EvaluationRe-Evaluation Worksheet by parpar


									                                                           Evaluation/Re-Evaluation Worksheet

Date: _________________                                    Initial      Re-eval   (Circle One)                Case Manager: _________________________

Student Name: ___________________________________                                      Disability: ________________ Birth Date: ______________

Pre-Eval Meeting Date: ________________ Eval Meeting Date: _________________                                                       Eval Due Date: ______________

Describe other options or factors that were considered relevant to this evaluation such as behavior, blindness, or visual impairment, deafness or hard of hearing,
assistive technology, race, culture, or language: _________________________________________________________________________________________

Following is a statement of adaptations needed to conduct this evaluation: ____________________________________________________________________

IPF: Teacher Informants_________________________                                                 Sensory Status-Nurse
                                                                                                 To assess vision and hearing.
BASC: Teacher Informants______________________
                                                                                                 Assessment Procedure:
                                                                                                   Record/File Review
Academic & Functional Performance                                                                  Vision Screening
To determine levels of achievement in reading, math, and written language.
Assessment Procedure:                                                                              Pure Tone and Tymp Screening
  Record/File Review                                                                             Communication- Speech Therapist
                                                                                                 To assess articulation status, receptive, and expressive language abilities
  Wechsler Individual Achievement Test – 2nd Edition
                                                                                                 Assessment Procedure:
  Woodcock Johnson Achievement Battery – 3rd Edition
                                                                                                   Record/File Review
  Oral and Written Language Skills (OWLS)                                                           Articulation:
   The Test of Early Mathematics Ability-3rd Edition (TEMA-3)
                                                                                                    Photo Articulation Test - 3rd Edition
   Test of Early Reading Ability – 3rd Edition (TERA-3)
                                                                                                    Goldman Fristoe 2 – Test of Articulation’
   Test of Early Written Language – 2nd Edition (TEWL-2)
                                                                                                    Speech samples
   Classroom observation and classroom performance                                                  Language:
   Informational Assessments                                                                        Clinical Evaluation of Language Fundamentals–4th Edition
                                                                                                    Clinical Evaluation of Language Fundamentals – 4th Edition - Spanish
Autism Spectrum Disorders Assessment:                                                               Expressive One Word Picture Vocabulary Test
Assessment Procedures:                                                                              Expressive One Word Picture Vocabulary Test –Spanish – Bilingual
  Record/File Review                                                                                Peabody Picture Vocabulary Test – 4th Edition – Spanish
                                                                                                    Oral and Written Language Scales
  Informal Interviews-Parent, Teacher Student                                                       Boehm Test of Basic Concepts – 3rd Edition
  Behavioral Observation                                                                            Test of Pragmatic Language – 2
  Checklist for the Identification of Individuals with                                              Test of Auditory Comprehension of Language
Asperger’s Syndrome                                                                                 Test of Word Knowledge
  Childhood Autism Rating Scale (CARS)                                                              Pragmatic Communication Skills Protocol
  Gilliam Autism Rating Scale (GARS)                                                                Functional Communication Skills Profile - Revised
    Gilliam Asperger’s Disorder Scale (GADS)                                                        Assessment of Social & Comm. Skills for Children with Autism
   Autism Diagnostic Observation Schedule (ADOS)                                                    Observation
                                                                                                    Language Sample
                                                                                                    Problem Solving:
Motor Skills – OTR                                                                                  Test of Language Development-P:3
To assess fine motor and sensory motor skills.
                                                                                                    Test of Problem Solving
Assessment Procedure:                                                                               Lip Reading:
  Record/File Review                                                                                The Craig Lip Reading Inventory Word Recognition
  Fine Motor Scale of the Bruininks-Oseretsky Test of Motor                                         Utley Lip Reading Test
  Proficiency-2nd Edition                                                                           Auditory Processing:
  Test of Visual Perceptual Skills-3rd Edition                                                      Test of Auditory Processing Skills - 3rd Edition (TAPS-III)
  Developmental Test of Visual Motor Integration-5th Edition                                        Test of Auditory Reasoning and Processing Skills
  Revised                                                                                           Oral Motor:
   Motor-Free Visual Perception Test – 3rd Edition (MVPT-III)                                       The Apraxia Profile
   Peabody Developmental Scales-2                                                                   Oral Speech Mechanism Screening Examination - Revised
   Sensory Integration Inventory Revised for Individuals with                                       Informal Oral Motor Evaluation
   Developmental Disabilities                                                                       Voice Evaluation Profile
   Test for Visual Motor Skills                                                                     Fluency:
   Sensory Profile                                                                                  Stuttering Severity Instruments for Children and Adults-3rd Edition
   Observation                                                                                      Speech samples
   Staff/Parent Interviews                                                                          Stuttering Prediction Instrument
   Touch Inventory for Elementary Age Children
Intellectual/Cognitive Functioning
To determine ability level and to gather data about information processing style.
Assessment Procedure:
  Record/File Review
  Informal Interviews: Parent, Teacher, Student
  Wechsler Intelligence Scale for Children – 4th Edition
  Leiter International Performance Scale
  Stanford - Binet test of Intelligence – 5th Edition (SB:FE)
  Wechsler Preschool and Primary Scale of Intelligence-III
  Wechsler Nonverbal Scale of Ability (WNSA)
   Universal Nonverbal Intelligence Test (UNIT)
   Bayley Scales of Infant Development

Memory & Attention/Impulsivity
To determine ability level and style of recall of information and level of attention and
Assessment Procedure:
  Record/File Review
  Conners’ Behavior Rating Scale-Revised
  Children’s Memory Scale (CMS)
  Conners’ Continuous Performance Test – 2nd Edition
  Information Processing Form (IPF)

Emotional/Social and Behavior Functioning
To determine effects of behavior on school achievement.
Assessment Procedure:
  Record/File Review
  Informal Interviews: Parent, Teacher, Student
  Conners’ Rating Scales – Revised (CRS-R): Parent,
   Teacher, Student
  Behavior Assessment System for Children – 2nd Edition
   (BASC-II): Parent, Teacher, Student
  Children’s Depression Inventory (CDI)
  Beck Depression Inventory – 2nd Edition (BDI-II)
  Reynold’s Adolescent Depression Scale – 2nd Edition
  Revised Children’s Manifest Anxiety Scale (RCMAS)
   Social Skills Rating Scales (SSRS): Parent, Teacher, Student

Adaptive and Functional Skills
To determine levels of adaptive behavior.
Assessment Procedure:
  Record/File Review
  Behavioral Observation
  Informal Interviews: Parent, Teacher, Student
  Vineland Adaptive Behavior Scales – 2nd Edition
   (VABS-II): Parent, Teacher
  Adaptive Behavior Assessment System–2nd Ed.
   (ABAS-II): Parent; Teacher

Revised 10/10/07

To top