Lake County SELPA

Speech-Language Assessment Report

CONFIDENTIAL

Student: / Date of Report:
Date of Birth: / Test Date(s)
School: / Chronological Age:
Primary Language: / Language of Home:
Parents: / Examiner:

The following report summarizes the assessments conducted by the above named evaluator with your child. Included in this report is information that may assist in making appropriate educational recommendations. The components of this report meet the requirements of Education Code, Section 56327. The Individualized Educational Program (I.E.P.) meeting is held to discuss the assessment results; however, if you should have further questions regarding this report please do not hesitate to contact the evaluator. This report is made a part of your child’s special education records and you may request a copy through the special education office.

REASON FOR REFERRAL

Initial referral from: / Teacher / Parent / SST / Psychologist
3-year Evaluation / Transfer / Annual Review / LSH Screening
Current Placement:
Who Referred Student:
Reasons for Referral:
Accommodations Previously Made:
Results of Accommodations:
Individual Assessment Plan:

BACKGROUND INFORMATION

Health and Developmental History

Hearing Screening / Date: / Right: / Left:
Vision Screening / Date: / Right: / Left:
Known health/medical concerns:
Medications:
Known developmental delays:
Speech and Language History:
School History and Prior Testing:
California English Language Development Test / Date: / Proficiency Level:
Listening/Speaking:
Reading:
Writing:
Composite:
California Standards Test / Date: / Proficiency Level: / Score:
English/Language Arts
Math
California Achievement Test/6 / Date: / Scaled Score: / Percentile:
Reading
Language
Math
Spelling
Language Assessment Scales / Date: / Proficiency Level:
Total Oral
Comments:

BEHAVIORS OBSERVED DURING EVALUATION

Motivation/Effort: / Good / Fair / Poor
Attention: / Good / Fair / Poor
Rapport: / Easily attained / Slowly attained / Not attained
Response Time: / Average / Fast / Impulsive / Delayed
Other: / Failed to ask for clarification
Requested clarification often
Reauditorization
Perseveration
Needed frequent repetition
Limited verbal interaction with examiner
Needed frequent prompts
Frequently responded inappropriately
Comments:

ASSESSMENTS ADMINISTERED

Review of Records

/

Parent Interview

/

Teacher Interview

Student Interview

/

Classroom Observation

/

Standardized Testing

Language Sample

/ /

SLP01 (1/08)