Pajaro Valley Unified School District
Special Education Local Plan Area
REVIEW OF DATA FOR ELIGIBILITY
Student: Date of Birth: C. A.:
Date of Review: School: Grade:
The following information is based upon the current assessment data and is provided for the IEP
team’s consideration in determining eligibility.
AREA OF POSSIBLE ELIGIBILITY
Hard of Hearing
CRITERIA (All Three Must Apply)
Y N There is a current audiological evaluation documenting that the student has a
hearing impairment, either permanent or fluctuating.
Y N The hearing impairment is so severe that it impairs the processing of linguistic
information (including speech and language reception and speech and language
discrimination) through hearing even with amplification.
Y N These impairments adversely affect the student's educational performance, and the
student's needs cannot be solely met within the general education classroom
RPT 01-RDE (1/07) Student’s Name: DOB: