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
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)
(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?
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.