including but not limited to students with sensory impairments, inborn errors of metabolism, microcephaly, fetal alcohol syndrome, epilepsy, and Down Syndrome, and other chromosomal abnormalities.
Measures used:
☐Y ☐N / 3. / The deficits in development are not primarily the result of vision or hearing acuity; emotional disability; or cultural factors, environmental or economic disadvantage.
☐Y ☐N / 4. / Evaluation information confirms that English proficiency was not a determinant factor in the eligibility decision.
The requirement for demonstrated adverse educational impact does not apply for the purpose of developmental disability eligibility determination. The emphasis should not be on standardized diagnostic instruments, but rather functional quantitative performance data that provides an accurate picture of what the child can and cannot do in the developmental areas as compared to typical developmental performance.
The IEP team used the above interpretation of the evaluation data to determine:
☐ The student has a developmental delaythat adversely impacts his/her developmental progress and is eligible for specifically designed instruction and related services (IEP).
☐ The student has a developmental delay but it does not adversely impact his/her developmental progress; therefore, the student is not eligible for an IEP.
☐ The student does not have a developmental delay and is not eligible for an IEP.
☐ Evaluation data was insufficient to determine eligibility. Additional assessments and/or data will be obtained/collected in the area(s) of:
SE 07/13