Documentation Checklist: (All Documents to Be Enclosed and Ticked Off by School to Confirm

Education Adjustment Program – Verification of Disability
Cover Sheet & Checklist
Education Adjustment Program (EAP) / EAP Verification Form – SED (EAP 9 updated 2014)
Verification of Disability in the Education Adjustment Program Category of Social Emotional Disorder
Student: Click here to enter text. / School: Click here to enter text. / Year Level Click here to enter text.
Disability Category: Social Emotional Disorder
☐ / Initial Verification / (i.e. no previous verification)
☐ / Review / of an existing verification
☐ / Adding / a new category to an existing verification: / Adding / ☐ASD / ☐HI / ☐ID / ☐PI / ☐SLI / ☐VI
☐ / Removal / from an existing category: / Removing / ☐ASD / ☐HI / ☐ID / ☐PI / ☐SLI / ☐VI / ☐SED
☐ / Changing / from an existing category to a new category: / Change from / To SED
☐ / Transferring / into the RI System from a Non-Catholic sector

Documentation Checklist: (All documents to be enclosed and ticked off by school to confirm inclusion in the submission.)

Process / School / RI Verifier / Comments
EAP Consent Form
(EAP 1 updated 2013)
EAP Verification Form
SED (EAP 9 updated 2014)
PART A – Student Details
PART B – Evidence
Criterion 1
Section 1 – School to complete Student Details
Section 2 – Specialist Report
PART B –
Criterion 2
Educational impact and adjustments
PART B -
Professional Reasoning
Verification Outcome
School to complete Student Details
Verifier to sign the outcome
PART C –
Principal Request/Signature
EAP Profile
Educational Planning Document (IEP, PLP, ISP) etc
(or equivalent school planning doc.)
If Review – include previous EAP Confirmation Documentation
Additional Attachments:
Specialist’s reports/assessments
Education Adjustment Program (EAP) / EAP Verification Form – SED (EAP 9 updated 2014)
Verification of Disability in the Education Adjustment Program Category of Social Emotional Disorder

Members of the school team complete this form collaboratively, ensuring that relevant personnel have been involved in the data gathering and decisions relating to the impairment and activity limitations and participation restrictions for this student.

The verification form in each of the EAP categories consists of the following sections which must be completed:

PART A Student Details
PART B Evidence Supporting Verification of Disability
PART C Principal Request for Verification of Disability

Two (2) copies of this form and required attachments (outlined in Part B) to be submitted to:
The RI EAP Verification Team at the RI Equity Network meeting
Part A: Student Details
Last Name / Click here to enter text. / Date of Birth / Click here to enter text. /
First Name / Click here to enter text. / Gender / Click here to enter text. /
School / Click here to enter text. / Year Level / Click here to enter text. /
School Address / Click here to enter text. / School Phone / Click here to enter text. /
Contact person in school for this verification / Click here to enter text. / Position / Click here to enter text. /
Email Address / Click here to enter text. / Phone / Click here to enter text. /
Existing Categories:
☐Nil / ☐ASD / ☐HI / ☐ID / ☐PI / ☐SLI / ☐VI
This verification request is for:
☐ / Initial Verification (i.e. no previous verifications)
☐ / Review of an existing verification
☐ / Adding a new category to an existing verification
☐ / Changing EAP Category
☐ / Removal from an existing category
☐ / Transferring into RI College from a non-Catholic sector

Copyright in this work is owned by the State of Queensland (Acting through the Department of Education, Training and Employment) and has been adapted by Brisbane Catholic Education and Religious Institute Colleges with consent. Page | 1

Education Adjustment Program (EAP) / EAP Verification Form – SED (EAP 9 updated 2014)
Verification of Disability in the Education Adjustment Program Category of Social Emotional Disorder

Criterion 2: The identified Social Emotional Disorder results in activity limitations and participation restrictions for the student at school requiring significant education adjustments.

This section is to be completed through a collaborative process which MUST include input from the student’s teacher/s.

Evidence of the educational impact of the identified impairment
The Prompts for SED Criterion 2 Form can be used as a guide for the completion of this section
CURRICULUM
achieved curriculum / teaching strategies / staff resources / educational resources / specialist staff support
use of assistive technology / assessment/reporting
Describe the student’s functioning (activity limitations and participation restrictions) related to the social emotional disorder:
Outline the associated significant education adjustments that are currently in place for this student:
COMMUNICATION
receptive / expressive / pragmatics (language use) / speech / specialist staff support
Describe the student’s functioning (activity limitations and participation restrictions) related to the social emotional disorder:
Outline the associated significant education adjustments that are currently in place for this student:
SOCIAL PARTICIPATION/EMOTIONAL WELLBEING
social/interaction skills / self-management strategies / individualised plans / use of social development resources / specialist staff support
Describe the student’s functioning (activity limitations and participation restrictions) related to the social emotional disorder:
Outline the associated significant education adjustments that are currently in place for this student:
LEARNING ENVIRONMENT/ACCESS
classroom and non-classroom environment / organisational skills / sensory needs / transition skills / specialist staff support
Describe the student’s functioning (activity limitations and participation restrictions) related to the social emotional disorder:
Outline the associated significant education adjustments that are currently in place for this student:
HEALTH AND PERSONAL CARE, SAFETY
health management / risk management / self-care skills / specialised self-care procedure / individualised plans / specialist staff support
Describe the student’s functioning (activity limitations and participation restrictions) related to the social emotional disorder:
Outline the associated significant education adjustments that are currently in place for this student:
Proposal for Verification in the EAP Category of Social Emotional Disorder
(To be completed by the School Guidance Officer or Consulting Psychiatrist, Paediatrician)
Student Name: Click here to enter text. Date of Birth: Click here to enter text.
Profession Specific Quality Assurance Decision Making:
Provide a statement summarising the evidence considered when making a proposal for verification in the EAP category of Social Emotional Disorder, or removal of an existing verification in the EAP category of Social Emotional Disorder.
Criteria / Applicable details – Please complete / Confirmed
There are activity limitations and participation restrictions resulting from the diagnosed condition / ☐ YES
☐ NO
The activity limitations and participation restrictions resulting from the condition are sufficiently severe to require significant education adjustments / ☐ YES
☐ NO
Adjustments related to the effects of the diagnosed condition have been put into place and programs implemented using the schools usual resources and these were found to be insufficient to meet the student’s needs. / ☐ YES
☐ NO

Comments:

Following the QCEC criteria and RI Colleges’ Equity Network processes, I have gathered, documented and considered all available data for this student and with the information I am able to:
☐ / Propose the verification of Social Emotional disorder as described by the QCEC criteria
☐ / Propose the removal of the existing verification of Social Emotional Disorder as described by the QCEC criteria
School Guidance Officer or Consulting Psychologist or Psychiatrist
Name: Click here to enter text. / Signature:
Email: Click here to enter text. / Date: Click here to enter text.
Phone: Click here to enter text. /
Verification Outcome:
Student Name: Click here to enter text. / Date of Birth: Click here to enter text.
School: Click here to enter text. / Year Level: Click here to enter text.
To be completed by the Verifier:
Criterion 1: The student has a current relevant diagnosis from a specialist
There is a relevant and documented diagnosis from the DSM-5 / ☐ / YES
☐ / NO
Criterion 2: The student’s documented social and emotional diagnosis results in activity limitations and participation restrictions at school requiring significant educational adjustments.
There are documented activity limitations and participation restrictions relating to the student’s diagnosis / ☐ / YES
☐ / NO
Significant education adjustments are required and are related to the effects of the diagnosed condition and are not due to other factors / ☐ / YES
☐ / NO
Eligibility
☐ / The process indicated in the Religious Institute Colleges protocols has been followed and I confirm that this student meets the criteria for the QCEC category of Social Emotional Disorder
Ineligibility
☐ / The process indicated in the Religious Institute Colleges protocols has been followed and I confirm that this student does not meet the criteria for the QCEC category of Social Emotional Disorder
Comment:
Recommendation for review of eligibility: / Review required / ☐ / YES / ☐ / NO / Date:
Criterion 1 / ☐ / YES / ☐ / NO / Date:
Criterion 2 / ☐ / YES / ☐ / NO / Date:
Signed: / Date:
Name of Verifier:
Address:
Telephone contact: / Fax:
Email contact:
Part C: Principal Request for Verification of Disability in the Education Adjustment Program Category of Social Emotional Disorder
Verification of disability in the EAP category of Social Emotional Disorder according to QCEC’s criteria is requested for the following student according to the details outlined in PART A and PART B of this report and the related attachments:
Student Name Click here to enter text.
School Click here to enter text. / Date of Birth Click here to enter text. / Year Level Click here to enter text.
In making this request I have ensured that:

the student is enrolled and attending the school

a completed EAP Consent Form (EAP 1) is kept in the student’s school file

discussions have been held with the parent and/or student regarding this verification and agreement to proceed has been reached

appropriate personnel have been involved in data gathering and reporting

processes are in place to support this student within the school

all documents for verification are complete

the original EAP documentation is kept in the student’s school file

copies of relevant documents will be sent to the EAP Verification Team as per RI processes.

Principal Name:
Principal Signature: / Date: