Evaluation Summary Report Checklist Scoring Rubric
Prior Written Notice /
Quality Indicators
4 / 3 / 2 / 11. / The notice includes a description of the action proposed or refused by the agency. / Yes / No
2. / The notice includes an explanation of why the agency proposes or refuses to take the action. / Yes / No
3. / The notice includes a description of other options that the IEP Team considered. / Yes / No
4. / The notice includes reasons why other options considered were rejected by the team. / Yes / No
5. / The notice includes a description of each evaluation procedure, assessment, record, or report the agency used as a basis for the proposed or refused action. / Yes / No
6. / The notice includes a description of other factors that are relevant to the agency's proposal or refusal. If no other relevant factors are identified, “none at this time” is an acceptable response. / Yes / No
7. / There is a direct match between assessments listed on Eval Plan PWN and those included in the ESR. / Yes / No
ESR Evaluation Rubric
ESR Section / Quality Indicators
4 / 3 / 2 / 1
1. Student Header Information
1)Student’s name 4) Current grade
2)School 5) ID #
3)Date of birth 6) Date of ESR / ESR addresses all 6 elements. / ESR addresses 5 of 6 elements. / ESR addresses 4 of 6 elements. / ESR addresses 3 or fewer elements.
2. Reason for Referral
1)Areas of strength described
2)Area(s) of concern described
3)Reasons for conducting the evaluation / ESR addresses all 3 elements. / ESR addresses 2 of 3 elements. / ESR addresses 1 of 3 elements. / ESR addresses none of the elements.
3. Sources of Information
1)All evaluation tool nameslisted
2)Staff names listed for all tools. Staff titles listed at least once
3)Dates of administration listed
4)Multi-disciplinary team reflected in staff titles (note: categorical licensure required for all disabilities except Deaf/Blind, Traumatic Brain Injury, & Other Health Disabilities). / ESR addresses all 4elements. / ESR addresses 3of 4elements. / ESR addresses 2of 4elements. / ESR addresses 1 or fewerof the elements.
4. Background Information
1)General background information
2)History of schools attended
3)History of evaluations/services (504 and/or sp. ed. services, history of sp. ed. evaluations, sensory or health related concerns, results for vision/hearing screenings)
4)Pre-referral interventions
5)Current services and accommodations for SpEd, IEP goals, medical/health, and outside agencies
6)Attendance records (# days absent, significant concerns)
7)School rule violations & consequences NA forECSE
8)Grades/credits earned (high school).NA for ECSE
9)Test scores (MCAs, MAP, FAST) NA for ECSE / ESR addresses all applicable elements. / ESR addresses 1 item less than all applicable elements. / ESR addresses 2 items less than all applicable elements. / ESR addresses 3 items less than all applicable elements.
ESR Section / Quality Indicators
4 / 3 / 2 / 1
5. Evaluation Results
Each assessment section:
1)Summary of tool
2)Explanation of scoring (If there are no scores obtained, explain how the data are used)
3)Summary of results (scores/data)
4)PLAAFP in the areas evaluated (narrative explaining the results)
5)Statement describing if standard administration procedures and conditions were varied, if appropriate
6)Statement describing behavioral observations during testing related to the validity and reliability of results (norm-referenced tests only)
ESR as a whole:
7)AT was considered and summarized in ESR
8)Information provided by parents
9)Summary of evaluation included at the end of the report
10)Statement regarding overall validity of the evaluation (located in summary of evaluation)
11)If child has minority status, a statement relating to nondiscriminatory procedures being followed during the evaluation
12)For students grades 7 and up, two transition assessments were completed / ESR addresses all applicable elements. / ESR addresses 1 item less than all applicable elements. / ESR addresses 2 items less than all applicable elements. / ESR addresses 3 or more items less than all applicable elements.
(note: elements 5, 6, 11, 12 and/or 13 may
not be applicable for all students)
6. Conclusion/Eligibility for Special Education(review all eligibility areas assessed)
1)MN State eligibility criteria listed
2)Statement describing the team’s interpretation of results per each criteria. Put the statement under each section of the eligibility criteria
3)Concluding statement about whether or not the student is eligible and/or has a continuing need for special education in each area assessed
4)ESR provides sufficient evidence to determine eligibility (initial evaluation or reevaluation) or determine whether there is a continuing need for special education services (reevaluation) and appropriate assessments were given to address criteria.
5)Statement(s) describing educational needs and accommodations based on assessment dataIf the student does not qualify for services, team recommendations for the general educational setting are listed. / ESR addresses all 5 elements. / ESR addresses 4 of 5 elements. / ESR addresses 3 of 5 elements. / ESR addresses less than 3 of the elements.
7. Overall ESR Quality
1)Grammar
2)Spelling
3)Readability / ESR has acceptable quality in all elements. / ESR reflects acceptable quality in 2 of 3 elements. / ESR reflects acceptable quality in 1 of 3 elements. / ESR reflects poor overall quality for all elements.
Revised August 2016SCRED ESR Evaluation Rubric -1