Student:

Date:

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RICHMOND COMMUNITY SCHOOLS

SPECIAL SERVICES DEPARTMENT

900 South L Street Tel: (765) 973-3496

Richmond, IN 47374 Fax: (765) 973-3782

MULTIDISCIPLINARY TEAM EVALUATION REPORT

Psychoeducational Evaluation

CONFIDENTIAL

Name
Date of Birth
Age
Parent (s)
Address
Phone Number
School
Grade
Date(s) of Evaluation

Student:

Date:

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Student:

Date:

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REASON FOR REFERRAL AND SUSPECTED AREA OF DISABILITY

The current assessment is an initial evaluation of (student’s name) educational needs. (He/She) was referred for evaluation to assist in determining Article 7 eligibility for special education services within the area of suspected disability indicated to be (disability).

ASSESSMENT PROCEDURE

Psychoeducational Evaluation – (Name), School Psychologist or Educational Diagnostician

Classroom Observation – (Name), Special Education Teacher

SOCIAL AND DEVELOPMENTAL HISTORY

TBD

BEHAVIORAL OBSERVATIONS

Observations during Assessment

TBD

ASSESSMENT FINDINGS

Academic Achievement

Woodcock-Johnson Tests of Achievement – Third Edition (WJ-III)

The Woodcock-Johnson Tests of Achievement – Third Edition is a wide-range comprehensive set of individually administered tests for measuring academic achievement.

Subtest / Standard Score / Grade Equivalent
Letter-Word Identification
Reading Fluency
Calculation
Spelling
Passage Comprehension
Applied Problems
Writing Samples
Word Attack
Picture Vocabulary

Standard Score Key: Borderline = 70-80; Low Average = 80-90; Average = 90-110

Cognitive Ability

Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV)

The Wechsler Intelligence Scale for Children - Fourth Edition is a valid and reliable measure of academic achievement. The table on the following page represents Shianne’s scores on this measure:

Index / Standard Score / Percentile
Verbal Comprehension (VCI) / 108 / 70
Perceptual Reasoning (PRI) / 106 / 66
Working Memory (WMI) / 88 / 21
Processing Speed(PSI) / 91 / 27
Full Scale (FSIQ) / 101 / 53

Standard Score Key: Borderline = 70-80; Low Average = 80-90; Average = 90-110

Verbal Comprehension (VCI) / Scaled Score / Perceptual Reasoning (PRI) / Scaled Score
Similarities / 13 / Block Design / 11
Vocabulary / 9 / Picture Concepts / 9
Comprehension / 13 / Matrix Reasoning / 13
Working Memory (WMI) / Scaled Score / Processing Speed (PSI) / Scaled Score
Digit Span / 6 / Coding / 6
Letter-Number Sequencing / 10 / Symbol Search / 11

Scaled Score Key: Below Average = under 9; Average = 9-11; Above Average = above 11

Social-Emotional Functioning

Behavior Assessment System for Children – Second Edition (BASC-2)

The Behavior Assessment System for Children – Second Edition is designed to facilitate the differential diagnosis and classification of a variety of emotional and behavioral disorders in children. The Teacher Rating Scales (TRS) provide descriptions of a child’s observable behavior at school, while the Parent Rating Scales (PRS) provide descriptions of a child’s observable behavior in the home environment.

Clinical Scales / T-Score / T-Score
Ms. Cermak
(5th Grade Teacher) / Melissa Hall
(Mother)
Hyperactivity
Aggression
Conduct Problems
Anxiety
Depression
Somatization
Atypicality
Withdrawal
Attention Problems
Learning Problems

T-Score Key: Clinically Significant = 70↑; Significant = 60-69; Average = 40-59; Low Score < 40

Adaptive Scales
Adaptability
Social Skills
Leadership
Study Skills
Functional Communication

T-Score Key: Clinically Significant = 30↓; At-Risk = 31-40; Average = 40↑

Composite Scores
Externalizing Problems
Internalizing Problems
School Problems
Behavioral Symptoms
Adaptive Skills

T-Score Key: Clinically Significant = 70↑; At-Risk = 60-69; Average = 40-59; Low Score < 40

PROPOSED ACTION

The multidisciplinary team evaluation (does/does not) support Article 7 eligibility for special education services under the eligibility category of (disability category name). Final determination will be made by the case conference committee.

Respectfully submitted,

______

School Psychologist