[ 1]NEW HANOVER COUNTY SCHOOLS

FORMAL EVALUATION DESIGN

  1. Demographics

Child’s Name: / DOB: / NCWise#:
School: / Meeting Date[ 2]
Team Leader: / Target Review Date[ 3]: / :

Purpose for Initial Formal Evaluation:

Determination of need for specially designed instruction (eligibility)

Purpose for Reevaluation:

Redetermination of need for specially designed instruction (eligibility)

Determination of effectiveness & appropriateness of services currently received

Determination of future services based on evaluation information

Gather additional information for educational planning including related service needs

Other (describe here:)

[ 4][ 5]

ACADEMIC / READINESS SKILLS
Strengths / Needs / Assessment(s) / Person/Agency Responsible
COGNITIVE
Strengths / Needs / Assessment(s) / Person/Agency Responsible
COMMUNICATION
Strengths / Needs / Assessment(s) / Person/Agency Responsible
BEHAVIORAL / EMOTIONAL
Strengths / Needs / Assessment(s) / Person/Agency Responsible
MOTOR (FINE / GROSS)
Strengths / Needs / Assessment(s) / Person/Agency Responsible
MEDICAL
Strengths / Needs / Assessment(s) / Person/Agency Responsible
ADAPTIVE BEHAVIOR
Strengths / Needs / Assessment(s) / Person/Agency Responsible
SOCIAL / DEVELOPMENTAL
Strengths / Needs / Assessment(s) / Person/Agency Responsible
TRANSITION (14 YRS OR OLDER)
Strengths / Needs / Assessment(s) / Person/Agency Responsible
TRANSPORTATION
Strengths / Needs / Assessment(s) / Person/Agency Responsible
OTHER:
Strengths / Needs / Assessment(s) / Person/Agency Responsible

Notes:

[ 1]This form is used in any school for the evaluation design for Autism, Traumatic Brain Injury, Intellectually Disabled - Moderate (IDMO), and Intellectually Disabled - Severe (IDSE). In non-PSM schools the form is to be used for all evaluations

[ 2]Record the date of the meeting to design the evaluation. This date starts the 90-day time line and is recorded in the IEP folder 3 in Goalview.

[ 3]Review Date must state month, day, year and must occur within 60 days or less of parent consent for initial referral to insure the completion of the process within the required 90 day time line.

[ 4]An Invitation to IDEA Conference must be completed and the purpose indicated for completing a Formal Evaluation. Informed consent must be provided by parents. See chart for required minimum participants

PARTICIPANTS MUST MATCH THE PURPOSE OF THE MEETING

[ 5]Please refer to the NC Policies Governing Services for Children with Disabilities for the required screenings and evaluations for each eligibility category:

Autism

Deaf Blindness

Deaf

Developmental Delay

Emotional Disability

Hearing Impairment

Intellectual Disability

Multiple Disabilities

Orthopedic Impairment

Other Health Impaired

Specific Learning Disability

Speech or Language Impairment

Traumatic Brain Injury

Visual Impairment