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Assessment/Evaluation

Medical Statement fillable form

Medical Statement 

Test  Manual/ Test Kit Request

When requesting a test manual or kit to be checked out fill out this request form and submit it to your TOSA. Test kits cannot be ponied, but must be picked up at the Special Education office at the BESC.

Word Document (Read Only): This form can be filled out by hand and either scanned and attached via email or sent via the PONY.

Writable PDF

Screening Forms

Screening Permission Form (English)

Screening Permission (Spanish)

Screening Permission (Somali)

Screening Permission (Vietnamese)

Screening Permission (Russian)

Screening Permission (Chinese)

Screening Results Form (English)

Screening Results (Spanish)

Screening Results (Somali)

Screening Results (Vietnamese)

Screening Results (Russian)

Screening Results (Chinese)

Evaluation Calendar

 60 School Day Calendar Updated 10/04/2019

Corrective Action Form 

The Corrective Action Form (CAF) is used when an initial evaluation goes over 60 school days. If an initial evaluation goes over 60 school days the case manager needs to submit the completed form to the records clerk. You do not need to submit a CAF if you have completed the written agreement to extend the timeline for a Specific Learning Disabilty eligibility evaluation.

Corrective Action Form (CAF) 

Written Agreement Table

Written Agreement Table 

Kaufman Test of Educational Achievement, Third Edition (KTEA-3)

Academic Evaluation Report Templates

KTEA Academic Report (Google Doc)

Non-KTEA Academic Report (Google Doc)

KTEA Support Documents

KTEA Summer 2019 Revision Webinar

Progress Monitoring for Specific Learning Disability

Progress monitoring is the documentation of a student’s achievement on a regular basis.  It involves the formal assessment of the student’s progress during instruction in reading and/or math. Progress monitoring documents how a student responds to appropriate instruction, and it may be collected for a single student or for an entire class.  Progress monitoring must include a minimum of four data points. These data are typically collected once every two weeks.