Henry County Schools s1

DOUGLAS COUNTY SCHOOLS

Re-Evaluation Determination Checklist

Student: Student #: Grade: School:

(Last) (First) (Middle)

I. DATA REVIEWED:

Date of Most Recent Eligibility: / EXCEPTIONALITY(ies):
General Ed. teacher input / Present age, grade and placement / Work toward diploma choice
Information from parents / Discipline record / Type of service options used in past
IEP goals/objectives / Previous information / Review of accommodations utilized
Previous psychological evaluation / Medical records / Behavior Rating Scale
Standardized test results / Progress and grade reports / Specialized instruction utilized
Social history/Update / Anecdotal data/records / Adaptive Behavior (scored)
Functional Behavior Assessment / Current work samples/observations / Self-help skills
Attendance / OT/PT data / Assistive technology data
Speech-Language update / Transition Plan / Private Evaluation results
Hearing/Vision screening update / Behavioral Intervention Plan
Most recent state assessment results with descriptions “does not meet, meets, exceeds, etc.” (CRCT, GKAP, GHSGT, EOCT, Writing)
State assessment completed with accommodations OR State assessment completed without accommodations
Is additional data needed to determine present levels of performance and educational needs of the student? Yes No
Is additional data needed to determine whether the student continues to need special education and related services? Yes No
Is additional data needed to determine whether any additions or modifications to the special education and related services are needed
to meet IEP goals and participate, as appropriate, in the general curriculum? Yes No

II. RECOMMENDATION:

No additional data is needed for continued eligibility. Parent can request assessment at a later date to determine if student continues to be a student with a disability. Eligibility must be re-determined three years subsequent to this date.
Student was determined eligible in another state, and eligibility is continued for ______
Student was determined eligible in another state, but additional information is required in the following areas:
______
______Due Date:______
To consider new and/or additional eligibility, assessment in the following area(s) is required:
______
______Due Date: ______
No longer appears eligible based on above data.

This is to certify that I was invited to participate in the re-evaluation determination and understand the above recommendations. I have received a copy of the following:

Parent Rights Re-evaluation Determination Form Consent for Evaluation

Parent Signature Date

PEC-07 Revised 6/08