COLLEGE OF EDUCATION
DEPARTMENT OF SPECIAL EDUCATION, REHABILITATION
AND SCHOOL PSYCHOLOGY
CALIFORNIA STATE UNIVERSITY, School Psychology Diagnostic Clinic
SACRAMENTO 6000 J Street
Sacramento, California 95819-6079
[DATE OF REPORT]
BIRTH DATE: GRADE:
ASSESSMENT DATES: TRACK:
PRIMARY LANGUAGE: EXAMINER:
REASONS FOR REFERRAL
Name was referred for testing as a part of a three-year re-evaluation. This testing is designed to
help determine (a) if Name continues to have a disability, (b) if s/he continues to need special education,
(c) to document present levels of functioning and educational needs, and (d) to determine if additions or
modifications to the special education program are needed.
From a review of prior assessment data, behavioral observations, teacher report, and input from
Name’s parents, the following procedures were selected in order to address the reasons for referral:
Name is a (grade) grade (gender) who attends School. Currently, s/he receives (List special
education services as specified in the IEP). The rational for this placement as stated on Name's current
(date of IEP) Individualized Education Program (IEP) is as follows: "(Report the rationale for services
as stated on the IEP)." Current teacher reports indicate (Discuss progress toward annual goals as
reported by teachers). For additional background information, including developmental and health
history, the reader is encouraged to refer to the prior evaluations dated (date of last evaluation).
Name was previously assessed on (Date of previous testing) by (Examiner). Results suggested
(Brief summary of results). Academic progress as measured by prior individually administered
achievement testing is summarized in the following table of standard scores (mean, 100; standard
TEST Date Date Date
Test Taking Behavior
Basic Psychological Processes
Social and Emotional Functioning
SUMMARY AND EDUCATIONAL IMPLICATIONS
Name is a (CA) (Grade) grade (Gender) who has been assessed as part of his/her legally
mandated re-evaluation. Current assessment data suggests Name’s (summarize data reflecting present
levels of functioning).
From the available data it is concluded that Name does/does not continue to have a learning
disability. (Summarize the data used to reach this conclusion). The following recommendations
address Name’s current learning needs.
1. Name does/does not continue to meet eligibility criteria as a student with (Identify the
appropriate special education eligibility classification and summarize the data that
supports the eligibility conclusion).
2. Specific special education placement and service recommendations include (From the
available data specify your placement/service recommendation).
3. Additional recommendations designed to ensure Name’s success in the least restrictive
The final decision as to whether or not Name meets special education eligibility will be made by
the individualized education program team, including assessment personnel, and will take into account all
relevant material which is available on Name. No single score or product of scores, test or procedure has
been used as the sole criterion for the decision of the individualized education program team as to his/her
eligibility for special education.
Stephen E. Brock, Ph.D., NCSP
Licensed Educational Psychologist
30 EC 56381 - Reassessment of Pupils; Triennial
(a) A reassessment of the pupil, based upon procedures specified in Article 2 (commencing
with Section 56320) shall be conducted at least once every three years or more
frequently, if conditions warrant a reassessment, or if the pupil's parent or teacher
requests a reassessment and a new individualized education program to be developed. If
the reassessment so indicates, a new individualized education program shall be
(b) As part of any reassessment, the individualized education program team and other
qualified professionals, as appropriate, shall do the following:
(1) Review existing assessment data on the pupil, current classroom-based assessments
and observations, and teacher and related services providers' observations.
(2) On the basis of the review conducted pursuant to paragraph (1), and input from the
pupil's parents, identify what additional data, if any, is needed to determine:
(A) Whether the pupil continues to have a disability described in paragraph (3) of Section
1401 of Title 20 of the United States Code.
(B) The present levels of performance and educational needs of the pupil.
(C) Whether the pupil continues to need special education and related services.
(D) Whether any additions or modifications to the special education and related services
are needed to enable the pupil to meet the measurable annual goals set out in the
individualized education program of the pupil and to participate, as appropriate, in the
(c) The district, special education local plan area, or county office shall administer tests and
other assessment materials as may be needed to produce the data identified by the
individualized education program team.
(d) If the individualized education program team and other qualified professionals, as
appropriate, determine that no additional data is needed to determine whether the pupil
continues to be an individual with exceptional needs, the district, special education local
plan area, or county office shall notify the pupil's parents of that determination and the
reasons for it, and the right of the parents to request an assessment to determine whether
the pupil continues to be an individual with exceptional needs; however, the district,
special education local plan area, or county office shall not be required to conduct an
assessment unless requested to by the pupil's parents.
(e) A district, special education local plan area, or county office shall assess an individual
with exceptional needs in accordance with this section and procedures specified in Article
2 (commencing with Section 56320) before determining that the pupil is no longer an
individual with exceptional needs.
(f) No reassessment shall be conducted unless the written consent of the parent is obtained
prior to reassessment except pursuant to subdivision (e) of Section 56506.