ࡱ> ikhb jbjb{x{x $V i&&&&&&&\8|8d\4J2pp3333333,97R9x4&4p&&44ppp&&3p:N&&&&3pp*1&&2 egm124041:p:,2p&\\$ \\  FORMCHECKBOX  Initial  FORMCHECKBOX  Annual  FORMCHECKBOX  Triennial  FORMCHECKBOX  Transition  FORMCHECKBOX  Interim  FORMCHECKBOX  Other  FORMTEXT       To parent/guardian of:  FORMTEXT       Date:  FORMTEXT       District:  FORMTEXT      School:  FORMTEXT       Grade:  FORMTEXT     Birth date:  FORMTEXT       Primary language:  FORMTEXT       English proficiency/CELDT Level  FORMTEXT       The district proposes to assess your child to determine his/her eligibility for special education services or continued eligibility and present levels of academic performance and functional achievement. Your child will be assessed in all areas of suspected disability as needed. To meet your childs individual education needs, this assessment will consist of an evaluation in only the areas checked by the local educational agency (LEA)/district. Evaluation Area Examiner Title  FORMCHECKBOX  Academic AchievementThese tests measure reading, spelling, arithmetic, oral and written language skills, and/or general knowledge. FORMTEXT       FORMCHECKBOX  Health Health information and testing is gathered to determine how your child s health affects school performance. FORMTEXT       FORMCHECKBOX  Intellectual Development These tests measure how well your child thinks, remembers, and solves problems. FORMTEXT       FORMCHECKBOX  Language/Speech Communication Development- These tests measure your child s ability to understand and use language and speak clearly and appropriately. FORMTEXT       FORMCHECKBOX  Motor Development These tests measure how well your child coordinates body movements in small and large muscle activities. Perceptual skills may also be measured. FORMTEXT       FORMCHECKBOX  Social/Emotional/Adaptive/Behavior These scales will indicate how your child feels about him/herself, gets along with others, takes care of personal needs at home, school and in the community. FORMTEXT       FORMCHECKBOX  Post Secondary Transition  Age appropriate transition assessments related to training, education, employment and where appropriate independent living skills. FORMTEXT       FORMCHECKBOX  Other Measures  FORMTEXT       FORMTEXT       FORMCHECKBOX  Alternative Means of Assessment (Describe alternative methods of assessing the child, if applicable)  FORMTEXT       FORMTEXT      I consent to the assessment. I understand that the results will be kept confidential and that I will be invited to attend the IEP team meeting to discuss the results. I also understand that no special education services will be provided to my child without my written consent. I do not consent to the proposed assessment described above. I would like the following assessment information to be considered by the IEP team: Signature of Parent/Guardian: Date: _____ / _____ / Address: ____________________________________________ Phone number Comments: Please Return This Form Within 15 Days of Receipt To:  FORMTEXT       NOTE: Prior Written Notice attached if this is an initial evaluation.     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