"Statement of Eligibility - Eligibility Team Report - Specific Learning Disabilities" - Nevada

Statement of Eligibility - Eligibility Team Report - Specific Learning Disabilities is a legal document that was released by the Nevada Department of Education - a government authority operating within Nevada.

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Date
STATEMENT OF ELIGIBILITY
ELIGIBILITY TEAM REPORT
SPECIFIC LEARNING DISABILITIES
Pupil’s Name
Birthdate
Grade
ELIGIBILITY DETERMINATION:
According to state regulations (NAC 388.420):
This pupil is not eligible for special education under the category of specific learning disabilities.
This pupil is eligible for special education under the category of specific learning disabilities, based on
the following criteria.
GENERAL CRITERIA FOR SPECIFIC LEARNING DISABILITIES BASED ON ASSESSMENT OF
RESPONSE TO INTERVENTION AND/OR COMPARATIVE ANALYSIS:
The pupil has been provided with learning experiences and instruction appropriate for the pupil’s age.
The determination that the pupil has a specific learning disability has been made based upon the
results of the evaluation described in NAC 388.420. In interpreting the evaluation data, information was
drawn from a variety of sources, including aptitude and achievement tests, parent input, and teacher
recommendations, as well as information about the pupil's physical condition, social or cultural
background, and adaptive behavior, and information from all of these sources was documented and
carefully considered.
The pupil does not achieve adequately for the pupil's age or to meet State-approved grade-level
standards in one or more of the following areas (check all that apply):
□ Oral expression
Written expression
□ Listening comprehension
Basic reading skill
□ Mathematical calculation
Reading fluency skills
□ Mathematical problem solving
Reading comprehension
Any identified underachievement is not primarily the result of a visual, hearing or motor disability;
mental retardation; emotional disturbance; cultural factors; environmental or economic disadvantage; or
limited English proficiency.
There is documented, data based evidence that any identified underachievement is not due to a lack of
appropriate instruction in math or reading. This determination is based upon each of the following:
□ Data that demonstrate that prior to, or as part of, the referral process, the pupil was provided
appropriate instruction in regular education settings, delivered by qualified personnel; and
□ Data based documentation of repeated assessments of achievement at reasonable intervals,
reflecting formal assessment of the pupil's progress during instruction, and which was provided
to the pupil's parents.
The controlling factor for the pupil's eligibility is not lack of appropriate instruction in math.
The controlling factor for the pupil's eligibility is not lack of appropriate instruction in reading, including
the essential components of reading instruction. Explicit and systematic instruction has been provided
for each of the following:
□ Phonemic awareness
□ Phonics
□ Vocabulary development
□ Reading fluency, including oral reading skills
□ Reading comprehension strategies
Interventions implemented in general education classrooms have not remedied any identified
underachievement.
The following relevant behavior was noted during the observation of the pupil:
None noted.
As follows:
June 2015
1
Date
STATEMENT OF ELIGIBILITY
ELIGIBILITY TEAM REPORT
SPECIFIC LEARNING DISABILITIES
Pupil’s Name
Birthdate
Grade
ELIGIBILITY DETERMINATION:
According to state regulations (NAC 388.420):
This pupil is not eligible for special education under the category of specific learning disabilities.
This pupil is eligible for special education under the category of specific learning disabilities, based on
the following criteria.
GENERAL CRITERIA FOR SPECIFIC LEARNING DISABILITIES BASED ON ASSESSMENT OF
RESPONSE TO INTERVENTION AND/OR COMPARATIVE ANALYSIS:
The pupil has been provided with learning experiences and instruction appropriate for the pupil’s age.
The determination that the pupil has a specific learning disability has been made based upon the
results of the evaluation described in NAC 388.420. In interpreting the evaluation data, information was
drawn from a variety of sources, including aptitude and achievement tests, parent input, and teacher
recommendations, as well as information about the pupil's physical condition, social or cultural
background, and adaptive behavior, and information from all of these sources was documented and
carefully considered.
The pupil does not achieve adequately for the pupil's age or to meet State-approved grade-level
standards in one or more of the following areas (check all that apply):
□ Oral expression
Written expression
□ Listening comprehension
Basic reading skill
□ Mathematical calculation
Reading fluency skills
□ Mathematical problem solving
Reading comprehension
Any identified underachievement is not primarily the result of a visual, hearing or motor disability;
mental retardation; emotional disturbance; cultural factors; environmental or economic disadvantage; or
limited English proficiency.
There is documented, data based evidence that any identified underachievement is not due to a lack of
appropriate instruction in math or reading. This determination is based upon each of the following:
□ Data that demonstrate that prior to, or as part of, the referral process, the pupil was provided
appropriate instruction in regular education settings, delivered by qualified personnel; and
□ Data based documentation of repeated assessments of achievement at reasonable intervals,
reflecting formal assessment of the pupil's progress during instruction, and which was provided
to the pupil's parents.
The controlling factor for the pupil's eligibility is not lack of appropriate instruction in math.
The controlling factor for the pupil's eligibility is not lack of appropriate instruction in reading, including
the essential components of reading instruction. Explicit and systematic instruction has been provided
for each of the following:
□ Phonemic awareness
□ Phonics
□ Vocabulary development
□ Reading fluency, including oral reading skills
□ Reading comprehension strategies
Interventions implemented in general education classrooms have not remedied any identified
underachievement.
The following relevant behavior was noted during the observation of the pupil:
None noted.
As follows:
June 2015
1
Date
STATEMENT OF ELIGIBILITY
ELIGIBILITY TEAM REPORT
SPECIFIC LEARNING DISABILITIES
Relationship of any relevant behavior to the academic functioning of the pupil:
The following educationally relevant medical findings were noted:
None noted.
As follows:
ADDITIONAL CRITERIA FOR ELIGIBILITY:
Additional Criteria for Response to Intervention:
The pupil has not made sufficient progress to meet age or State-approved grade-level standards in one
or more of the areas identified above (oral expression, listening comprehension, mathematical
calculation, mathematical problem solving, written expression, basic reading skill, reading fluency skills,
reading comprehension) when using a process based on the child’s response to scientific, research-
based intervention.
The following instructional strategies were used:
The following student-centered data were collected:
Any identified underachievement is not correctable without special education services.
On (date)
the pupil's parents were notified about Nevada's policies
regarding the amount and nature of student performance data that would be collected and the
general education services that would be provided; strategies for increasing the child's rate of
learning; and the parents' right to request an evaluation.
June 2015
2
Date
STATEMENT OF ELIGIBILITY
ELIGIBILITY TEAM REPORT
SPECIFIC LEARNING DISABILITIES
AND/OR
Additional Criteria for Comparative Analysis:
The pupil exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative
to age, State-approved grade-level standards, or intellectual development, that is determined by the
group to be relevant to the identification of a specific learning disability, using appropriate assessments.
The pupil exhibits a severe discrepancy between achievement and intellectual ability in one or more of
the areas identified above (oral expression, listening comprehension, mathematical calculation,
mathematical problem solving, written expression, basic reading skill, reading fluency skills, reading
comprehension).
The severe discrepancy has been determined through the use of a statistically valid formula
which takes into account the age and level of ability of the pupil, the correlation between tests
of ability and achievement, and the reliability of each test used. In the case of a pupil under the
age of 6 years, a discrepancy may be identified through the use of one or more tests of
language concepts or academic readiness skills.
OR
In considering the continuing existence of a severe discrepancy between achievement and
intellectual ability in a reevaluation of the pupil, the determination of a severe discrepancy has
been made based upon information other than the statistically valid formula.
The severe discrepancy is not correctable without special education services.
The severe discrepancy is corroborated by classroom-based assessment.
Additional Information (Optional):
By reason of the pupil’s Specific Learning Disability, the pupil needs special education and related
services.
Eligibility Team Members:
Any member who disagrees with the eligibility determination must prepare a statement of the conclusions of that member.
Signature/Regular Classroom Teacher
Agree/Disagree
Signature/Parent
Agree/Disagree
Signature/Special Education Teacher
Agree/Disagree
Signature/Other
Agree/Disagree
Signature/School Psychologist
Agree/Disagree
Signature/Other
Agree/Disagree
Any decision of an eligibility team must be justified in a written report. Parents have been provided a copy of the report and any
other documentation relating to the determination of the pupil's eligibility. (NAC 388.340.4)
June 2015
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