Indicators 9 & 10 Procedural Survey

Please answer the following questions.

For each item that you answer YES to in Section 1, please identify the written procedures and applicable section of the document that correspond to the survey item. Following the survey completion, please submit all named procedural documentation.

No additional documentation is required for items named in section 2 or if you response is NO to any question. However, if there is documentation that you feel supports your response, please feel free to submit that data.

School Corporation Number ______

School Corporation Name ______

Name of Individual(s) Completing the Form

______

SECTION 1: Procedural Review

Does your school have WRITTEN procedures:

  1. Describing how a multidisciplinary team will be assigned to conduct educational evaluations? 511 IAC 7-40-3(c)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that assessments and evaluation materials are provided in the student’s native language or other mode of communication? 511 IAC 7-40-3(e)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that assessments and evaluation materials are provided in a form most likely to yield accurate information on what the student knows and can do academically, developmentally, and functionally? 511 IAC 7-40-3(e)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that assessments and evaluation materials are selected and administered so as not to be discriminatory no a racial or cultural basis? 511 IAC 7-40-3(e)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that assessments and evaluation materials are used for the purposes for which the assessments or measures are valid and reliable? 511 IAC 7-40-3(e)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that assessments and evaluation materials are administered by trained personnel and in accordance with the evaluation/assessment protocol? 511 IAC 7-40-3(e)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that assessments and evaluation materials include those tailored to assess specific areas of educational need and not merely those designed to provide a single general IQ? 511 IAC 7-40-3(e)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that assessments and evaluation materials are selected and administered to ensure that the assessment accurately reflects the student’s achievement rather than reflect the student’s impaired sensory, manual, or speaking skills (unless the instrument is designed to assess those areas)? 511 IAC 7-40-3-(e)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that the student is assessed (or that information is collected) in all areas related to the suspected disability as described in 511 IAC 7-41? 511 IAC 7-40-3(e)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that assessment tools and strategies provide relevant information that directly assists the case conference committee in determining the student’s eligibility for special education? 511 IAC 70=-40-3(e)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Requiring the multidisciplinary team to use a variety of assessment tools and strategies to gather required and relevant information about the student in accordance with 511 IAC 7-41? 511 IAC 7-40-3(f)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that the multidisciplinary team includes the requisite qualified professionals? 511 IAC 7-40-5(b)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Requiring the multidisciplinary team to review existing evaluation data on the student, obtain input from the student’s parent, identify the suspected disability, and determine additional data needed to determine the student’s eligibility for special education services? 511 IAC 7-40-5(c)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that the evaluation report for a student with the suspected disability of Autism Spectrum Disorder includes assessment results and other information collected as aligned to the characteristics of Autism Spectrum Disorder? 511 IAC 7-40-5(f)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring the evaluation report for a student with the suspected disability of Specific Learning Disability includes the elements described in 511 IAC 7-40-5(g)?

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that the CCC does not determine that a student is eligible for special education if the determinant factor is the lack of instruction in reading or math or the student’s limited English proficiency? 511 IAC 7-40-6(b)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that the CCC does not determine that a student is eligible for special education if the student does not meet the eligibility criteria for the disability as described in 511 IAC 7-41? 511 IAC 7-40-6(b)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that the CCC does not determine the student eligible for special education when the student’s only need is a related service? 511 IAC 7-40-6(d)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that the case conference committee includes the requisite members as described in 511 IAC 7-42-3(b)?

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

  1. Ensuring that at least one of the qualified professionals from the multidisciplinary team attends the initial case conference committee meeting? 511 IAC 7-42-3(c)

___ YES ___ NO

If YES, name document submitted for review: ______

Applicable section: ______

SECTION 2: Narrative Response

  1. If you answered no to any of the questions above, how do you ensure that these activities are carried out in compliance with federal and state requirements?

______

  1. Does your school utilize a Response to Intervention, Response to Instruction, or similar process to provide interventions and supports for students who have not yet been identified as eligible for special education services? If so, please provide a brief description

______

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