Evaluation Report (Montana)

Tool Search: Special Ed Documents

The Evaluation in Campus is used to document the student's educational needs and the student's determination of eligibility for special education. This document describes each editor, a description of each field on the editor, and any special considerations and instructions for using the editor and fields.

An evaluation must be created whether or not the student is determined to have a disability. A copy of the evaluation summary report, including the documentation of eligibility, is given to the student’s parents by the school district.

The current format of this document is the MT Evaluation Report. Evaluation formats are selected in Special Ed Eval Types.

Screenshot of Editor Home screen.Editor Home

Editor Home

The Editor Home lists the editors available, their status, and Modification and Completion information.

HeaderDescription
NameThe name of the editor.
Status

The state of the editor. Statuses can be:

  • In Progress indicates a user has entered and saved data in that editor.
  • Not Started is the default status for all editors.
  • Complete indicates a user has clicked the Complete button on the editor, and the editor is read-only. This does not lock the editor from further editing but indicates the user considers the editor finished.
  • Not Needed indicates a user has clicked the Not Needed button on the editor. This is usually done for editors that do not apply to the student.

The following statuses are only available for certain state-specific documents:

Modified ByThe date and the user by whom the editor was last edited.
Completed ByThe date and the user who clicked the Complete button for that editor.

General Information

The following table lists the actions available for the editors. When resizing the window, certain buttons are condensed into a single Action button. 

ButtonDescription
Save

Different editors have different save options. Click the arrow next to the Save & Stay button to view all saving options for any given editor.

  • Save captures progress and navigates the user to the Editor Home or to the List Screen for List editors. See the Editor Types section for additional information.
  • Save & Stay captures progress and keeps the user on the current editor. This save button is the default save option and is usually found within the detail screen or list editors, such as Goals and Objectives. 
  • Save & Next captures progress and navigates the user to the next editor.
  • Save & New captures progress and creates a new record. This save button is usually found within the detail screen of a list editor, such as Goals and Objectives. See the Editor Type section for additional information.
Refresh

Retrieves a new copy of data from the student's record. This includes enrollment, student, parent/guardian, and team member information. This also returns any accidentally deleted records. Manually entered fields do not change when the refresh button is clicked. The user must Save after clicking Refresh to capture changes.


A side panel displays a listing of all the student's applicable enrollment records. See the Enrollments tool documentation for additional information.

CancelNavigates the user to the Editor Home screen or the List Screen for List editors.

Status

Changes the status of the editor. 

  • Complete indicates the editor is finished. This makes the editor read-only. However, this does not lock the editor from further editing. The user must click In Progress to further edit after an editor is marked Complete.
  • Not Needed indicates the editor does not apply to the student's plan or evaluation. This makes the editor read-only. However, this does not lock the editor from further editing. Click the In Progress button to further edit after an editor is marked Not Needed.
  • In Progress only displays when the editor is in the Complete or Not Needed status and allows additional edits to be made.

The following status is only available for the Nevada IEP:

Print

Prints the entire document.

EditorsOpens a side panel listing all the available editors and their status. Select an editor from this list to navigate to that editor or click Close to collapse the side panel.
PreviousNavigates the user to the previous editor.
NextNavigates the user to the next editor.

Editor Types

There are two types of editors available: List or Basic editors. When navigating to a Basic editor, the list of fields within the editor is displayed. List editors display a list of all records within that editor. Clicking an existing record or the New button opens the detail view for an individual record.

Editor Lock Out and Release Logic

Only one user at a time can actively work on an editor. A person with a padlock icon (Screenshot of the Padlock Icon.) displays in the Editors side panel, Editor Home, and List Screen of list editors indicating which editors currently have users working on them. Hovering over the icon displays the name of the user who has checked out the editor, including the current user (you).

Editors that are currently being edited are read-only for all other users. The name of the person working on the editor displays in the header. 

To release an editor, the user must:

  • navigate to the next editor by clicking Save and Next or the Editors button and selecting the next editor from the side panel.
  • click the Cancel button to return to the Editor Home screen.
  • log out of the Campus application.
  • navigate to a different tool in the Campus application.

Editors are automatically released when the in-application timeout limit has been exceeded. This is a back-end process and is usually around 30-60 minutes.

Template Banks

Certain fields within several editors have an Add Template icon that displays next to their name. Clicking this button displays a side panel with the available library of predetermined text for that field. Template Banks are managed in System Administration.

Screenshot of the Add Template icon highlighted and the Template Bank side panel displayed on the right.Template Bank Side PanelClick the plus (+) icons next to the category to view the available template values.

Screenshot of an expanded Template Bank Category on the left and several template values selected on the right. Expanded Category and Values SelectedTemplate Bank Categories display on the left and the selected text displays on the right. Click the Add button to add the template value. This adds the template to the queue of values on the right. The red X removes selected templates while the sequence field can be used to reorder the templates. Another option is to use the up and down arrows next to the sequence field to reorder values. 

Click Cancel to go back to the document. The Clear Selected Template(s) button removes all selected template values from the right selection screen. 

Once selections are finalized, click the Insert Selected Template(s) button to add the values to the field within the document in the selected order. Template values are separated by carriage returns.

Screenshot of an example field with several template bank selections added.Example Template Bank Selections in the Document

Text Editors

Images should not be inserted into text fields. 

Editors

The following section lists each editor and describes each field on the editor.

Evaluation Information

The Evaluation Information editor provides basic information regarding the evaluation.

Screenshot of the Evaluation Information editor.Evaluation Information Editor

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FieldDescription
Evaluation Date
Required
The date of the evaluation.
Evaluation Type The type of evaluation. Options include: 
  • Initial
  • Reevaluation
Date Consent Received
Required
The date the parent/guardian gave consent to evaluate the student.

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Student Information

The Student Information editor displays basic information about the student such as demographic information. This is a read-only editor. 

The Refresh button retrieves a fresh copy of data from the student's record. See the General Information section for additional information.

Screenshot of student information editor.Student Information Editor

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FieldDescriptionAd Hoc
Last NameThe student's last name.

Census > People > Demographics > Last Name

identity.lastName

First NameThe student's first name.

Census > People > Demographics > First Name

identity.firstName

Middle NameThe student's middle name.

Census > People > Demographics > Middle Name

identity.middleName

SuffixThe student's suffix.

Census > People > Demographics > Suffix Name

identity.suffix

AgeThe student's age.

Census > People > Demographics > Age

identity.age
BirthdateThe student's birthdate.

Census > People > Demographics > Birth Date

identity.birthDate

GenderThe student's gender.

Census > People > Demographics > Gender

identity.gender

Federal DesignationThe student's federal race designation.Census > People > Demographics > Federal Designation
identity.raceEthnicityDetermination
Race, Ethnicity (state)The student's state race/ethnicity designation.Census > People > Demographics > Race/Ethnicity Determination
identity.raceEthnicity
Address

The student's address.


This field becomes a dropdown when more than one address exists for the student. The primary household displays by default.

Census > Households > Address Info

address.number; address.street; address.tag; address.prefix; address.dir; address.apt; address.city; address.state; address.zip

Student NumberThe student's identification number.Census > People > Demographics > Student Number
Case Manager Information
These fields are read-only.
NameThe first and last name of the team member.Student Information > Special Ed > General > Team Members
TitleThe role of the team member.Student Information > Special Ed > General > Team Members
PhoneThe phone number of the team member.Student Information > Special Ed > General > Team Members

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Parent/Guardian Information

The Parent/Guardian Information editor populates based on the guardian checkbox on the student's Relationships tool. The editor includes Demographics information for the student's guardian. 

The Delete button next to each parent/guardian can be used to remove a parent/guardian from the IEP. 

The Refresh button retrieves a new copy of parent/guardians' data. This also returns any accidentally deleted people. Manually entered fields do not change when the refresh button is clicked. The user must Save after clicking Refresh to capture changes.

Screenshot of Parent Guardian information editor.Parent/Guardian Information Editor

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FieldDescriptionAd HocValidation
Last NameThe last name of the parent/guardian.

Census > People > Demographics > Last Name

identity.lastName

This field populates from Census. This is part of the header for the parent/guardian.
First NameThe first name of the parent/guardian.

Census > People > Demographics > First Name

identity.firstName

This field populates from Census. This is part of the header for the parent/guardian.
Middle NameThe suffix of the parent/guardian.

Census > People > Demographics > Suffix Name

identity.suffix

This field populates from Census. This is part of the header for the parent/guardian.
SuffixThe suffix of the parent/guardian.

Census > People > Demographics > Suffix Name

identity.suffix

This field populates from Census. This is part of the header for the parent/guardian.
RelationshipThe relation of the parent/guardian to the student.Census > People > RelationshipsThis field populates from Census. This is part of the header for the parent/guardian.
SequenceThe print order of the parent/guardian(s) on the IEP.N/AWhen no Sequence is selected, parent/guardian(s) print in the order displayed in the UI. When any Sequences are selected, only parent/guardian(s) with a sequence number prints in the order defined.
AddressThe parent/guardians' address.

Census > Households > Address Info

address.number; address.street; address.tag; address.prefix; address.dir; address.apt; address.city; address.state; address.zip

This field populates from Census. 


When there are multiple addresses for a person, a drop down with an option to select which address displays. When there is only one address, the drop down only has one option. The populated address is the one marked "Primary."

Work PhoneThe work phone of the parent/guardian.Census > People > Demographics > Work PhoneThis field populates from Census.
Cell PhoneThe cell phone of the parent/guardian.Census > People > Demographics > Cell PhoneThis field populates from Census.
EmailThe primary email address for the parent/guardian.Census > People > Demographics > EmailThis field populates from Census.

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Enrollment Information

The Enrollment Information editor reports Special Education information from the student's Enrollment.

The Refresh button retrieves a fresh copy of data from the student's record. See the General Information section for additional information.

Screenshot of Enrollment information editor.Enrollment Information Editor

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FieldDescriptionAd HocValidation
Resident DistrictThe district where the student lives.N/AThis field is pulled from the Enrollment record. This field is read only.
School Phone The phone number of the school associated with the student's Enrollment record.N/AThis field is pulled from System Administration > Resources > School > School Phone.
This field is read only.
School YearThe school year.N/AThis field is pulled from the Enrollment record. This field is read only.
Grade The student's current grade.

Enrollment > Grade

enrollment.grade

This field is pulled from the Enrollment record. This field is read only.
School NameThe name of the school associated with the student's Enrollment record.Learner Planning > Learning Plans > servingSchoolNameThis field is pulled from the Enrollment record. This field is read only.
District Information
These fields are read only.
District Number The district number associated with the Enrolled school.N/ASystem Administration > Resources > District Information > State District Number
District Name The district name associated with the Enrolled school.N/ASystem Administration > Resources > District Information > Name
District Address The district address associated with the Enrolled school.N/ASystem Administration > Resources > District Information > Address
District Phone The district phone number associated with the Enrolled school.N/ASystem Administration > Resources > District Information > Phone

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Parent/Student Comments

The Parent/Student Comments editor is used to document any evaluation information provided by the parent and/or student.

This editor is required.

Screenshot of the Parent Student Comments editor.Parent/Student Comments

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FieldDescription
Parent Comments
Required
A description of the comments provided by the parent/guardian regarding the student evaluation.
Student Comments A description of the comments provided by the student regarding the their evaluation.
Implications for Educational Planning A description of the implications of this information regarding the student's educational planning.

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Classroom Based Assessments

The Classroom Based Assessment editor is used to document any classroom evaluations, results, and implications for instructional planning for the student.

This editor is required.

Screenshot of the Classroom Based Assessments editor.Classroom Based Assessments Editor

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FieldDescription
Date of Evaluation/ObservationThe evaluation date.
EvaluatorThe person completing the evaluation.
Other EvaluatorsAny other person involved in the evaluation.
Evaluations
Required

A description of the evaluations done for the student.

Results
Required
The results of the evaluation.
Implications for Instructional Planning
Required
A description of the implications of this information regarding the student's instructional planning.

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Observations

The Observations editor is used to document any evaluations, results, and implications for instructional planning for the student.

Screenshot of the Observations editor.Observations Editor

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FieldDescriptionValidation
Date of Evaluation/ObservationThe evaluation date.N/A
EvaluatorThe person completing the evaluation.Users in this dropdown are based on staff members who have the Special Ed checkbox marked on their District Assignment.
Other EvaluatorsAny other person involved in the evaluation.N/A
Evaluations
Required
A description of the evaluations done for the student.N/A
Results
Required
The results of the evaluation.N/A
Implications for Instructional Planning
Required
A description of the implications of this information regarding the student's instructional planning.N/A

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Assessments

The Assessments editor is used to document the type of assessments used to evaluate the student.

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Assessments List Screen

Screenshot of the assessments list screen.Assessments List Screen

FieldDescription
Padlock IconThe user currently editing the record.
Assessments Date The date of the assessment.
Assessment Area The area of assessment.
Evaluator The person completing the evaluation.

Assessments Detail Screen

Screenshot of the assessments detail screen.Assessments Detail Screen

FieldDescription
Date of Evaluation/ObservationThe evaluation date.
Assessment Area
Required

The area of assessment. Options include: 

  • Academic Achievement
  • Assistive Technology/Services
  • Behavioral
  • Communication
  • Developmental
  • Functional Behavior Assessment
  • Physical
  • Psychological
  • Social/Emotional
  • Transition
  • Other
EvaluatorThe person completing the evaluation.
Other EvaluatorsAny other person involved in the evaluation.
Evaluations
Required
A description of the evaluations done for the student.
Results
Required
The results of the evaluation.
Implications for Instructional Planning
Required
A description of the implications of this information regarding the student's instructional planning.

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Determination of Eligibility Checklist

The Determination of Eligibility editor provides a collection of checklists for each disability the student is determined to have. Checklists include the considerations and questions to be addressed for that disability.

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Determination of Eligibility Checklist List Screen

Screenshot of the determination of eligibility checklist list screen.Determination of Eligibility Checklist List Screen

FieldDescription
Padlock IconThe user currently editing the record.
DateThe date the determination was made.
ChecklistThe checklist item.
EligibleIndicates the eligibility status of each checklist item.

Determination of Eligibility Checklist Detail Screen

Screenshot of the determination of eligibility checklist detail screen.Determination of Eligibility Checklist Detail Screen - Autism Example

FieldDescriptionValidation
Checklist
Required

The checklist item. Options include: 

  • Autism
  • Cognitive Delay
  • Deafness
  • Deaf-Blindness
  • Developmental Delay
  • Emotional Disturbance
  • Hearing Impairment
  • Learning Disability RTI
  • Learning Disability Severe Discrepancy
  • Orthopedic Impairment
  • Other Health Impairment
  • Speech-Language Impairment
  • Traumatic Brain Injury
  • Visual Impairment

When an option is selected from the drop down, the criteria checklist displays (see below).

Date of Eligibility Determination Criteria form filled out
Required
The date the determination criteria form was completed.N/A
EligibleIndicates the eligibility status of each checklist item.N/A
Print in EvaluationIndicates this record prints.This is marked by default.

Autism Criteria Checklist

FieldValidation
Initiating or maintaining eye contact while interacting with others:Yes or No
Use of facial expressions to communicate with others:Yes or No
Identifying and/or understanding the communicative intent of another person's facial expressions;Yes or No
Using gestures to direct attention to an object (for example: showing, bringing or pointing out objects of interest;Yes or No
Using gestures for communication;Yes or No
Responding to or interpreting other's use of gestures;Yes or No
Noticing or interpreting other's use of body language;Yes or No
Use of own body language for communication;Yes or No
Expressive verbal or alternative communication;Yes or No
Receptive verbal or alternative communication; orYes or No
Interpretation of other's verbal communication (often concrete and literal; for example: does not understand idioms or sarcasm)Yes or No
Significant difficulties in social interaction must be documented for at least one of the following characteristics:
Seeking to share enjoyment, interests, or achievements with others;Yes or No
Initiating social interaction unless seeking preferred items or help;Yes or No
Responding to social interactions initiated by others;Yes or No
Initiating a conversation on non-preferred topicsYes or No
Sustaining a conversation on non-preferred topics;Yes or No
Explaining another person's perspective (for example: what other people are thinking or feeling);Yes or No
Joining play activities of others (solitary play preferred);Yes or No
Play lacks elements of make-believe;Yes or No
Participating in make-believe play with others; orYes or No
Engaging in social imitative play (for example: playacting, fantasy characters, animals, pretending, adult role).Yes or No
Significant difficulties resulting from restricted and repetitive behaviors and interests must be documented for at least one of the following characteristics:
Makes repeated vocalizations or verbalizations (for example: repeats same word, phrase or sound);Yes or No
Persistent preoccupation with specific objects or parts of objects;Yes or No
Engages in repeated, repetitive movements with objects such as sticks or string, lining up toys, flipping objects, spinning objects;Yes or No
Preoccupation with particular interests causes difficulties in social interaction and/or academic performance;Yes or No
Resists when asked to discontinue preferred or special interest activity;Yes or No
Prefers consistency and resists expected and/or unexpected changes (for example: changing activities, leaving activity unfinished, changes in routine or daily schedule); or Yes or No
Engages in repetitive physical behaviors such as body rocking, spinning self, finger flicking, hand flapping.Yes or No
Does the student have at least on characteristic in each of these three areas:
Social CommunicationYes or No
Social InteractionYes or No
Restricted and Repetitive Behaviors and InterestsYes or No

Total number of characteristics in all three areas:

Must have eight or more.
Student NameThis information pulls from the Census record.
Evaluation Meeting DateN/A
Additional Required Team Members
Required team members for the determination of Autism must be a school psychologist and a speech-language pathologist, each of whom is qualified to conduct individual diagnostic examinations of children.
Psychologist Name
Required
N/A
Speech-Language Pathologist Name
Required
N/A

Cognitive Delay

FieldValidation
The student has a significantly sub average general intellectual functioning; andYes or No
Corresponding deficits in adaptive behavior and educational performance, especially in the area of application of basic academic skills in daily life activities.Yes or No
The presence of sub average general intellectual functioning must occur between conception and the 18th birthday.Yes or No
Definitions:
Student NamePulls from Census
Evaluation Meeting DateN/A
Additional Required Team Members
Required team members for the determination of cognitive delay must be a school psychologist, whom is qualified to conduct individual diagnostic examinations of children
Psychologist Name
Required
N/A

Deafness

FieldValidation
An audiological report documents that hearing loss is so severe that the student is impaired in processing linguistic information, with or without amplification, to the extend that prevents the auditory channel from being the primary mode of speech and language.Yes or No
The student's education performance is adversely affected as documented by specific examples:Yes or No
Specify:N/A
Definitions:
Student NameThis information pulls from the Census record.
Evaluation Meeting DateN/A
Additional Required Team Members
Required team members for the determination of deafness must be a speech-language pathologist or an audiologist, each of whom is qualified to conduct individual diagnostic examinations of children.
Speech-Language Pathologist NameN/A
Audiologist NameN/A

Deaf-Blindness

FieldValidation
The student:N/A
Meets the criteria in ARM 10.16.3022 for visual impairment;Yes or No
Meets the criteria in ARM 10.16.3020 for speech-language impairment;Yes or No
Meets the criteria in ARM 10.16.3016 for hearing impairment or in ARM 10.16.3014 for deafness; andYes or No
Is experiencing severe delays in communication and other developmental and educational skills such as the services designed solely for students with deafness or for students with blindness would not meet the student's educational needs.Yes or No
Student NameThis information pulls from the Census record.
Evaluation Meeting DateN/A
Additional Required Team Members
Required team members for the determination of deaf-blindness must be a speech-language pathologist, whom is qualified to conduct individual diagnostic examinations of children.
Speech-Language Pathologist Name
Required
N/A

Developmental Delay

FieldValidation
The student is at least three (3) and not yet nine (9) years old.N/A
The student functions at a developmental level:N/A
Two or more standard deviations below the norm in any ONE of the following areas of development:N/A
Areas of DevelopmentOptions include: 
  • adaptive functioning skills
  • cognitive development
  • communication development
  • physical development
  • social and emotional development
orN/A
1.5 more more standard deviations below the norm in TWO OR MORE of the following areas of development:N/A
Areas of DevelopmentOptions include: 
  • adaptive functioning skills
  • cognitive development
  • communication development
  • physical development
  • social and emotional development
Documentation of a developmental delay must include:N/A
Appropriate developmental assessment that addressed each of the areas above.N/A
Observation of the student's communication development and social and emotional development in a classroom or other group settingN/A
Student NameThis information pulls from the Census record.
Evaluation Meeting DateN/A

Emotional Disturbance

FieldValidation
An inability to build or maintain satisfactory relationships with peers and teachers;Yes or No
Inappropriate types of behavior or feelings under normal circumstances, including behaviors which are psychotic or bizarre in nature or behaviors which are atypical and for which no observable reason exists;Yes or No
A general, pervasive mood of unhappiness or depression, including major depression and dysthymia, but excluding normal grief reactions;Yes or No
A tendency to develop physical symptoms or fears associated with personal or school problems, including separation anxiety, avoidant disorder and overanxious disorder;Yes or No
SchizophreniaYes or No
Each of the conditions above shall meet the criteria having been present:
To a marked degree,Yes or No
Over a long period of time, and Yes or No
Adversely affecting the student's educational performance.Yes or No
The student has been observed in more than one setting within the educational environmentYes or No
The local education agency has planned and implemented one or more positive behavioral interventions specific to the individual student.Yes or No
Interventions shall not unnecessarily delay appropriate identification when it can be shown through a student's social or developmental history, compiled directly from the student's parents or from records when the parents are not available, the existence of characteristics that clearly identify emotional disturbance.N/A
Exclusionary Factors

The student may not be identified as having emotional disturbance if:

Delays in educational performance are primarily due to visual impairment, hearing impairment, orthopedic impairment, cognitive delay, health factors, cultural factors or limited educational opportunity.

Common disciplinary problems may exist in conjunction with emotional disturbance, but cannot be used as the sole criteria for determining the existence of an emotional disturbance. 

The term emotional disturbance does not apply to students who are socially maladjusted, unless it is determined that they meet the criteria for emotional disturbance.

Definitions:
"Adversely affect the student's educational performance" means that there is evidence that measures of student performance (e.g. achievement tests, grades, behavioral assessments, analysis of classroom assignments, or criterion-referenced tests, etc.) indicate a pattern of educational attainment that can wholly or in part be attributed to the disabling condition.
Student NameThis information pulls from the Census record.
Evaluation Meeting DateN/A
Additional Required Team Members
Required team members for the determination of emotional disturbance must be a school psychologist, whom is qualified to conduct individual diagnostic examinations of children.
Psychologist Name
Required
N/A

Hearing Impairment

FieldValidation
An audiological report documents a permanent hearing loss in excess of 20dB better ear average in the speech range (500, 1,000 or 2,000 Hz), unaided, orYes or No
A history of fluctuation hearing loss which has interrupted the normal acquisition of speech and language and continues to adversely affect educational performance.Yes or No
Definitions:
"Adversely affect the student's educational performance" means that there is evidence that measures of student performance (e.g. achievement tests, grades, behavioral assessments, analysis of classroom assignments, or criterion-referenced tests, etc.) indicate a pattern of educational attainment that can wholly or in part be attributed to the disabling condition.
Student NameThis information pulls from the Census record.
Evaluation Meeting DateN/A
Additional Required Team Members
Required team members for the determination of hearing impairment must be a speech-language pathologist or an audiologist, each of whom is qualified to conduct individual diagnostic examinations of children.
Speech-Language Pathologist NameN/A
Audiologist NameN/A

Learning Disability RTI

FieldValidation
The student has been provided learning experiences appropriate to the student's age or grade-level based on state-approved K-12 content standards.Yes or No
The student did not make sufficient progress to meet age or grade level based on state-approvedK-12 content standards in one or more of the following areasYes or No
Areas:Options include: 
  • Basic Reading Skills
  • Oral Expression
  • Reading Comprehension
  • Written Expression
  • Reading Fluency Skills
  • Mathematics Calculation
  • Listening Comprehension
  • Mathematics Problem Solving
The student was determined to have a specific learning disability based on an insufficient response to scientific, research-based interventions resulting in a low level of academic achievement.Yes or No
Insufficient response to interventions occurred when, despite the implementation of the interventions over a sustained period of time, the student did not achieve adequately based on the student's age or grade level based on state-approved K-12 content standards.Yes or No
Scientific, research based interventions were:
Matched to the specific needs of the student as identified through systematic, data-based processes for examining the presenting problem, including parental input, to identify instructional interventions that have a high likelihood of success;Yes or No
Focused on changing the instructional strategies or techniques used with the student; andYes or No
Regularly monitored for student progress and correct implementation via regular and frequent data collection, and analyzed and modified as necessary based on data analysis.Yes or No
In determining the response to scientific research-based interventions the evaluation team considered data:
Regarding how appropriately the intervention was delivered by qualified personnel, andYes or No
Comparing the student's rate of learning and current levels of performance with the student's initial levels of performanceYes or No
The student did not make sufficient response to scientific, research-based interventions, and Yes or No
The level of intervention necessary to sustain the response can only be provided through special education services.Yes or No
Documentation also includes:
The scientific, research-based interventions and instructional strategies uses; andYes or No
The student-centered data collected during the implementation of at least two intensive individualized interventions implemented for a sustained period of time.Yes or No
The evaluation team documented the student's academic performance in the regular classroom setting through observation.Yes or No
Requirements for documentation of observation were met by observation of routine classroom instruction and monitoring of the student's performance that was done before the child was referred or an evaluation, orYes or No
At least one member of the evaluation team conducted an observation of the child's academic performance in the regular classroom after the child has been referred for an evaluation and parental consent was obtained.Yes or No
If the student was younger than school age or out of school, an evaluation team member observed the student in an environment for a student of that age.Yes or No
Educationally relevant medical findings, if any, were considered; and Yes or No
Two or more interventions specific to the individual student were implemented.Yes or No
Interventions did not unnecessarily delay appropriate identification.Yes or No
Exclusionary Factors:
The student may not be identified as having a specific learning disability if the student's significantly low rate of progress in meeting age or grade level based on state-approved K-12 content standards is primarily the result of a visual, hearing, or motor impairment; cognitive delay; emotional disturbance; environmental or economic disadvantage; cultural factors; or a lack of appropriate instruction.
Student Name:This information pulls from the Census record.
Evaluation Meeting Date:N/A
Additional Required Team Members:
Required team members for the determination of specific learning disability must be a school psychologist, a speech-language pathologist, or a remedial reading teacher, each of whom is qualified to conduct individual diagnostic examinations of children.
Psychologist NameN/A
or;N/A
Speech-Language Pathologist NameN/A
or;N/A
Remedial Reading Teacher NameN/A

Learning Disability - Severe Discrepancy

FieldValidation
The student has been provided learning experiences appropriate to the student's age or grade-level based on state-approved K-12 content standardsYes or No
The student did not make sufficient progress to meet age or grade level based on state-approved K-12 content standards in one or more of the following areas:Yes or No
Areas:Options include: 
  • Basic Reading Skills
  • Oral Expression
  • Reading Comprehension
  • Written Expression
  • Reading Fluency Skills
  • Mathematics Calculation
  • Listening Comprehension
  • Mathematics Problem Solving
The student was determined to have a specific learning disability based on a severe discrepancy between the student's intellectual ability and achievement in one or more of the areas listed in ARM 10.16.3019.Yes or No
Documentation also includes:
The evaluation team documented the student's academic performance in the regular classroom setting through observation.Yes or No
Requirements for documentation of observation were met by observation of routine classroom instruction and monitoring of the student's performance that was done before the child was referred for an evaluation, orN/A
At least one member of the evaluation team conducted an observation of the child's academic performance in the regular classroom after the child has been referred for an evaluation and parental consent was obtained.Yes or No
If the student was younger than school age or out of school, an evaluation team member observed the student in an environment appropriate for a student of that age.Yes or No
Educationally relevant medical findings, if any, were considered; and Yes or No
Two or more interventions specific to the individual student were implemented.Yes or No
Interventions did not unnecessarily delay appropriate identification.Yes or No
Exclusionary Factors:
The student may not be identified as having a specific learning disability if the student's significantly low rate of progress in meeting age or grade level based on state approved K-12 content standards is primarily the result of a visual, hearing, or motor impairment; cognitive delay; emotional disturbance; environmental or economic disadvantage; cultural factors; or a lack of appropriate instruction.
Definitions:
(a) A severe discrepancy is defined as a 50 percent or higher probability of a two standard deviation discrepancy between general cognitive ability and achievement in one or more of the areas identified in ARM 10.16.3019 when adjusted for regression to the population mean. (b) Error in test measurement requires judgment for students who score near two standard deviations below the population mean. When exercising this judgment, consideration of additional information, such as classroom performance relative to the student's performance on norm-referenced tests, shall be used as the basis for determining the severe discrepancy. (c) Alternatives to norm-referenced tests, such as curriculum-based assessments, shall be utilized to determine severe discrepancy whenever cultural factors, test conditions, size of test item sampling for the student's age, or other factors render standardized assessment results invalid. When utilizing alternative assessment procedures, a determination must still be made that a discrepancy between ability and achievement exists at a level of severity similar in size to the discrepancy that would have otherwise been found as described in (a) above.
Student Name:This information pulls from the Census record.
Evaluation Meeting Date:N/A
Additional Required Team Members:
Required team members for the determination of specific learning disability must be a school psychologist, a speech-language pathologist, or a remedial reading teacher, each of whom is qualified to conduct individual diagnostic examinations of children.
Psychologist NameN/A
or;N/A
Speech-Language Pathologist NameN/A
or;N/A
Remedial Reading Teacher NameN/A

Orthopedic Impairment

FieldValidation
The student is diagnosed by a qualified medical practitioner as having an orthopedic impairmentYes or No
The impairment is severe; andYes or No
The impairment adversely affects the student's educational performanceYes or No
Definitions:

The term orthopedic impairment includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some member, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputations, and fractures or burns that cause contractures).

"Adversely affect the student's educational performance" means that there is evidence that measures of student performance (e.g., achievement tests, grades, behavioral assessments, analysis of classroom assignments, or criterion-referenced tests, etc.) indicate a pattern of educational attainment that can wholly or in part be attributed to the disabling condition.

Student Name:This information pulls from the Census record.
Evaluation Meeting Date:N/A

Other Health Impairment

FieldValidation
The student has limited strength, vitality or alertness, including a heightened alertness to environmental stimuli that results in limited alertness with respect to the educational environment, that is due to chronic or acute health problems such as asthma, attention deficit disorder or attention deficit hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia or tuberculosis; andYes or No
The condition adversely affects the student's educational performance.Yes or No
The student has medical diagnosis of a chronic or acute health problem. (REQUIRED)Yes or No
Definitions:
"Adversely affect the student's educational performance" means that there is evidence that measures of student performance (e.g., achievement texts, grades, behavioral assessments, analysis of classroom assignments, or criterion-referenced tests. etc.) indicate a pattern of educational attainment that can wholly or in part be attributed to the disabling condition.
Student Name:This information pulls from the Census record.
Evaluation Meeting Date:N/A

Speech-Language Impairment

FieldValidation
The student has a significant deviation in speech such as fluency, articulation or voice; orYes or No
The student has a significant deviation in the ability to decode or encode oral language which involves phonology, morphology, semantics or pragmatics or a combination thereof.Yes or No
Documentation of the student's interpersonal communication effectiveness in a variety of educational settings by the teacher, parents, speech-language pathologist, and others as appropriate supports the adverse educational effect of the speech-language impairment or oral communication in a classroom or school settingYes or No
Exclusionary Factors:
The student may not be identified as having a speech-language impairment if the speech or language problems primarily result from environmental or cultural factors.
Definitions:

The student has a significant deviation in oral performance if the student’s performance on standardized test is two standard deviations below the population mean, or between 1.5 and two standard deviations below the population mean, and there is documented evidence over a six month period prior to the current evaluation of no improvement in the speech-language performance of the student even with regular classroom interventions.

For articulation, a significant deviation is consistent articulation errors persisting one year beyond the highest age when 90 percent of the students have acquired the sounds based upon specific developmental norms.

If norm-referenced procedures are not used, alternative assessment procedures shall substantiate a significant deviation from the norm.

Student Name:This information pulls from the Census record.
Evaluation Meeting Date:N/A
Speech-Language Pathologist Name:N/A

Traumatic Brain Injury

FieldValidation
The student has an acquired injury to the brain caused by external physical force which substantially limits the student's functional or psychosocial ability or both and the student's ability to learn or participate in the general education curriculum.Yes or No
Exclusionary Factors:
The student may not be identified as having a traumatic brain injury if the injury to the brain is congenital, degenerative, or caused by birth trauma.
Definitions:
The term traumatic brain injury applied to open or closed head injuries resulting in impairments in one or more areas such as cognition, language, memory, attention, reasoning, abstract thinking, judgement, problem solving, sensory, perceptual, and motor abilities, psycho-social behavior, physical function, information processing, and speech.
Student Name:This information pulls from the Census record.
Evaluation Meeting Date:N/A
Additional Required Team Members:
Required team members for the determination of traumatic brain injury must be a school psychologist and a speech-language pathologist, each of whom is qualified to conduct individual diagnostic examinations of children.
Psychologist NameN/A
Speech-Language Pathologist Name:N/A

Visual Impairment

FieldValidation
The student has an impairment in vision that, even with correction, adversely affects the student's educational performance;Yes or No
orN/A
The student has a medically indicated expectation of visual deterioration that would qualify the child as having a visual impairment as described above.Yes or No
Student Name:This information pulls from the Census record.
Evaluation Meeting Date:N/A

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Eligibility Determination

The Eligibility Determination editor lists the student's determining factor for qualifying for Special Education services.

Screenshot of the eligibility determination editor.Eligibility Determination Editor

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FieldDescriptionValidation
Eligibility Determination
Student IS eligible for special education and related services under the Individuals with Disabilities Education Act. Basis for making the determination that the student has a disability and needs special education and related services:Indicates the student is eligible to receive services.N/A
Disability Criteria:A description of the disability criteria.N/A
Disability Criteria Checklist AttachedIndicates disability criteria checklist has been attached to the evaluation.N/A
Why does the student need special education and related services?
Required
An explanation for why the student needs services.N/A
Select all disabilities that apply:

The student's disabilities. Options include:

  • Autism
  • Cognitive Delay
  • Deafness
  • Deaf-Blindness
  • Developmental Delay
  • Emotional Disturbance
  • Hearing Impairment
  • Orthopedic Impairment
  • Other Health Impairment
  • Speech-Language Impairment
  • Traumatic Brain Injury
  • Visual Impairment
  • Specific Learning Disability
Multiple options can be selected.
Specify Specific Learning Disability
*Required
The specific learning disability. Options include: RTI and Severe Discrepancy.*This field is available and required when Specific Learning Disability is selected above.
If this is an initial evaluation, was the student referred from Part C?

Indicates if the student was referred from Part C.

Yes or No
Date ReferredThe date the student was referred.N/A
Reason the IEP was not developed and implemented by the child's third birthday:

The reason the IEP was not created for the student by their third birthday.

  • Student was referred to a different district
  • The parent repeatedly failed or refused to produce the child for the evaluation
  • Rescheduled at parent request
  • Parent chose the date for the meeting
  • Evaluation not complete
  • Summer/Winter vacation
  • District and parent agreed to postpone initial evaluation until beginning of school year
  • Staff unable to attend
  • Schedule conflict
  • Foster placement concerns
  • Part C agency did not provide evaluation information in a timely manner
  • No reason given
N/A

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Recommendations

The Recommendations editor is used to document the recommended areas of service the student may need for the IEP team.

Screenshot of the recommendations editor.Recommendations Editor

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FieldDescriptionValidation
Special Education Services

A list of the recommended services. Options include:

  • Adapted Phys. Ed
  • Assistive Tech
  • Braille Instruction
  • Career/Vocational
  • Communication
  • Math
  • Reading
  • Self-Help/Ind.
  • Sensory-Motor
  • Social/Emotional/Behavioral
  • Speech/Language
  • Transition
  • Travel Training
  • Written Expression
Multiple options can be selected.
Related Services

A list of the recommended related services. Options include:

  • Assistive Tech
  • Audiology
  • Counseling
  • Early Identification/Assessment
  • Medical (diagnostic)
  • Occupational Therapy
  • Orientation and Mobility
  • Parent Counseling and Training
  • Physical Therapy
  • Psychological
  • Recreation
  • Rehabilitation Counseling
  • School Health/Nurse Services
  • Social Work in Schools
  • Speech/Language
  • Therapeutic Recreation
  • Transportation
  • Other
Multiple options can be selected.
If other, specifyA description of the other service, if applicable.This field displays and is required when "Other" is selected above.

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Dissenting Report

The Dissenting Report editor is used to document any opinions regarding the student's evaluation and recommended services that do not match those of the rest of the evaluation team.

Screenshot of the dissenting report editor.Dissenting Report Editor

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FieldDescription
Dissenting Report will be attachedIndicates a dissenting report is attached to the evaluation.
Print in Evaluation ReportIndicates this editor prints on the evaluation report.
Person(s) submitting a separate statement of conclusions:The people submitting the separate documentation.
Reasons:The reasons for dissent.

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Not Eligible

The Not Eligible editor is used to document if the student is not eligible to receive special education services.

Screenshot of the not eligible editor.Not Eligible Editor

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FieldField
Student IS NOT eligible for special education and related services under the Individuals with Disabilities Education Act for the following reason(s):
Required

The reason the student is ineligible to receive services. Options include: 

  • Does not meet disability criteria
  • Lack of instruction in reading or math
  • Does not demonstrate a need for special education
  • English Learner
DiscussionA description of the eligibility status.
Recommendation for accommodation or referral for other services as appropriate:A description of accommodations or referral for other services, if applicable.

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Prior Written Notice

The prior written notice editor is used to document the action proposed/refused of the initiation or change in the evaluation or identification of the student and detailed explanations and descriptions of additional considerations, factors, and reasoning.

This editor is required.

Screenshot of the prior written notice editor.Prior Written Notice

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FieldDescription
Initiation or change in the evaluation of the studentIndicates an initiation or change in the evaluation of the student. 
Initiation or change in the identification of the studentIndicates an initiation or change in the identification of the student.
Description of the specific proposed or refused action(s):
Required
A description of the specific proposed or refused actions.
Additional Documentation attachedIndicates additional documentation is attached.
Explanation of why the district proposed or refused to take the action(s):
Required
An explanation of why the district proposed or refused to take action.
Additional Documentation attachedIndicates additional documentation is attached.
Description of each evaluation procedure, assessment, record or report the district used as a basis for the proposal or refusalA description of the procedures, assessment, record, or report used as a basis for the proposal or refusal.
Additional Documentation attachedIndicates additional documentation is attached.
Description of any other options the district considered and the reasons why those options were rejected:A description of other options considered.
Additional Documentation attachedIndicates additional documentation is attached.
Description of other factors relevant to the district's proposal or refusal to take actionA description of other factors relevant to the proposal or refusal to take action. 
Additional Documentation attachedIndicates additional documentation is attached.

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Evaluation Report Notes

The Evaluation Report Notes editor is used to document any additional notes related to the evaluation meeting.

Screenshot of the evaluation report notes editor.Evaluation Report Notes

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Previous Versions

Evaluation Report (Montana) [.2311 and previous]