Your Child Has Been Referred For

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EVALUATION PLAN

Date of Referral 02/15/04

Your child has been referred for:

Initial Evaluation 3 Year Re-evaluation/Triennial Other SCI Assistance Evaluation to provide information for the development of the IEP

Student Amaro RichardDate of Birth 06/03/96

LastFirst

School Oak Tree ElementaryGrade 2nd

District Southern California Unified School District

Parent Name Tom and Annie AmaroHome Phone 739-3871

Parent Address 3456 Oak Grove Lane Work Phone 739-1234

Tree City, CA 91010

Primary Language English LEP No YesLanguage Assessment Date N/A

If the student’s primary language is not English, an interpreter may be used to assure the accuracy of the assessment if appropriate.

In order to meet your child’s educational needs, the following evaluation is proposed. This evaluation will provide information related to enabling your child to participate in the general curriculum (or appropriate activities for preschool children). The evaluation will be conducted by qualified personnel and is designed to assess your child in all areas of suspected disability. In addition to the assessments indicated below, a variety of tools and strategies will be utilized, which may include observation of the student, teacher/parent/student interviews, reviews of student records and prior assessments. The assessment instruments have been validated for the specific purpose for which they will be used, unless otherwise indicated, and are selected so as not to be discriminatory on a racial or cultural basis. You will receive a copy of the evaluation report(s). You will be asked to participate in a meeting of the individualized education program (IEP) team following completion of the evaluation. If your child is determined to have a disability as defined in state/federal law, the results of the evaluation will be considered by the IEP team when developing an IEP for your child. The IEP team may recommend a special education program and/or other services. No single procedure will be used as the sole criterion for determining an appropriate education program for your child. No placement in a special education program or provision of other services will be initiated without your written permission. All information and results will be kept confidential.

AREAS TO BE ASSESSED ARE CHECKED

ACADEMIC ACHIEVEMENTADMINISTERED BY

Purpose: These tests measure a student’s current reading, writing mathematics, or pre-readiness skills. Tests may include, but are not limited to:

Brigance Inventory of Basic SkillsKaufman Test of Educational Achievement (KTEA)

Peabody Individual Achievement Test (PIAT)Early Screening Profiles (ESP)

Key MathWide Range Achievement Test (WRAT)

Wechsler Individual Achievement Test (WIAT)Woodcock-Johnson Achievement Battery (WJ-R)

Norris Educational Achievement TestBateria Woodcock-Muñoz

Other

PSYCHO-MOTOR DEVELOPMENT/PERCEPTUAL FUNCTIONINGADMINISTERED BY

Purpose: Instruments in this area measure how well students coordinate body movements in small and large muscle activities. They may also include visual perceptual skills. Tests may include, but are not limited to:

Bruininks-Oseretsky Test of Motor ProficiencyBender-Gestalt

Motor-Free Visual Perception Test (MVPT)Detroit Test of Learning Aptitude

Developmental Test of Visual Motor Integration (VMI) Test of Visual Perceptual Skills (TVPS)

Other

LANGUAGE/SPEECH COMMUNICATION DEVELOPMENTADMINISTERED BY

Purpose: These tests measure a student’s ability to understand, relate to and use language, and to speak clearly and appropriately. Tests may include, but are not limited to:

Clinical Evaluation of Language Fundamentals(CELF)Language Sample Test of Problem Solving (TOPS)

Peabody Picture Vocabulary Test (PPVT)Tests of Language Development (TOLD)

Expressive One Word Picture Vocabulary Test Receptive One Word Picture Vocabulary Test

Structured Photograph Expressive Language Test Voice and/or Fluency Measurements

Goldman-Fristoe Test of ArticulationWoodcock-Muñoz Language Survey

Language Processing Test (LPT)Test of Auditory Perceptual Skills (TAPS)

Expressive Vocabulary Test (EVT)Test of Auditory Reasoning & Processing Skills (TARPS)

Oral & Written Language ScalesWord Test

Other

SDCOE - SELPA Rev. 8/01/03White – Central/District OfficeCanary – Parent/Guardian/Surrogate Pink – School Site

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