ALBEMARLE COUNTY PUBLIC SCHOOLS
DEPARTMENT OF SPECIAL SERVICES
401 McINTIRE ROAD, CHARLOTTESVILLE, VIRGINIA 22902
(434) 296-5885
ELIGIBILITY SUMMARY ADDENDUM
FOR IDENTIFICATION OF A TRAUMATIC BRAIN INJURY
Name Date
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. (34 CFR 300.8(c)(12))
CRITERIA
Yes No
I. The student acquired an injury to the brain caused by an external physical force.
The committee must describe the open or closed head injury:
II. The brain injury results in total or partial functional disability or impairment in one or more areas:
(Check all that apply)
Information processing / Judgment / Language
Memory / Motor abilities / Perceptual abilities
Problem solving / Psychosocial behavior / Reasoning
Sensory abilities / Speech / Physical functions
III. There is an adverse effect on the child's educational performance due to one or Yes No
more documented characteristics of traumatic brain injury.
The committee must provide data and describe the adverse effects on educational
performance due to the characteristics of the brain injury.
IV. Result
If ALL of the above questions are answered “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.
From No. 50.18 – 7/10