Speech (Articulation) Eligibility Checklist

CHARLES COUNTY PUBLIC SCHOOLSDEPARTMENT OF SPECIAL EDUCATION

Speech (Articulation) Eligibility Checklist

Name of Student: / Date of Birth:
School: / Date of Eligibility Determination:
☐Y☐N / 1. / Documentation that the student exhibits errors of speech sound production or phonological processes beyond the age at which 90% of peers have achieved mastery (latest developmental chart).
Evaluation source/date:
☐Y ☐N / 2. / Adverse impact conversational intelligibility and listener perception.
☐Y ☐N / 3. / Most error sounds are not stimulable for correct production.
AND
Documentation of Educational Impact Form and other documentation as needed such as informal testing, speech samples, and other educational evidence supplied by the educator that demonstrates the adverse impact of the articulation disorder upon the student’s success in the educational setting in one or more of the areas listed below. Examples of impact include:
☐Y ☐N / 4. / ACADEMIC IMPACT (ability to benefit from the curriculum) demonstrated by communication problems in academic areas as documented by difficulty conveying information orally and/or in writing directly related to speech errors.
☐Y ☐N / 5. / SOCIAL IMPACT (ability to interact with peers and/or adults) demonstrated by communication problems which interfere with the ability to be understood, difficulty initiating/maintaining/terminating interactions, teasing by peers due to speech difficulties, or observation of student demonstrating embarrassment and/or frustration regarding communication problems.
☐Y ☐N / 6. / VOCATIONAL IMPACT (applicable to students who participate in vocational or job-related activities) demonstrated by communication problems which interfere with the ability to be understood, difficulty initiating/maintaining/terminating interactions.

The IEP team used the above interpretation of the evaluation data to determine:

☐ The student has a speech articulation impairment which adversely impacts his/her education and is eligible for specifically designed instruction and related services (IEP).

☐ The student has a speech articulation impairment but it does not adversely impact his/her education; therefore, the student is not eligible for an IEP.

☐ The studentdoes not have a speech articulation impairment and is not eligible for an IEP.

☐ Evaluation data was insufficient to determine eligibility. Additional assessments and/or data will be obtained/collected in the area(s) of:

SE 07/13