PO Box 218 • 202 Elm Street            •   Bergland, MI 49910
                                                                                       Phone: (906) 575-3438                      Fax: (906) 575-3373

                                                                                                          3 Yr. Re-evaluation

                                                                                             Initial Evaluation                       Eligibility Change

                                                        Multidisciplinary Evaluation Team Summary
                                                         Speech and Language Impairment (SLI): R340.1710
Name:                                                                                                        Birthdate:
District:                                                                                           School / Program:
Grade:                                               MET Date:                                            Prepared by:
  I. Parent input was solicited as follows:
            By:                                                         Method of Contact:                                    Date:
 II. Present Level of Educational Performance: With enough detail to determine a starting point for instruction, describe this student's
      present level of educational performance, including a description of how the disability affects his / her progress in the general curriculum: (For
      preschool age children, describe how the disability affects involvement in age-level activities.)
III. Eligibility Criteria for the Speech and Language Impairment (R340.1710)
       A. A speech and language impairment shall be determined through manifestation of one or more of the following communication impairments
           which adversely affects educational performance. Does the student exhibit one of the following impairments? (Check all that apply)
                                                                                                                               YES            NO
          (a) Articulation impairment, including omissions, substitutions, or distortions of sound, persisting beyond
               the age at which maturation alone might be expected to correct the deviation.
            (b) Voice impairment, including inappropriate pitch, loudness, or voice quality.
            (c) Fluency impairment, including abnormal rate of speaking, speech interruptions; and repetition of
                sounds, words, phrases, or sentences, which interferes with effective communication.
            (d) Language impairments, one or more of the following phonological, morphological, syntactic,
                 semantic, or pragmatic use of aural / oral language as evidenced by both of the following:
                 (i) A spontaneous language sample demonstrating inadequate language functioning.
                 (ii) Test results, on not less than 2 standardized assessment instruments or two subtests designed to
                      determine language functioning, which indicate inappropriate language fuctioning for the child's age.
      B. Is the impairment based solely on 1) lack of instruction in reading and math, or 2) Limited English Proficiency?
      C. Does this student require special education program / services?
 IV. Recommendations
                  The Multidisciplinary Evaluation Team 1) finds all of the disgnostic assurances statements to be true and
                  2) recommends, based on the evaluation finding, that this student be determined eligible for special
                  education programs / services under the Speech and Language Impairment Rule (R340.1710).
                                              Eligible                                    Not Eligible

  V. MET Members                                                     Report Attached                                                    Agree with Findings
                                                                     YES         NO                                                      YES          NO

                  Speech & Language Pathologist                                                           Date of Report

                            Teacher                                                                       Date of Report

                            Teacher                                                                       Date of Report

                             Other                                                                        Date of Report
                                                  *Person in disagreement will indicate and submit a separate statement.

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