"Statement of Eligibility - Speech and Language Impairment" - Nevada

Statement of Eligibility - Speech and Language Impairment is a legal document that was released by the Nevada Department of Education - a government authority operating within Nevada.

Form Details:

  • Released on June 1, 2015;
  • The latest edition currently provided by the Nevada Department of Education;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Nevada Department of Education.

ADVERTISEMENT
ADVERTISEMENT

Download "Statement of Eligibility - Speech and Language Impairment" - Nevada

Download PDF

Fill PDF online

Rate (4.3 / 5) 15 votes
Date
STATEMENT OF ELIGIBILITY
ELIGIBILITY TEAM REPORT
SPEECH AND LANGUAGE IMPAIRMENT
Pupil’s Name
Birthdate
Grade
According to state regulations (NAC 388.405):
This pupil is not eligible for special education under the category of speech and language impairment.
This pupil is eligible for special education under the category of speech and language impairment,
based on the following criteria.
CRITERIA FOR SPEECH AND LANGUAGE IMPAIRMENT
PHONOLOGY OR ARTICULATION (three or more of the following conditions)
Physiological potential to make the neuromuscular adjustments necessary for oral expression;
The communicative ability of the pupil is interfered with by the pupil's lack of intelligibility;
The pupil cannot adequately discriminate, imitate, or sequence sound patterns;
The ability of the student to articulate is significantly less than that which is expected in view of the
cognitive abilities and level of development of the pupil; or
The deficit or disorder has an adverse social, emotional, or academic effect upon the pupil.
USE AND COMPREHENSION OF LANGUAGE (two or more of the following conditions)
The ability of the pupil to comprehend language is significantly less than that which is expected in
view of the cognitive abilities and level of development of the pupil;
The use of expressive language by the pupil is significantly less than that which is expected in view of
the cognitive abilities and level of development of the pupil;
Pragmatic use of language by the pupil is inappropriate; or
The deficit or disorder has an adverse social, emotional, or academic effect upon the pupil.
FLUENCY (two or more of the following conditions)
The speech of the pupil is observed to be dysfluent;
The severity of the deficit or disorder is such that it interferes with communication by the pupil; or
The deficit or disorder has an adverse social, emotional, or academic effect upon the pupil.
QUALITY, PITCH, OR INTENSITY OF PUPIL'S VOICE (two or more of the following conditions)
Voice therapy is recommended by a physician or another person certified as a specialist in the
identification and treatment of oral, nasal, or laryngeal anomalies;
The severity of the deficit or disorder is such that it interferes with communication by the pupil; or
The deficit or disorder has an adverse social, emotional, or academic effect upon the pupil.
1
June 2015
Date
STATEMENT OF ELIGIBILITY
ELIGIBILITY TEAM REPORT
SPEECH AND LANGUAGE IMPAIRMENT
Pupil’s Name
Birthdate
Grade
According to state regulations (NAC 388.405):
This pupil is not eligible for special education under the category of speech and language impairment.
This pupil is eligible for special education under the category of speech and language impairment,
based on the following criteria.
CRITERIA FOR SPEECH AND LANGUAGE IMPAIRMENT
PHONOLOGY OR ARTICULATION (three or more of the following conditions)
Physiological potential to make the neuromuscular adjustments necessary for oral expression;
The communicative ability of the pupil is interfered with by the pupil's lack of intelligibility;
The pupil cannot adequately discriminate, imitate, or sequence sound patterns;
The ability of the student to articulate is significantly less than that which is expected in view of the
cognitive abilities and level of development of the pupil; or
The deficit or disorder has an adverse social, emotional, or academic effect upon the pupil.
USE AND COMPREHENSION OF LANGUAGE (two or more of the following conditions)
The ability of the pupil to comprehend language is significantly less than that which is expected in
view of the cognitive abilities and level of development of the pupil;
The use of expressive language by the pupil is significantly less than that which is expected in view of
the cognitive abilities and level of development of the pupil;
Pragmatic use of language by the pupil is inappropriate; or
The deficit or disorder has an adverse social, emotional, or academic effect upon the pupil.
FLUENCY (two or more of the following conditions)
The speech of the pupil is observed to be dysfluent;
The severity of the deficit or disorder is such that it interferes with communication by the pupil; or
The deficit or disorder has an adverse social, emotional, or academic effect upon the pupil.
QUALITY, PITCH, OR INTENSITY OF PUPIL'S VOICE (two or more of the following conditions)
Voice therapy is recommended by a physician or another person certified as a specialist in the
identification and treatment of oral, nasal, or laryngeal anomalies;
The severity of the deficit or disorder is such that it interferes with communication by the pupil; or
The deficit or disorder has an adverse social, emotional, or academic effect upon the pupil.
1
June 2015
Date
STATEMENT OF ELIGIBILITY
ELIGIBILITY TEAM REPORT
SPEECH AND LANGUAGE IMPAIRMENT
ADDITIONAL CRITERIA
The pupil has demonstrated the ability to profit from speech and language therapy.
The pupil requires a program of instruction because of the nature or severity of the pupil's impairment which
is not feasible in the current educational setting of the pupil because:
intensive remedial techniques or strategies which can only be implemented in a clinical or therapeutic
setting are required to improve the communication skills of the pupil;
the nature of the pupil's impairment requires that the pupil receive the services of a teacher of the
speech and language impaired; or
the pupil's impairment is of such severity or multiplicity that individual or small group management
available only on a speech and language program is required.
The pupil with limited proficiency in English is eligible for special services and programs of instruction on the
same basis as other pupils if the pupil's impairment:
manifests itself in the pupil's native language and in English; and
is not attributable to the phonological system of the pupil's native language or to dialectical
differences of articulation and language form between that language and English.
The controlling factor for the student's eligibility is not the lack of appropriate instruction in reading, including
the essential components of reading instruction, or appropriate instruction in math.
The controlling factor for the student's eligibility is not limited English proficiency.
By reason of the pupil’s Speech and Language Impairment, the pupil needs special education and related
services.
Eligibility Team Members:
Signature/Speech and Language Specialist
Agree/Disagree
Signature/Parent
Agree/Disagree
Signature/Regular Classroom Teacher
Agree/Disagree
Signature/Other
Agree/Disagree
Signature/Special Education Teacher if the
Agree/Disagree
Signature/Other
Agree/Disagree
pupil has another disability in addition
to speech and language impairment
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)
2
June 2015
Page of 2