GUIDE TO SPECIAL EDUCATION FORMS | Wisconsin Department

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WISCONSIN DEPARTMENT OF PUBLIC INSTRUCTION

GUIDE TO SPECIAL EDUCATION FORMS

Originally published September 2008

October 2023 Revisions: Disability Category Criteria Forms, I-1-C, I-4, M-7, M-8, P-1, and P-2

INTRODUCTION

Special education forms assist local educational agencies (LEA) and parents in implementing federal and state special education laws by guiding them

through referring and evaluating students, developing individualized education programs (IEPs), and determining educational placements. Some forms

assist in implementing other requirements, such as conducting a manifestation determination and determining the need for extended school year services.

In addition, the forms serve as a LEA’s primary documentation tool for demonstrating compliance with many of the requirements of federal and state

special education laws and improving outcomes for students with disabilities. Information about improving outcomes for students with disabilities under

Results Driven Accountability (RDA) may be found at http://dpi.wi.gov/sped/results-driven-accountability.

The information in this guide is intended to provide general guidance to assist LEA staff and parents in implementing requirements of federal and state

special education law. It is not intended to provide student-specific legal advice. State special education law, Subchapter V of Chapter 115, and the

Federal Individuals with Disabilities Education Act (IDEA), 34 CFR Parts 300 & 303, along with related information and materials for implementing

federal and state special education requirements is available at http://dpi.wi.gov/sped/laws-procedures-bulletins.

The Department of Public Instruction’s (DPI) special education forms (also translated in Spanish and Hmong) and this guide are available in hard copy

by contacting the Special Education Team, DPI, P.O. Box 7841, Madison, WI 53707-7841; or accessing the DPI website at https://dpi.wi.gov/sped/laws-

procedures-bulletins/procedures/sample/forms.

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TABLE OF CONTENTS

INTRODUCTION 1

TABLE OF CONTENTS 2

Prior Written Notice 5

Timelines 6

Referral and Evaluation 9

R-1 Referral for Special Education Evaluation. Wis. Stat. § 115.777. 9

IE-1 Notice of Receipt of Referral and Start of Initial Evaluation 12

IE-2 Initial Evaluation: Notice that No Additional Assessments Needed 15

IE-3 Initial Evaluation: Notice and Consent Regarding Need to Conduct Additional Assessments 17

RE-1 Notice of Reevaluation 20

RE-2 Notice of Agreement to Conduct a Reevaluation More Than Once a Year 23

RE-3 Notice of Agreement that a Three-Year Reevaluation Not Needed 25

RE-4 Reevaluation: Notice that No Additional Assessments Needed 27

RE-5 Reevaluation: Notice and Consent Regarding Need to Conduct Additional Assessments 30

ED-1 Existing Data Review to Determine if Additional Assessments or Evaluation Data Are Needed 33

ER-1 Evaluation Report Including: Determination of Disability Category and Need for Specially Designed Instruction 38

ER-1-DIS Introduction to Disability Category Determinations as Part of a Comprehensive Evaluation 48

ER-1-AUT Criteria for Disability Category: Autism 49

ER-1-BVI Criteria for Disability Category: Blind and Visually Impaired 53

ER-1-DHH Criteria for Disability Category: Deaf and Hard of Hearing 57

ER-1-DB Criteria for Disability Category: Deafblind 61

ER-1-EBD Criteria for Disability Category: Emotional Behavioral Disability 66

ER-1-ID Criteria for Disability Category: Intellectual Disability 72

ER-1-OHI Criteria for Disability Category: Other Health Impairment 76

ER-1-OI Criteria for Disability Category: Orthopedic Impairment 79

ER-1-SDD Criteria for Disability Category: Significant Developmental Delay 82

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ER-1-SLI Criteria for Disability Category: Speech or Language Impairment 87

ER-1-TBI Criteria for Disability Category: Traumatic Brain Injury 95

ER-2A Required Documentation for Specific Learning Disability (SLD) – Initial Evaluation 98

ER-2B Required Documentation for Specific Learning Disability (SLD) – Reevaluation 103

ER-2C Required Documentation for Specific Learning Disability (SLD) – Initial Evaluation Using Significant Discrepancy 106

ER-3 Evaluation Report: Documentation for Determining Braille Needs for a Child with a Visual Impairment 111

ER-4 Notice of IEP Team Findings that Child Is Not a Child with a Disability 112

Arranging/Scheduling Individualized Education Program Meetings 113

I-1 Invitation to a Meeting of the Individualized Education Program Team (IEP) 113

I-1-A Request to Invite Outside Agency Representative(s) to the Individualized Education Program (IEP) Meeting 119

I-1-B Request to Invite Birth to 3 Program Representative(s) to the Initial Individualized Education Program (IEP) Meeting 121

I-1-C Request to Invite Others with Knowledge or Special Expertise to an Individualized Education Program (IEP) Meeting 122

I-2 Agreement on IEP Team Participant Attendance at IEP Meeting 123

I-3 IEP Team Meeting Cover Page 126

Developing Individualized Education Programs 130

I-4 IEP: Linking Present Levels, Needs, Goals and Services Form 130

I-5 Annual Review of IEP Goals 149

I-6 Interim Review of IEP Goals 151

I-7 Statewide and District-wide Assessments 153

I-7-A Participation Guidance for Alternative Assessment 155

I-7 District-wide Assessment 156

I-7 ACCESS for ELLs®/Alternative ACCESS for ELLs

™

159

I-7 The ACT® with writing 161

I-7 Pre-ACT® Secure 163

I-7 DLM® 164

I-7 Forward 166

I-8 Postsecondary Transition Plan Worksheet 167

I-10 Notice of Changes to IEP without an IEP Meeting 170

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I-11 Extended School Year 172

I-12 Manifestation Determination Review 173

DW-1 Documenting Educational Services During Disc. Removals that Do Not Constitute a Disc. Change of Placement 175

Determining Placements 177

P-1 Determination and Notice of Placement: Consent for Initial Placement 178

P-2 Determination and Notice of Placement 182

P-3 Notice of Graduation 186

P-4 Notice of Ending of Services Due to Age 188

P-5 Parent Revocation of Consent for Special Education 189

P-6 Notice of Cessation of Special Education and Related Services in Response to Parental Revocation of Consent 190

Miscellaneous 192

M-1 Notice of Response to an Activity Requested by a Parent 192

M-2 Notice of Agreement to Extend Time Limit to Complete Evaluation for Transfer Student 193

M-3 Agreement to Extend the Time Limit to Complete the Eval. of a Child Suspected of Having a Specific Learning Disability 195

M-5 Consent to Bill Wisconsin Medicaid for Medically-Related Special Education and Related Services 197

M-6 Notification of Upcoming Transfer of Rights 198

M-7 Student Notification of Transfer of Rights 199

M-8 Parent Notification of Transfer of Rights 200

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Prior Written Notice

Parents must be provided written notice a reasonable time before a LEA:

● proposes to initiate or change the identification, evaluation, or educational placement of a student or the provision of FAPE to the student; or

● refuses to initiate or change the identification, evaluation, or educational placement of a student or the provision of FAPE to the student.

34 CFR § 300.503(a); Wis. Stat. § 115.792(1)(b).

Anytime written notice is required it must include:

● a description of the action proposed or refused by the LEA;

● an explanation of why the LEA proposes or refuses to take the action;

● a description of each evaluation procedure, assessment, record, or report the LEA used as a basis for the proposed or refused action;

● a description of any other options that the LEA considered and the reasons why those options were rejected;

● a description of other factors that are relevant to a LEA’s proposal or refusal;

● a statement that parents have protection under the procedural safeguards of special education law and, if the notice is not an initial referral for

evaluation, the means by which a copy of a description of the procedural safeguards can be obtained; and

● sources for parents to contact to obtain assistance in understanding the provisions of special education law.

34 CFR § 300.503(b); Wis. Stat. § 115.792(2).

Notices must be:

● written in language understandable to the general public;

● provided in the native language of the parent or other mode of communication of the parent, unless it is clearly not feasible to do so; and

● if the native language or other mode of communication of the parent is not a written language the LEA must take steps to ensure that

(1) the notice is translated orally or by other means to the parent in his or her native language or other mode of communication, and (2) the

parent understands the content of the notice. The LEA must maintain written evidence of having complied with the requirements in (1) and (2).

34 CFR § 300.503(c); Wis. Stat. § 115.792(2).

NOTE:

In the Sample Special Education forms for Wisconsin, the prior written notice requirement is documented in a variety of forms, including, but not limited

to, the Evaluation and Reevaluation Notices (IE-1 through IE-3 and RE-1 through RE-5), the Determination and Notice of Placement (P-1 or P-2), Notice

of Graduation (P-3), Notice of Ending of Services Due to Age (P-4), Notice of Cessation of Special Education in Response to Parental Revocation of

Consent (P-6), and Notice of Response to an Activity Requested by Parent (M-1).

When a student reaches the age of majority (age 18 in Wisconsin), the rights under special education law transfer to the student unless a guardian has

been appointed. Model forms M-6, M-7, and M-8 provide the parent(s) and adult student with upcoming notice and notice of this transition. Wis. Stat. §

115.807(3). Consequently, when any of the above notices are sent to an adult student, the LEA should modify the language (e.g., changing “your child

or your student” to “you”). In addition, when any of these notices are sent to an adult student, a copy also must be sent to the student’s parents.

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Timelines

Evaluation

● At least annually, the LEA must inform parents and others required to make referrals about the LEA’s referral and evaluation procedures.

Wis. Stat. § 115.777(3)(d).

● Notify the parent(s) in writing that a referral was received and of the start of the initial evaluation, or of initiating a reevaluation. 34 CFR §

300.503(a); Wis. Stat. § 115.792(1)(b). Within 15 business days of receiving a referral to evaluate a student, or initiating a reevaluation, the

IEP team must complete its review of existing evaluation data and send the student’s parents a request for consent to evaluate, or if no

additional data are necessary, notify the parents of that determination. “Business day” means Monday through Friday except for Federal and

State holidays. There are no legal exceptions or provisions for extension of the 15-business-day timeline. Wis. Stat. § 115.777(3)(e).

● Within 60 calendar days of receiving parent consent to evaluate, or informing parents that no additional assessment or evaluation data are

needed, the LEA must complete its evaluation of the student and determine whether the student is or continues to be a “child with a disability”

under IDEA. 34 CFR § 300.301(c); Wis. Stat. § 115.78(3)(a). There are exceptions to the 60-day timeline. The timeline may be extended by

mutual written agreement between the parent and the LEA when the student is being evaluated for a specific learning disability for the first

time. 34 CFR § 300.309(c); Wis. Admin. Code P.I. § 11.36(6)(b). This provision provides the LEA time to gather information about a student’s

responses to interventions. Also, the timeline may be extended when a student transfers from one LEA to another during the 60-day time

period if the receiving LEA is making sufficient progress to ensure prompt completion of an initial evaluation or reevaluation and the parent

and LEA agree to a specific time when it will be completed. 34 CFR § 300.301(d)(2) and (e); Wis. Stat. § 115.78(3)(b)1. Another exception

is when the parent repeatedly refuses or fails to make the student available for an evaluation or a reevaluation. 34 CFR § 300.301(d)(1); Wis.

Stat. § 115.78(3)(b)2. LEAs must ensure that a reevaluation occurs if the LEA determines the educational or related service needs, including

improved academic achievement and functional performance, warrant a reevaluation or if the student’s parent or teacher requests the

reevaluation. 34 CFR § 300.303(a).

● At least once every 3 years a student with a disability must be reevaluated unless the parent and LEA agree that a reevaluation is unnecessary.

There are no exceptions or provisions for extension in the law. 34 CFR § 300.303(b)(2); Wis. Stat. § 115.782(4)(a)2.

● The IEP team reevaluates the student no more than once a year unless the student’s parents and the LEA agree otherwise 34 CFR

§ 300.303(b)(1); Wis. Stat. § 115.782(4)(a)2.

● The IEP team must evaluate a student with a disability before determining that the student is no longer a student with a disability. However,

a reevaluation is not required before the ending of special education services because the student has graduated from secondary school or

because they have reached the age of 18. Wis. Stat. § 115.782(4)(a)1.

Individualized Education Programs (IEPs)

● Within 30 calendar days of determining a student is or continues to be a “child with a disability” under IDEA, the IEP team must meet to

develop an IEP and determine a placement for the student. 34 CFR § 300.323(c)(1); Wis. Stat § 115.78(3)(c).

● Each LEA shall have an IEP in effect for each student with a disability at the beginning of each school year. 34 CFR § 300.323(a); Wis.

Stat. § 115.787(1). IEPs must be reviewed periodically, but at least annually. 34 CRR § 300.324(b)(1)(i); Wis. Stat. § 115.787(4)(a)1.

● Beginning not later than the first IEP that will be in effect when a student with a disability is or turns age 14 and updated annually thereafter,

the IEP must include a statement of measurable postsecondary goals and the transition services necessary to assist the student in reaching the

goals. 34 CFR § 300.320(b); Wis. Stat. § 115.787(2)(g)1 and 2.

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Placement

● Within 30 calendar days of determining a “child is or continues to be a child with a disability” under IDEA, the IEP team must meet to

determine a placement for the student. Wis. Stat. § 115.78(3)(c).

● A student’s placement must be determined at least annually. Wis. Stat. § 115.79(1)(b).

Other

● A manifestation determination must be made within 10 school days of any decision to change the placement of a “child with a disability” for

disciplinary reasons. 34 CFR § 300.530(e)(1).

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Referral and Evaluation

R-1 Referral for Special Education Evaluation. Wis. Stat. § 115.777

Form R-1 is used to start the initial evaluation process to determine whether a student is a “child with a disability” under IDEA and state law. State law

does not allow a LEA to refuse a referral for an initial evaluation. When a referral is received by the LEA, the LEA must notify the parent(s) in writing

that a referral was received and of the start of the initial evaluation. The date the LEA receives the referral begins the 15-business-day timeline to complete

the review of existing evaluation data and send the student’s parent(s) notice and request to administer additional assessments or other evaluation materials

or notify the parents no additional assessments or other evaluation materials are needed. Wis. Stat. § 115.777(3)(e).

Under state special education law, LEAs are required to do all of the following:

● establish written procedures for accepting and processing referrals;

● provide information and in-service opportunities to all of its licensed staff to familiarize them with the LEA’s referral procedures; and

● at least annually, inform parent(s) and persons required to make referrals about the LEA’s referral and evaluation procedures.

34 CFR § 300.111; Wis. Stat. § 115.777(3).

The State of Wisconsin has developed an electronic referral system, the Preschool Transition Application, enabling Birth to 3 programs to refer children

with suspected disabilities to LEAs prior to their third birthdays. The Preschool Transition Application is used by the LEA to access all notifications and

referrals received from the Birth to 3 Program. The date the LEA receives the referral in the Preschool Transition Application begins the 15-business-

day timeline. If a child referred by a county Birth to 3 program is determined to be a child with a disability, the LEA must develop and implement an

IEP by the child’s third birthday. The LEA must participate in a transition planning conference arranged by the lead agency for the Birth to 3 program.

The LEA determines the LEA personnel who will attend the transition planning conference.

Implementation Considerations:

Each LEA must establish procedures for accepting and processing referrals. The referral procedures must address referrals from school staff, parents,

and others in the community. Districts must establish consistent procedures, including electronic procedures where appropriate, for recording and tracking

dates and timelines related to the IEP process. LEAs should establish and implement a process to ensure whoever receives the referral records the date it

was received.

IEP team participants should be informed of the date by which the IEP team must complete their review of existing evaluation data and determine whether

additional assessments are needed so the LEA, within the 15-business-day timeline, can notify the parent(s) and request consent to administer the

additional assessments or other evaluation materials, or notify the parents no additional assessments or other evaluation materials are needed.

LEAs have an obligation to inform parents of the procedures for making special education referrals. If a parent or other individual indicates they believe

a student may have a disability and need special education, the LEA must inform the individual how to make a referral. The referral must be in writing

and include the name of the student and the reasons why the person believes the student is a “child with a disability” under IDEA and state law. Since a

referral must be in writing, most LEAs use a referral form for documentation. A LEA cannot require a parent who submitted a written referral in another

manner to complete the LEA’s referral form as a prerequisite to acting on the referral.

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FORM CONTENT

CLARIFICATION/EXPLANATION

WISEid (if known)

Date and method of notifying parent of

intent to refer. Wis. Stat. § 115.777(2)(b).

The WISEid area is included in the forms to allow vendors to use information on IEP forms for data

collection purposes.

An individual required under state law to make a referral must notify the student’s parent(s) before

submitting a referral to the LEA. The parent may be informed orally or in writing, e.g., by email, letter,

phone call, at a parent-teacher conference, etc.

Parent’s native language or other primary

mode of communication, if other than

English

Is an interpreter needed?

Student’s native language or other primary

mode of communication if other than

English

This information helps ensure parent(s) will receive notices and other information in a manner that is

understandable to them.

Check “yes” if an interpreter is needed and “no” if it is not needed.

This information identifies the student’s native language or other primary mode of communication for

administering tests and other evaluation materials.

Date referral received by school district /

LEA. Wis. Stat. § 115.777(3)(b).

The LEA must document the date each referral is received by the district. This date begins the 15-

business-day timeline in which to complete the review of existing evaluation data and send the

student’s parent(s) notice and consent regarding need to conduct additional assessments, or notice no

additional assessments are needed.

Describe why you believe this student has

a disability. Wis. Stat. § 115.777(2)(a).

What are your areas of concern? Wis. Stat.

§ 115.777(2)(a).

The person making the referral must state the reason(s) why they believe the student is a “child with a

disability.” This information is required and will help identify areas to evaluate. In completing this

information, consider concerns about the student’s access, engagement and progress in age/grade level

general education curriculum, instruction, environment, or other school activities. The suspected area

of impairment is not required to be provided.

It is important all academic and functional

concerns are identified in the referral to ensure a

comprehensive evaluation. In completing this information, consider concerns in the areas of academics,

cognitive learning, communication, independence and self-determination, physical/health, social and

emotional learning.

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If known, include information about any of

the following

Additional supporting information is helpful to the IEP team when identifying the areas of concern

during the existing data review and determining

the need for additional assessments. Supporting

information may include the student’s early learning or academic achievement

(early literacy or

reading); functional performance, including

cognitive learning, communication, independence and

self-determination, social and emotional learning; relevant medical information, such as information

about a student’s physical health, vision and hearing; and programs, services, or interventions that have

been used in regular education and/or special education to address the student’s needs and the results

of the interventions. This supporting information is not required.

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IE-1 Notice of Receipt of Referral and Start of Initial Evaluation

Following receipt of a referral for an initial evaluation, form IE-1 is completed and sent to the parents (or adult student with a copy to the parents).

The purposes for conducting an initial evaluation are to determine:

● whether the student is a “child with a disability” and the educational needs of the student;

● the present levels of academic achievement and functional performance and related developmental needs of the student;

● whether the student needs special education and related services;

● if applicable, the nature and extent of special education and related services the student needs; and

● if applicable, the content of the student’s IEP, including information related to enabling the student to be involved in and progress in the general

education curriculum.

34 CFR §§ 300.301, 300.304, and 300.305; Wis. Stat. §§ 115.777 and 115.782.

A LEA receiving a referral for an initial evaluation to determine whether a student is a “child with a disability” under IDEA and state law must appoint

an IEP team and conduct an evaluation of the student. State law does not allow a LEA to refuse a referral for an initial evaluation. 34 CFR § 300.321;

Wis. Stat. § 115.777.

Each IEP team must consist of the following:

● the parents of the student;

● at least one regular education teacher of the student if the student is, or may be, participating in a regular educational environment;

● at least one special education teacher who has recent training or experience related to the student’s known or suspected area of special education

needs or, where appropriate, at least one special education provider of the student;

● a representative of the local educational agency who is qualified to provide or supervise the provision of special education; is knowledgeable

about the general curriculum; and is knowledgeable about and authorized to commit the available resources of the local educational agency;

● an individual who can interpret the instructional implications of evaluation results;

● at the discretion of the parent or the LEA, other individuals who have knowledge or special expertise about the student, including related services

personnel as appropriate;

● whenever appropriate, the student: if a purpose of the meeting will be consideration of post-secondary goals and transition services, the LEA

must invite the student;

● if a student is attending school through whole grade sharing, open enrollment, or a tuition waiver, at least one person designated by the resident

district who has knowledge or special expertise about the student;

● when a student is suspected of having a specific learning disability for the first time and progress data from intensive intervention will be

considered, a licensed person qualified to assess data on individual rate of progress using a psychometrically valid and reliable methodology, the

licensed person who implemented the scientific, research-based or evidence-based, intensive interventions with the referred pupil, and a licensed

person qualified to conduct individual diagnostic evaluations of children/students; and

● when a student is suspected or known to need occupational therapy, physical therapy, or speech and language therapy, a therapist in each

respective area of service.

34 CFR § 300.321; Wis. Stat. § 115.78.

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Implementation Considerations:

Another LEA member of the IEP team, e.g., the special education teacher, may also serve as the LEA representative, provided the individual meets the

requirements to act in that capacity. To identify the LEA representative in these situations, write the individual’s name in each applicable space on the

form. Likewise, IEP team participants filling the required roles when considering SLD eligibility for the time may serve in more than one capacity on

the IEP team, as appropriate.

The determination of whether an individual invited to the IEP team meeting by the parent or by the LEA has knowledge or special expertise about the

student is made by the party who invited the individual.

FORM CONTENT

CLARIFICATION/EXPLANATION

The LEA received a referral to evaluate a

child to determine whether the child has a

disability. 34 CFR § 300.503; Wis. Stat. §

115.792.

A LEA must inform the parents of why it proposes to evaluate a child. The notice documents that the

reason for the referral is to determine whether the child has a disability.

The IEP team will conduct the evaluation.

34 CFR § 300.503; Wis. Stat. §§ 115.777,

115.78, and 115.792.

Under state special education law, an IEP team must conduct the evaluation. The LEA must send a written

notice of its proposed action to the student’s parents.

IEP team participants. 34 CFR §§ 300.321

and 300.503; Wis. Stat. §§ 115.78;

115.782 and 115.792.

Parents must be notified about the composition of the IEP team, including the participants’ names if

known at the time of the notice.

Other options considered and reasons

rejected, and a description of any other

relevant factors. 34 CFR § 300.503;

Wis. Stat. § 115.792.

Enter other options, if any, that were considered; the reasons those options were rejected; and a

description of any other relevant factors. For example, the parent may request particular LEA staff be

included or excluded from the IEP team, and the LEA may refuse to honor the request. If no options were

considered, check the “None” box.

IEP team will review existing data to

determine what, if any, further assessment

or evaluation data are needed. 34 CFR §§

300.305 and 300.503; Wis. Stat. §§

115.782, and 115.792

The LEA must inform the parents of the specific actions the LEA proposes to take. The first action is a

review of existing evaluation data to determine whether additional data are needed. Enter the date by

which the LEA will request parent consent for evaluation or notify the parent no additional data are

needed.

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Narrative regarding the IEP team role, the

evaluation and IEP process, timelines, and

right to be provided additional time.

34 CFR §§ 300.301; 300.305; 300.306;

300.323 and 300.503; Wis. Stat. §§

115.78 and 115.782.

The notice also provides general information to assist parents in understanding the evaluation and IEP

process, including the timelines for completing the evaluation.

If the parents of a student or LEA staff determine additional time is needed to permit meaningful parent

participation, the LEA must provide it within the applicable timelines for completing an evaluation and

meeting to develop an IEP.

Parents have procedural safeguards and

can contact other sources for assistance

about understanding their rights.

34 CFR §§ 300.503 and 300.504;

Wis. Stat. § 115.792.

Any required notice must inform parents of the protections they have under the procedural safeguards

of state and federal special education law and of sources they may contact to obtain information and

assistance in understanding state and federal special education law. Because this evaluation is an initial

evaluation, the LEA is required to provide the parents with a complete procedural safeguards notice.

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IE-2 Initial Evaluation: Notice that No Additional Assessments Needed

The IEP team, including the parents, must review existing evaluation data to determine whether additional assessments are needed. Form IE-2 is used

when the IEP team determines additional assessments are not needed.

There must be sufficient information and data for the IEP team to determine:

● whether the student is a “child with a disability” and the educational needs of the student;

● the present levels of academic achievement and functional performance and related developmental needs of the student;

● whether the student needs special education and related services;

● the nature and extent of special education and related services that the student needs; and

● the content of the student’s IEP including information related to enabling the student to be involved in and progress in the general education

curriculum.

34 CFR §§ 300.301; 300.304 and 300.305; Wis. Stat. §§ 115.777 and 115.782.

Implementation Considerations:

The review of existing evaluation data may be done at an IEP team meeting; however, there is no requirement to conduct a meeting for this purpose.

34 CFR § 300.305. LEAs should use the Existing Data Review to Determine if Additional Assessments or Evaluation Materials are Needed (form ED-

1) to document the review.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date of notice. Wis. Stat. §§ 115.777(3) and

115.78(3).

The notice must be sent within 15 business days of receiving the referral. See the date the referral

was received on form R-1.

The date form IE-2 is sent begins the 60-calendar-day timeline in which to complete the evaluation

of the student and determine if the student is a “child with a disability.”

The IEP team, including the parents, has

considered existing data available about the

child and determined that additional testing

or evaluation is not needed. 34 CFR §§

300.305; 300.503; Wis. Stat. §§ 115.782

and 115.792.

As part of the notice, parents must be provided a description of the information used as the basis for

the IEP team’s decision not to conduct additional assessments. This list includes:

● evaluations and information provided by the parents;

● current classroom-based, local, or state assessments;

● classroom-based observations; and

● observations by teachers and related service providers.

Based on data from these sources, the IEP team has determined no additional assessments or other

evaluation materials such as achievement or performance tests, interviews, observations, checklists,

or rating scales are needed.

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Documentation of parent participation

34 CFR § 300.305; Wis. Stat. § 115.782

Parents are IEP team participants and must have an opportunity to participate in the decision about

whether additional assessments are needed. Check the first box if parents participated in determining

no additional assessments are needed. Describe the manner in which the parents participated. If the

parents did not participate in the decision, check the second box and describe the LEA’s attempts to

involve the parents.

The review may be conducted without a parent’s participation if the LEA is unable to involve the

parent. If the parent did not participate, the LEA must document at least three reasonable attempts to

involve the parent. Examples of documentation include:

● detailed records of telephone calls and the results of those calls;

● copies of correspondence sent to parent and any response received; and

● detailed records of visits made to the parent’s home or place of employment and results of the

visits.

Often school personnel will attempt to contact parents by telephone. A telephone call where there is

no answer is not a reasonable attempt. A voice mail message or a delivered e-mail are reasonable

attempts.

Reasons for this determination and other

options considered. 34 CFR § 300.503;

Wis. Stat. § 115.792.

The LEA must document the reasons why it proposes not to conduct additional assessments, including

a description of other options, if any; the LEA considered and the reasons for rejecting those options;

and a description of any other relevant factors. For example, the results of recent comprehensive

testing at a clinic may be available and therefore no additional assessment may be required.

Narrative regarding the IEP team role, the

evaluation and IEP process, and right to be

provided additional time. 34 CFR §§

300.301, 300.305, 300.306, 300.323, and

300.503; Wis. Stat. §§ 115.78, 115.782, and

115.792.

The notice also provides general information to assist parents in understanding the evaluation and IEP

team process. The IEP team process may be concluded in one meeting or may require more than one

meeting.

If the parent(s)

or LEA staff determine additional time is needed to permit meaningful parent

participation, the LEA must provide additional time. However, when providing additional time, the

LEA must comply with applicable timelines. See “General Comments About Timelines.”

Parents have procedural safeguards and can

contact other sources for assistance about

understanding their rights. 34 CFR §§

300.503 and 300.504; Wis. Stat. § 115.792

Any required notice must inform parents of the protections they have under the procedural safeguards

of IDEA and of sources to obtain information and assistance in understanding IDEA and state special

education law. Since the LEA previously provided a copy of the procedural safeguards with the initial

notice of evaluation (form IE-1), the LEA is not required to provide the parents with another copy

unless requested.

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IE-3 Initial Evaluation: Notice and Consent Regarding Need to Conduct Additional Assessments

Form IE-3 is used when the IEP team, after reviewing existing data including information from the parents, determines additional assessments or other

evaluation materials need to be administered.

The IEP team, including the parents, must review existing evaluation data to determine whether additional assessments are needed. There must be

sufficient information and data for the IEP team to determine:

● whether the student is a “child with a disability” and the educational needs of the student;

● the present levels of academic achievement and functional performance and related developmental needs of the student;

● whether the student needs special education and related services;

● if applicable, the nature and extent of special education and related services that the student needs; and

● if applicable the content of the student’s IEP including information related to enabling the student to be involved in and progress in the general

education curriculum.

34 CFR §§ 300.301, 300.304 and 300.305; Wis. Stat. §§ 115.777 and 115.782.

Parent consent is required before tests or other evaluation materials are administered to a student. 34 CFR §§ 300.300 and 300.304; Wis. Stat. §§ 115.777

and 115.782

Implementation Considerations:

The review of existing evaluation data may be done at an IEP team meeting; however, there is no requirement to conduct a meeting for this purpose.

34 CFR § 300.305. LEAs should use the Existing Data Review to Determine if Additional Assessments or Evaluation Materials are Needed (form ED-

1) to document the review.

If a parent of a student enrolled in or seeking to enroll in a public school does not consent to an initial evaluation, the LEA may, but is not required to,

pursue the evaluation by requesting mediation or initiating a due process hearing. However, if the student is enrolled in a home-based private education

program (home-schooled) or in a private school, the LEA may not use mediation or a due process hearing. 34 CFR §§ 300.300 and 300.506; Wis. Stat.

§§ 115.782, 115.797, and 115.80.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date of notice. Wis. Stat. § 115.777.

The notice must be sent within 15 business days of receiving the referral. See the date referral was

received on form R-1.

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The IEP team, including the parents, has

reviewed existing data available about the

child and determined that there is a need to

gather additional information and data

through the use of additional assessments

and other evaluation materials. 34 CFR §§

300.305 and 300.503; Wis. Stat. §§ 115.782

and 115.792.

As part of the notice, parents must be provided a description of the information used as the basis for

the IEP team’s decision to conduct additional assessments. This list includes:

● evaluations and information provided by the parents;

● current classroom based, local, or state assessments;

● classroom-based observations; and

● observations by teachers and related service providers.

Based on data from these sources, the IEP team has determined additional assessments or other

evaluation materials, such as achievement or performance tests, interviews, observations, checklists,

or rating scales are needed.

Documentation of parent participation

34 CFR § 300.305; Wis. Stat. § 115.782.

Parents are IEP team participants and must have an opportunity to participate in the decision about

whether additional assessments are needed. Check the first box if parents participated in determining

additional assessments are needed. Describe the manner

in which the parents participated. If the

parents did not participate in the decision, check the second box and describe the LEA’s attempts to

involve the parents in the decision.

The review may be conducted without a parent’s participation if the LEA is unable to involve the

parent. If the parent did not participate, the LEA must document at least three reasonable attempts to

involve the parent. Examples of documentation include:

● detailed records of telephone calls and the results of those calls;

● copies of correspondence sent to parent and any response received; and

● detailed records of visits made to the parent’s home or place of employment and results of the

visits.

Often school personnel will attempt to contact parents by telephone. A telephone call where there is

no answer is not a reasonable attempt. A voice mail message or a delivered e-mail are reasonable

attempts.

Areas to be evaluated, including

assessments to be given, and individuals

who will administer the assessments or

other evaluation materials. 34 CFR §§ 300.9

and 300.503; Wis. Stat. §§ 115.782 and

115.792.

The LEA must notify parents of any test or other evaluation materials it proposes to administer. If the

specific assessment tools are known, list the specific tools along with a brief description. At a

minimum, describe the types of tools that will be used and the area(s) that will be assessed, e.g.,

standardized testing to measure academic ability and achievement. In addition, identify the names of

the evaluator(s), if known at the time of the notice. If the names are not known, identify the types of

evaluators, e.g., school psychologist. It is good practice, if the name of the evaluator is provided and

later changes, that the parent be notified of the change in evaluator and why.

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Options considered and reasons rejected

34 CFR § 300.503; Wis. Stat. § 115.792

Enter other evaluation options considered, if any, the reasons those options were rejected, and any

other factors relevant to the proposed evaluation. For example, if a parent requests a particular test

and the LEA denies the request, the LEA must notify the parents in writing of its decision and the

reason why the test will not be administered. The LEA may state another test is more appropriate, or

a newer test is now available and should be used. If no other options were considered, check the

“None” box.

Narrative regarding the IEP team role, the

evaluation and IEP process, and right to be

provided additional time. 34 CFR §§

300.301; 300.305; 300.306; 300.323 and

300.503; Wis. Stat. §§ 115.78; 115.782 and

115.792.

The notice provides general information to assist parents in understanding the evaluation and IEP

team process.

If the parents of a student or LEA staff determine additional time is needed to permit meaningful

parent participation, the LEA must provide additional time within the applicable timelines for

completing the evaluation and meeting to develop an IEP. See “General Comments About Timelines”

in this guide.

Parents have procedural safeguards and can

contact other sources for assistance about

understanding their rights. 34 CFR §§

300.503 and 300.504; Wis. Stat. § 115.792.

Any required notice must inform parents of the protections they have under the procedural safeguards

of IDEA and state law, and of sources they can contact to obtain information and assistance in

understanding IDEA and state special education law. The LEA is not required to provide the parents

with another procedural safeguards notice if, in the current school year, the LEA previously provided

the notice. However, if the parents request a copy, or requested the reevaluation, then the LEA must

provide the parents a procedural safeguards notice.

Consent is needed before administering

assessments or other evaluation materials.

34 CFR § 300.300; Wis. Stat. § 115.782

Explanation regarding consent is voluntary,

the right to revoke that consent, and the

possible effects of not granting consent.

34 CFR §§ 300.9 and 300.300.

The LEA must obtain the informed consent of the parent before administering tests and other

evaluation materials to the student. The LEA must make reasonable efforts to obtain informed consent.

The consent for evaluation may not be construed as consent for initial provision of special education

services.

The LEA must inform parents the granting of their consent is voluntary and may be revoked at any

time prior to the administration of tests or other evaluation materials. Parents must be informed they

are not required to give their consent, and if consent is not granted, the LEA may request mediation

or a due process hearing about whether the assessments should be administered.

Revocation of consent is not retroactive. Revocation does not negate an action that has occurred after

the consent was given and before the consent was revoked.

Date school district received parent consent.

34 CFR § 300.301; Wis. Stat. § 115.78.

In the box under the parent’s signature and date, enter the date the LEA received parental consent.

This date starts the 60-calendar-day timeline in which to complete the evaluation and determine if

the student is a “child with a disability.”

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RE-1 Notice of Reevaluation

Form RE-1 is used to provide written prior notice to parents that the LEA is initiating a reevaluation. It explains the reevaluation process and identifies

the functions the IEP team will perform.

A LEA must reevaluate a student with a disability if the LEA determines the educational or related services needs of the student, including the student’s

academic achievement and functional performance, warrant a reevaluation, or if the student’s parent or teacher requests a reevaluation. However, a

reevaluation may occur not more than once a year unless the parent and the LEA agree otherwise (see form RE-2). A reevaluation must occur at least

once every 3 years unless the parent and LEA agree a reevaluation is unnecessary (see form RE-3). In addition, a “child with a disability” must be

reevaluated before determining the student is no longer a “child with a disability.” 34 CFR §§ 300.303 and 300.305; Wis. Stat. § 115.782(a). If a student

was previously found eligible for special education, but the parents did not provide consent, and the student is referred again for an evaluation, the

evaluation is considered an initial evaluation and initial criteria for a disability category is considered.

The purposes for conducting a reevaluation are to determine:

● whether the student continues to be a “child with a disability” and the educational needs of the student;

● the present levels of academic achievement and functional performance and related developmental needs of the student;

● whether the student continues to need special education and related services;

● the nature and extent of special education and related services that the student needs;

● the content of the student’s IEP including information related to enabling the student to be involved in and progress in the general education

curriculum; and

● whether any additions or modifications to the special education and related services are needed to enable the student to meet the measurable

annual goals set out in the student’s IEP.

34 CFR § 300.305; Wis. Stat. § 115.782(a).

Each IEP team must consist of the following:

● the parents of the student;

● at least one regular education teacher of the student if the student is, or may be, participating in a regular educational environment;

● at least one special education teacher who has recent training or experience related to the student’s known or suspected area of special education

needs or, where appropriate, at least one special education provider of the student;

● a representative of the local educational agency who is qualified to provide or supervise the provision of special education; is knowledgeable

about the general curriculum; and is knowledgeable about and authorized to commit the available resources of the local educational agency;

● an individual who can interpret the instructional implications of evaluation results, who may be another member of the IEP team other than the

parents or the student;

● at the discretion of the parent or the LEA, other individuals who have knowledge or special expertise about the student, including related services

personnel as appropriate;

● whenever appropriate, the student: if a purpose of the meeting will be consideration of post-secondary goals and transition services, the LEA

must invite the student;

● if a student is attending school through whole grade sharing, open enrollment, or a tuition waiver, at least one person designated by the resident

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district who has knowledge or special expertise about the student;

● when a student is suspected of having a specific learning disability for the first time and progress data from intensive intervention will be

considered, a licensed person qualified to assess data on individual rate of progress using a psychometrically valid and reliable methodology, the

licensed person who implemented the scientific, research-based or evidence-based, intensive interventions with the referred pupil, and a licensed

person qualified to conduct individual diagnostic evaluations of children;

• when a student is suspected or known to need occupational therapy, physical therapy, or speech and language therapy, a therapist in each

respective area of service.

34 CFR § 300.321(a); Wis. Stat. § 115.78(1m).

Implementation Considerations:

Another LEA member of the IEP team, e.g., the special education teacher, may also serve as the LEA representative provided the individual meets the

requirements to act in that capacity. To identify the LEA representative in these situations, write the individual’s name in each applicable space on the

form. Likewise, IEP team participants filling the required roles when considering SLD eligibility for the first time may serve in more than one capacity

on the IEP team, as appropriate.

The determination of whether an individual invited to the IEP team meeting by the parent or by the LEA has knowledge or special expertise about the

student is made by the party who invited the individual. 34 CFR § 300.21(c).

An evaluation conducted after an initial evaluation that determines a student is eligible for special education is considered a reevaluation. For example,

if a student initially found eligible as a “child” with a learning disability is evaluated for an emotional behavioral disability or for a speech or language

impairment, the new evaluation is a reevaluation. If a student who was previously evaluated and determined not eligible for special education is referred

again, the new evaluation is considered an initial evaluation. Note the law does not permit a LEA to refuse any referral for an initial evaluation.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date of notice. Wis. Stat. § 115.777(3)(e).

The date of this notice begins the 15-business-day timeline in which to complete the review of exiting

evaluation data and send the student’s parents a request for consent to evaluate, or if no additional data

are necessary, notify the parents of that determination. If a LEA uses form R-1 to initiate a reevaluation,

the date the LEA received form R-1 begins the 15 business-day timeline.

LEA intends to reevaluate a child and

reason for the reevaluation

The notice informs the parents of the LEA’s intent to reevaluate their child and the reason(s) for the

reevaluation. The areas of concern must be documented. These may be in the areas of academics,

cognitive learning, communication, independence and self-determination, physical/health, social and

emotional learning. The areas of concern may already be addressed by the student’s IEP, or they may

be new areas of concern. The areas of concern may be identified by the individual requesting the

reevaluation or as part of a three-year reevaluation. It is important to identify all areas of concern in

order to conduct a comprehensive reevaluation.

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IEP team participants

Wis. Stat.§ 115.78(1m).

The LEA must notify the parents about the composition of the IEP team, including the names of the

participants if known at the time of the notice.

Other options considered and reasons

rejected, and a description of any other

relevant factors

34 CFR § 300.503; Wis. Stat. §

115.792(2)(c).

Enter other options, if any, that were considered and rejected; the reasons those options were rejected;

and a description of any other relevant factors. For example, the parent may request particular LEA

staff be included or excluded from the IEP team, and the LEA may refuse the request. If no options

were considered and rejected, check the “None” box.

Narrative regarding the IEP team role, the

reevaluation and IEP process, timelines,

and the right to be provided additional

time. 34 CFR §§ 300.301, 300.305;

300.306, 300.323, and 300.503;

Wis. Stat. §§ 115.78, 115.782, and

115.792.

The notice also provides general information to assist parents in understanding the reevaluation and

IEP team process including the timelines in which these activities must be carried out.

If the parents of a student or the LEA staff determine additional time is needed to permit meaningful

parent participation, the LEA must provide it within the applicable timelines for completing the

reevaluation and meeting to revise the student’s IEP. The notice informs parents of their right to request

a copy of the IEP team’s most recent evaluation report. If requested, the LEA must provide the parent

with a copy before any IEP team meeting or due process hearing, and in no case more than 45 days

after the request.

Parents have procedural safeguards and can

contact other sources for assistance about

understanding their rights

34 CFR §§ 300.503 and 300.504;

Wis. Stat. § 115.792.

Any required notice must inform parents of the protections they have under the procedural safeguards

of IDEA and state law, and of sources they can contact to obtain information and assistance in

understanding IDEA and state special education law. The LEA is not required to provide the parents

with another procedural safeguards notice if, in the current school year, the LEA previously provided

the notice. However, if the parents request a copy, or requested the reevaluation, then the LEA must

provide the parents a procedural safeguards notice.

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RE-2 Notice of Agreement to Conduct a Reevaluation More Than Once a Year

A reevaluation may not occur more frequently than once a year unless the parent and the LEA agree otherwise. Notice of Agreement To Conduct A

Reevaluation More Than Once A Year (form RE-2) is used when a parent and a LEA agree to reevaluate a “child with a disability” within a 12-month

period. Prior to sending this notice, the parent and LEA must agree about the need for a reevaluation. If the parent and LEA agree to conduct a

reevaluation, form RE-2 is sent to the parents starting the evaluation process. 34 CFR § 300.303; Wis. Stat. § 115.782(a).

Implementation Considerations:

The LEA should identify a process for obtaining information to decide whether a student should be evaluated more than once within 12 months. The

LEA may involve the IEP team in this process. However, neither an IEP team meeting nor an IEP team is required to make the decision. The LEA should

designate staff with authority to enter into an agreement with the parent to reevaluate the student. The designated staff should consult with staff working

with the student. 34 CFR § 300.303(b)(1); Wis, Stat, § 115.782(4).

If a LEA believes a reevaluation is needed, but the parent disagrees, the LEA may request mediation or initiate a due process hearing regarding whether

the student should be reevaluated. The LEA cannot unilaterally decide to conduct more than one evaluation of a student within 12 months of the previous

evaluation.

The date of the most recent eligibility determination begins the 12-month period (See form ER-1). For example, if the date of a student’s IEP meeting to

determine eligibility was 10/1/19, any reevaluation initiated prior to 10/1/20 requires agreement of the parent and LEA. If a reevaluation is initiated on

or after 10/1/20, the LEA may conduct the reevaluation without an agreement between the parent and the LEA.

If a student previously evaluated and determined not to be a “child with a disability” is referred for an evaluation, even if the referral is within 12 months

of the previous evaluation, the new evaluation is considered an initial evaluation. Note state law does not allow a LEA to refuse a referral for an initial

evaluation. In this case, the LEA uses form IE-1, Notice of Receipt of Referral and Start of Initial Evaluation, to initiate the evaluation.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date of notice. Wis. Stat. § 115.777(3)(e)

The date of form RE-2 begins the 15-business-day timeline in which to complete the review of

existing evaluation data and send the child’s parents a request for consent to evaluate, or if no

additional data are necessary, notify the parents of that determination.

Parent agreement to conduct more than one

evaluation in a year

Form RE-2 documents the parent and LEA agree to conduct more than one evaluation in a year. The

notice documents the date and manner in which the agreement took place, e.g., face-to-face

conference, phone conversation, or exchange of e-

mails. The parent is not required to sign the

agreement.

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Reason for the reevaluation

The LEA must identify the reason(s) for the reevaluation, e.g., a change in the student’s academic

achievement or functional performance.

Other options considered related to

initiating the reevaluation and reasons

rejected, and a description of any other

relevant factors. 34 CFR § 300.503;

Wis. Stat. § 115.792(2)(c)

Enter other options, if any, considered when initiating the reevaluation and the reasons they were

rejected, including a description of any other relevant factors. If no other options were considered,

check the “None” box.

IEP team participants.

Wis. Stat. § 115.78(1m).

The LEA must notify the parents about the composition of the IEP team, including the names of the

participants if known at the time of the notice.

Other options considered related to

selection of IEP team participants and

reasons rejected, and a description of any

other relevant factors

34 CFR § 300.503;

Wis. Stat. § 115.792(2)(c)

Enter a description of other options, if any, that were considered and rejected; the reasons those

options were rejected; and a description of any other relevant factors. For example, the parent may

request particular LEA staff be included or excluded from the IEP team, and the LEA may refuse the

request. If no options were considered and rejected, check the "None” box.

Narrative regarding the IEP team role, the

reevaluation and IEP process, timelines, and

the right to be provided additional time.

34 CFR §§ 300.301, 300.305, 300.306,

300.323, and 300.503; Wis. Stat. §§ 115.78,

115.782, and 115.792)

The notice also provides general information to assist parents in understanding the reevaluation and

IEP process including the timelines in which these activities must be carried out.

If the parents of a student

or the LEA staff determine that additional time is needed to permit

meaningful parent participation, the LEA must provide additional time within the applicable timelines

for completing the reevaluation and meeting to revise the student’s IEP. The notice further informs

parents of their right to request a copy of the IEP team’s most recent evaluation report. If requested,

the LEA must provide parents with a copy before any IEP team meeting or due process hearing and

in no case more than 45 days after the request.

Parents have procedural safeguards and can

contact other sources for assistance about

understanding their rights

34 CFR §§ 300.503 and 300.504;

Wis. Stat. § 115.792.

Any required notice must inform parents of the protections they have under the procedural safeguards

of IDEA and state law, and of sources they can contact to obtain information and assistance in

understanding IDEA and state special education law. The LEA is not required to provide the parents

with another procedural safeguards notice if, in the current school year, the LEA previously provided

the notice. However, if the parents request a copy, or requested the reevaluation and the LEA agreed

to conduct the reevaluation, then the LEA must provide the parents a procedural safeguards notice.

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RE-3 Notice of Agreement that a Three-Year Reevaluation Not Needed

A reevaluation must occur at least once every three years, unless the parent and the LEA agree a reevaluation is unnecessary. Reevaluations determine

continuing eligibility under IDEA, but also the nature and extent of the special education and related services the student needs. Student needs do not

remain stagnant over time. Reevaluations are critical in determining the student’s present level of performance (the what); the effects of the disability

(the how); determining the student’s disability-related needs (the why); developing appropriate, ambitious, and achievable goals; and aligning services

to progress towards those goals. A reevaluation must be individualized and take into account the student’s current educational needs. 34 CFR §

300.303(b)(2); Wis. Stat. § 115.782 (4)(a)(2).

Prior to sending the Notice of Agreement That a Three-Year Reevaluation Not Needed, the parent and LEA must discuss and come to agreement that a

reevaluation is unnecessary. The decision not to conduct a three-year reevaluation must be given careful consideration. If the LEA does not conduct a

three-year reevaluation as a result of an agreement between the LEA and the parent, the next evaluation is due three years from the date of the notice.

For example, if the student was evaluated on October 1, 2023, and was determined to be a “child with a disability” under IDEA and state law, the

student’s next three-year reevaluation must be completed no later than October 1, 2026. However, if the parent and LEA agree the three-year reevaluation

is not needed and the district completed form RE-3 and it is dated September 15, 2023, the next reevaluation must be completed on or before September

15, 2026. 34 CFR § 300.303(b)(2); Wis. Stat. § 115.782(4)(a)2.

Implementation Considerations:

The LEA should designate the staff with authority to enter into an agreement with a parent not to conduct a three-year reevaluation. Whomever the LEA

designates with authority to enter into an agreement with the parent should consult with staff working with the student. The LEA should identify a process

for obtaining information and deciding whether to agree not to conduct a three-year reevaluation. The LEA may involve the IEP team in this process.

However, neither an IEP team meeting nor an IEP team is required in making this decision.

The decision not to conduct a three-year reevaluation must be given careful consideration. The parent and the designated school staff should discuss the

advantages and disadvantages of conducting a reevaluation, as well as what data may be needed to determine the student’s educational needs and develop

the IEP. A reevaluation may be necessary to obtain current data to determine the present levels of academic achievement and functional performance;

the effects of the disability; determining the student’s disability-related needs; developing appropriate, ambitious, and achievable goals; and aligning

services to progress towards those goals.

FORM CONTENT

CLARIFICATION/EXPLANATION

Reason for not conducting a three-year

reevaluation. 34 CFR § 300.303(b)(2);

Wis. Stat. § 115.782(4)(a)2.

The LEA must identify the reason(s) for not conducting a three-year reevaluation.

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Other options considered and reasons

rejected, and a description of any other

relevant factors. 34 CFR § 300.503;

Wis. Stat. § 115.792(2)(c).

Enter other options considered, if any, and the reasons they were rejected when agreeing not to

conduct the reevaluation and other factors relevant to the proposed action. If no other options were

considered, check the “None” box.

Parent agreement that a three-year

reevaluation is not needed. 34 CFR §

300.303(b)(2); Wis. Stat. § 115.782(4)(a)2.

The notice documents the parent and LEA agreed that a three-year reevaluation is unnecessary. There

is no requirement the parent sign the agreement.

Parents have procedural safeguards and can

contact other sources for assistance about

understanding their rights. 34 CFR §§

300.503 and 300.504; Wis. Stat. § 115.792.

Any required notice must inform parents of the protections they have under the procedural safeguards

of IDEA and state law, and of sources they can contact to obtain information and assistance in

understanding IDEA and state special education law. The LEA is not required to provide the parents

with another procedural safeguards notice if, in the current school year, the LEA previously provided

the notice. However, if the parents request a copy, or requested the reevaluation and the LEA agreed

to conduct the reevaluation, then the LEA must provide the parents a procedural safeguards notice.

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RE-4 Reevaluation: Notice that No Additional Assessments Needed

The IEP team, including the parents, must review existing evaluation data to determine whether additional assessments are needed. Form RE-4 is used

when the IEP team determines additional assessments are not needed. 34 CFR § 300.305; Wis. Stat. § 115.782(4)(c).

There must be sufficient information and data for the IEP team to determine:

● whether the student continues to be a child with a disability and the educational needs of the child;

● the present levels of academic achievement and functional performance and related developmental needs of the student;

● whether the student needs special education and related services;

● the nature and extent of special education and related services that the student needs; and

● the content of the student’s IEP including information related to enabling the student to be involved in and progress in the general education

curriculum.

34 CFR §§ 300.301; 300.304; and 300.305; Wis. Stat. §§ 115.777 and 115.782.

Implementation Consideration:

The review may be done at an IEP team meeting; however, there is no requirement to conduct a meeting for this purpose. 34 CFR § 300.305. LEAs

should use the Existing Data Review to Determine if Additional Assessments or Evaluation Materials are Needed (form ED-1) to document the review.

See form ED-1 for more information.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date of notice. Wis. Stat. §§

115.777(2)(e) and 115.78(3).

The notice must be sent no more than 15 business days from the date the LEA initiated the reevaluation.

A reevaluation may be initiated by sending form RE-1 or RE-2 to the parents. However, if the referral

form (R-1) is used to initiate the reevaluation, then the date on form RE-4 may be no more than 15

business days from the date the LEA received the referral as recorded on form R-1.

The date of this notice starts the 60-calendar-day timeline in which to complete the reevaluation of the

student and determine if the student continues to be a child with a disability.

IEP team, including the parents, has

considered existing data available about

the student and determined that additional

testing or evaluation is not needed

34 CFR §§ 300.305 and 300.503; Wis. Stat.

§§ 115.782 and 115.792.

As part of the notice, parents must be provided a description of the information used as the basis for the

IEP team’s decision not to conduct additional assessments. This list includes:

● evaluations and information provided by the parents;

● current classroom based, local, or state assessments;

● classroom-based observations; and

● observations by teachers and related service providers.

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Based on these data sources, the IEP team has determined no additional assessments or other evaluation

materials, such as achievement or performance tests, interviews, observations, checklists, or rating scales

are needed.

Documentation of parent participation.

34 CFR § 300.305; Wis. Stat. § 115.782.

Parents are IEP team participants and must have an opportunity to participate in the decision about

whether additional assessments are needed. The review may be conducted without a parent’s

participation if the LEA is unable to involve the parent. If the parent did not participate, the LEA must

document at least three reasonable attempts to involve the parent. Examples of documentation include:

● detailed records of telephone calls and the results of those calls;

● copies of correspondence sent to parent and any response received; and

● detailed records of visits made to the parent’s home or place of employment and results of the

visits.

Often school personnel will attempt to contact parents by telephone. A telephone call where there is no

answer is not a reasonable attempt. A voice mail message or a delivered e-mail are reasonable attempts.

Check the first box if parents participated in determining additional assessments are needed. Describe

the manner in which the parents participated. If the parents did not participate in the decision, check the

second box and describe the LEA’s attempts to involve the parents in the decision.

Reasons for this determination and other

options considered. 34 CFR §§ 300.305

and 300.503; Wis. Stat. § 115.792.

The LEA must document the reasons why it proposes not to conduct additional assessments or other

evaluation materials, including a description of other options, if any; the LEA considered and the reasons

for rejecting those options; and a description of any other relevant factors.

Parent has right to request that additional

assessments or other evaluation materials

be conducted. 34 CFR § 300.305;

Wis. Stat. § 115.782.

If the IEP team determines additional assessments are not needed, parents have the right to request

additional assessments to determine whether the student continues to be a child with a disability and to

determine the student

’s educational needs. The right to additional assessments is limited to

determinations of continued eligibility for special education services and the student’s educational needs.

The LEA is not required to conduct assessments for other reasons, such as meeting entrance requirements

for admission to college. If the LEA denies such a request from the parent, the LEA must provide reasons

why the LEA refuses to conduct additional assessments under the section “other options considered, and

reasons rejected” on this form or form M-1.

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Narrative regarding the IEP team role, the

evaluation and IEP process, and right to

be provided additional time. 34 CFR §§

300.303, 300.305, 300.306, and 300.503;

Wis. Stat. §§ 115.78, 115.782, 115.787,

and 115.792.

The notice provides general information to assist parents in understanding the reevaluation and IEP team

process.

If the parents of a student or the LEA staff determine additional time is needed to permit meaningful

parent participation, the LEA must provide additional time within the applicable timelines for completing

the reevaluation and meeting to review and revise the student’s IEP. The notice informs parents of their

right to request a copy of the IEP team’s most recent evaluation report. If requested, the LEA must

provide the parent with a copy before any IEP team meeting or due process hearing, and in no case more

than 45 days after the request.

Parents have procedural safeguards and

can contact other sources for assistance

about understanding their rights. 34 CFR

§§ 300.503 and 300.504;

Wis. Stat. § 115.792.

Any required notice must inform parents of the protections they have under the procedural safeguards of

IDEA and state law, and of sources they can contact to obtain information and

assistance in

understanding IDEA and state special education law. The LEA is not required to provide the parents

with another procedural safeguards notice if, in the current school year, the LEA previously provided the

notice. However, if the parents request a copy, or requested the reevaluation and the LEA agreed to

conduct the reevaluation, then the LEA must provide the parents a procedural safeguards notice.

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RE-5 Reevaluation: Notice and Consent Regarding Need to Conduct Additional Assessments

Form RE-5 is used when the IEP team, after reviewing existing data including information from the parents, determines additional assessments or other

evaluation materials need to be administered. Prior to providing this notice, the IEP team, including the parents, must consider the existing evaluation

data. The review may be conducted at an IEP team meeting, but there is no requirement to conduct an IEP team meeting for this purpose. 34 CFR §§

300.303(b) and 300.305(a)(2)(i)(B); Wis. Stat. § 115.782(4)(a)2.

There must be sufficient information and data for the IEP team to determine:

● whether the student continues to be a child with a disability and the educational needs of the student;

● the present levels of academic achievement and functional performance and related developmental needs of the student;

● whether the student continues to need special education and related services;

● if applicable, the nature and extent of special education and related services that the student needs; and

● if applicable, the content of the student’s IEP, including information related to enabling the student to be involved in and progress in the general

education curriculum.

34 CFR § 300.303(b) and 300.305(a)(2); Wis. Stat. § 115.782(4)(a)2.

Before additional assessments are administered to a student, parent consent is required. However, if the LEA can demonstrate it has made reasonable

efforts to obtain parental consent and the student’s parent failed to respond, the LEA can proceed with administering tests or other evaluation materials.

This exception only applies to reevaluations, not to initial evaluations. Wis. Stat. § 115.782(4)(b).

Implementation Considerations:

The review of existing evaluation data may be done at an IEP team meeting; however, there is no requirement to conduct a meeting for this purpose.

LEAs use the Existing Data Review to Determine if Additional Assessments or Evaluation Materials are Needed (form ED-1) to document the review.

A parent’s denial of consent and a parent’s failure to respond to a request for consent are not the same. Tests or other evaluation materials may be

administered without parental consent only when the parent fails to respond to requests for consent. Wis. Stat. § 115.782(4)(b).

If the parent refuses consent for a reevaluation, the LEA may, but is not required to, pursue the reevaluation through mediation or a due process hearing.

However, if the student is enrolled in a home-based private education program (home-schooled) or placed in a private school by the parents, the LEA

may not use mediation or a due process hearing.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date of notice. Wis. Stat. § 115.777(3)(e).

The notice must be sent no more than 15 business days from the date the LEA initiated the

reevaluation. A reevaluation may be initiated by sending form RE-1 or RE-2 to the parents. If the

referral form (R-1) is used to initiate the reevaluation, the date on form RE-5 can be no more than 15

business days from the date the LEA received the referral as recorded on form R-1.

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The IEP team, including the parents, has

considered existing data available about the

student and determined that additional

testing or evaluation is needed

34 CFR §§ 300.305 and 300.503;

Wis. Stat.§§ 115.782 and 115.792.

As part of the notice, parents must be provided a description of the information used as the basis for

the IEP team’s decision to conduct additional assessments. This list includes:

● evaluations and information provided by the parents;

● current classroom-based, local, or state assessments;

● classroom-based observations; and

● observations by teachers and related service providers.

Based on these data sources, the IEP team has determined additional assessments or other evaluation

materials, such as achievement or performance tests, interviews, observations, checklists, or rating

scales are needed.

Documentation of parent participation

34 CFR § 300.305; Wis. Stat. § 115.782.

Parents are IEP team participants and must have an opportunity to participate in the decision about

whether additional assessments are needed. The review may be conducted without a parent’s

participation if the LEA is unable to involve the parent. If the parent did not participate, the LEA must

document at least three reasonable attempts to involve the parent. Examples of documentation include:

● detailed records of telephone calls and the results of those calls;

● copies of correspondence sent to parent and any response received; and

● detailed records of visits made to the parent’s home or place of employment and results of the

visits.

Often school personnel will attempt to contact parents by telephone. A telephone call where there is

no answer is not a reasonable attempt. A voice mail message or a delivered e-mail are reasonable

attempts. Check the first box if parents participated in determining additional assessments are needed.

Describe the manner in which the parents participated. If the parents did not participate in the decision,

check the second box and describe the LEA’s attempts to involve the parents in the decision.

Areas to be evaluated, including

assessments to be given, and individuals

who will administer the assessments or

other evaluation materials. 34 CFR §§ 300.9

and 300.503; Wis. Stat. §§ 115.782 and

115.792.

The LEA must notify parents of any test or other evaluation materials it proposes to administer. If the

specific assessment tools are known, the specific tools should be listed along with a brief description.

At a minimum, the LEA must describe the types of tools that will be used and the area(s) that will be

assessed, e.g., standardized testing to measure academic ability and achievement. In addition, the LEA

must identify the names of the evaluator(s), if known at the time of the notice. If the names are not

known, the LEA must identify the types of evaluators, e.g., school psychologist.

Options considered and reasons rejected

34 CFR § 300.503; Wis. Stat. § 115.792.

Enter other evaluation options considered, if any; the reasons those options were rejected; and any

other factors relevant to the proposed evaluation. For example, if a parent requests a particular test and

the LEA denies the request, the LEA must notify the parents in writing of its decision and reason why

the test will not be administered. The LEA may state another test is more appropriate, or a newer test

is now available and should be used. If no other options were considered, check the “None” box.

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Narrative regarding the IEP team role, the

evaluation and IEP process, and right to be

provided additional time. 34 CFR §§

300.301, 300.305, 300.306, 300.323, and

300.503; Wis. Stat. §§ 115.78 and 115.782.

The notice also provides general information to assist parents in understanding the reevaluation and

IEP team process, including the timelines within which these activities must be carried out.

If the parents of a student or the LEA staff determine additional time is needed to permit meaningful

parent participation, the LEA must provide it within the applicable timelines for completing the

reevaluation and meeting to review and revise the student’s IEP. The notice informs parents of their

right to request a copy of the IEP team’s most recent evaluation report. If requested, the LEA must

provide the parent with a copy before any IEP team meeting or due process hearing, and in no case

more than 45 days after the request.

Parents have procedural safeguards and can

contact other sources for assistance about

understanding their rights. 34 CFR §§

300.503 and 300.504; Wis. Stat. § 115.792

Any required notice must inform parents of the protections they have under the procedural safeguards

of IDEA and state law, and of sources they can contact to obtain information and assistance in

understanding IDEA and state special education law. The LEA is not required to provide the parents

with another procedural safeguards notice if, in the current school year, the LEA previously provided

the notice. However, if the parents request a copy, or requested the reevaluation, then the LEA must

provide the parents a procedural safeguards notice.

Consent is needed before administering

assessments or other evaluation materials

34 CFR § 300.300; Wis. Stat. § 115.782

The LEA must have the informed consent of the parent before administering tests and other evaluation

materials to the student. The LEA must make reasonable efforts to obtain informed consent.

Explanation regarding consent is voluntary,

the right to revoke that consent, and the

possible effects of not granting consent.

34 CFR §§ 300.300 and 300.9.

The LEA must inform parents the granting of their consent is voluntary and may be revoked at any

time prior to the administration of tests or other evaluation materials. Parents must be informed they

are not required to give their consent, and if consent is not granted, the LEA may request mediation or

a due process hearing about whether the assessments should be administered.

Revocation of consent is not retroactive. Revocation does not negate an action that has occurred after

the consent was given and before the consent was revoked.

Date school district received parent consent

34 CFR § 300.301; Wis. Stat. § 115.78.

The date the LEA receives parental consent starts the 60-calendar-day timeline in which to complete

the evaluation and determine if the student continues to be child with a disability. If the parent fails to

respond to the LEA’s request for consent, the LEA may proceed with the reevaluation if it documents

it has taken reasonable efforts to obtain the parent’s consent, and the student’s parent failed to respond.

The LEA must notify the parent in writing it will proceed with the evaluation. The date of this

notification begins the 60-calendar-day timeline.

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ED-1 Existing Data Review to Determine if Additional Assessments or Evaluation Data Are Needed

As part of an evaluation, the IEP team first must review existing evaluation data available on the student related to each area of concern identified in the

referral or during the review of existing data. The review occurs after the parent has been notified in writing that a referral was received and after the

start of the initial evaluation or notice of reevaluation. Parental consent is not required before reviewing existing data as part of an initial evaluation or a

reevaluation. Based on that review, the IEP team must decide what additional data, if any, are needed to determine:

● whether the student meets disability criteria and the impact of the disability on educational performance;

● the present levels of academic achievement (including reading achievement or for preschool children, early literacy skills) and functional

performance (including cognitive learning, communication, independence and self-determination, physical/health, social and emotional

learning);

● the effects of the student’s disability and the student’s disability-related needs;

● goals to meet the student’s disability-related needs;

● whether the student needs or continues to need specially designed instruction and related services;

● the nature and extent of special education and related services the student needs to meet the measurable annual goals set out in the IEP and to

participate in the general education curriculum; and

● in the case of a reevaluation, whether any additions or modifications to the special education and related services are needed to enable the student

to meet the measurable annual goals set out in the IEP and to participate, as appropriate, in the general education curriculum.

34 CFR § 300.305; Wis. Stat. § 115.782.

The existing data review should occur in the context of concerns listed in the referral for a special education evaluation or the notice of reevaluation.

The purpose of the review of existing evaluation data is to determine whether there is sufficient information related to the concerns to conduct a

comprehensive evaluation of a student, including information to determine if the student meets disability criteria and the impact of the disability on

educational performance, and to determine the student’s disability-related needs, develop goals, and align special education services. The analysis of

the data to determine if the student meets criteria for a disability category occurs during the IEP team evaluation meeting to determine eligibility. Form

ED-1 is used by the IEP team to document the review of existing evaluation data. An IEP team meeting is not required for this purpose although it may

be appropriate and helpful to hold one. 34 CFR § 300.300. If a meeting is held, the Invitation to a Meeting of the IEP Team (form I-1) must be sent to

the parents and form ED-1 is used with the IEP Team Meeting Cover Page (form I-3) to document the meeting. As a result of the discussion during the

existing data review, additional academic and functional concerns may come to light and should be documented on the ED-1. A comprehensive

evaluation is based on a thorough identification of all concerns including academics, cognitive learning, communication, independence and self-

determination, physical/health, social and emotional learning. All concerns identified in the referral (or notice of reevaluation) and existing data review

are considered during the evaluation process. The existing data review must ensure there is sufficient data to evaluate all concerns.

Implementation Considerations:

Sources of existing data may include the student’s permanent or cumulative file, the behavioral records of the student, information or evaluations provided

by the parent(s)/family, previous evaluations, district-wide assessments, state assessments, medical records, post-secondary transition, work samples,

grades on daily assignments or tests, and/or observations from teachers, related service providers, or others.

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The existing data reviewed and the sources of information are identified on the ED-1. It is important to have sufficient information about reading

achievement or early literacy skills in order to determine if a student has a disability-related need that affects reading. If the IEP team determines additional

data are needed after reviewing existing data, the new assessments to be administered and other needed evaluation materials are described in Section III

of the ED-1. This description, along with the names of the specific assessment tools and personnel responsible for administering the evaluation(s), if

known, are recorded on form IE-3 or RE-5.

The review of existing data is an IEP team function, and a student’s parents are IEP team participants. 34 CFR § 300.321; Wis. Stat. § 115.78. If the

review occurs during an IEP team meeting, record the date of the meeting and the name of the person completing the form. Whether or not the review of

existing data is completed at an IEP team meeting, the LEA must document the parent’s participation or at least three attempts to involve the parent(s)

in the review of existing data. Often LEA personnel will attempt to contact parents by telephone. The LEA may not count a telephone call as an attempt

when there is no answer. A telephone call where a message is left may be counted as an attempt. The LEA may count a delivered email as an attempt.

Sometimes an error in the existing data review occurs when what is documented is a review by a problem-solving team (e.g., teacher assistance team,

building consultation team) prior to referral, instead of the IEP team’s review to decide whether additional evaluation data is needed to complete an IEP

team evaluation. Sometimes IEP team participants will review data prior to the parent being notified of the start of an initial evaluation or reevaluation.

The review of existing data occurs by IEP team participants after a parent is notified in writing of the start of an initial evaluation or reevaluation. Another

common error occurs when an IEP team participant completes form ED-1 and fails to include his or her own input. If the individual completing the form

is one of the IEP team participants, the individual needs to remember to record his or her name in the list of IEP team participants involved in the review

of existing data to determine if additional information is needed.

The ED-1 becomes part of the student’s education record and may be provided to the parent prior to or with the Notice and Consent Regarding Need to

Conduct Additional Assessments (either form IE-3 or RE-5) or the Notice that No Additional Assessments are Needed (either form IE-2 or RE-4), or

when the Evaluation Report is provided.

Problems can arise when the existing data review is not comprehensive and additional assessments are added later in the process. IEP team members

should consider all identified academic and functional concerns and determine if there is data related to each, then think expansively about the data

needed to assist them in determining eligibility for special education and what they may need to determine appropriate services.

FORM CONTENT

CLARIFICATION/EXPLANATION

Notice of receipt of referral.

34 CFR §§ 300.300, 300.503, and 300.504;

Wis. Stat. §§ 115.777, 115.782, and

115.792.

Record the date the notice of referral and start of initial evaluation or notice of reevaluation was

provided to the parents. After the notice is provided to the parent and within 15 business days of the

district receiving the referral, the review of existing data must be completed, and the parent must be

sent a request for consent to conduct additional assessments or notice that no additional testing is

needed.

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Information from referral.

34 CFR § 300.305; Wis. Stat. § 115.782.

The IEP team verifies they have reviewed information provided on the referral for special education or

notice of reevaluation by checking “Yes” or “No.” It is good practice to review the

referral for

information about the student’s reading ability or other existing information. Identify concerns listed in

the referral (or in the notice of reevaluation) to determine if there is sufficient existing data to assess

each area of concern or if additional data and information needs to be gathered as part of the evaluation.

Section I

Existing Data Review.

34 CFR § 300.305; Wis. Stat. § 115.782.

The IEP team must review existing data related to academic achievement and functional performance.

Check the box next to each area of existing data reviewed. If insufficient or no data exists in a particular

area, the IEP team must determine if additional data needs to be gathered. The IEP team should pay

particular attention to any areas of concern identified in the referral (or the notice of reevaluation) or

during the review of existing data and ensure there is sufficient data to assess each concern. For instance,

the parent may have referred the student because of concerns about the student’s ability to read grade

level materials. During the review of existing data, the student’s regular education teacher may identify

concerns about the student’s social and emotional well-being. Both areas should be checked under

“Existing Data” and a determination made as to whether there is sufficient existing data about each.

Sources of Information.

34 CFR § 300.305; Wis. Stat. § 115.782.

Check the box next to the sources of information. The IEP team must review existing evaluation data,

including:

● Information or evaluations provided by the parents/family;

● Previous evaluations;

● Current classroom based, district-wide, or state assessment results;

● Observations by teachers, related service providers and others (including current classroom-

based observations and observations by reading teacher/specialist, if applicable);

● Previous interventions and effects;

● Behavioral records (including but not limited to discipline data, suspensions, office referrals,

and data tracking a behavior);

● Assistive technology assessment (

including but not limited to assessment for accessible

educational materials and augmentative and alternative communication);

● Functional behavioral assessment;

● Adaptive PE Assessment; and

● Information from other sources (e.g., including but not limited to postsecondary transition,

medical, Birth to 3, etc.).

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Section II

Additional areas of concern identified

during the review of existing data, if any:

Section III

Description of Additional Data Needed

34 CFR § 300.305; Wis. Stat. § 115.782.

When IEP team members are reviewing the areas of existing data and sources of information, they may

identify concerns not listed on the referral (or in the notice of reevaluation). A comprehensive evaluation

should consider all areas of concern. List the additional areas of concerns identified during the existing

data review. Ensure any areas of concern identified during the existing data review are checked in

Section I and there is sufficient data to assess all areas of concern. If there are no concerns beyond those

identified in the referral (or notice of reevaluation), check “None.”

Once the existing data is reviewed, the IEP team must determine whether additional data is needed to

address all the identified areas of concern. When considering whether additional data is needed, keep in

mind that this data can be related to academic or functional areas, or both. If an IEP team member,

including the parent(s), identifies additional data is needed, check the box “Yes.” Describe the types of

additional assessments and other evaluation materials needed in Section III of the ED-1. A more detailed

description of additional assessments and other evaluation materials and titles, if known, and the

personnel responsible for administering assessments, if known, must be recorded on Form IE-3 or

RE-5. Ensure there is sufficient information about reading achievement or early literacy skills compared

to grade-level standards/age level expectations.

Section IV

IEP Team Participants

34 CFR § 300.305; Wis. Stat. § 115.782.

Documentation on form ED-1 must include the name of each individual, the date they were involved in

the review of existing data, and the method of involvement. Input regarding additional assessments and

other needed evaluation materials is documented in Section III. If the consideration of existing data was

done at a meeting, the IEP team participants are also listed on the IEP Team Meeting Cover Page (Form

I-3).

Parent(s)

34 CFR §§ 300.305 and 300.321;

Wis. Stat. §§ 115.78 and 115.782.

Parent Involvement Attempts

34 CFR §§ 300.305 and 300.321;

Wis. Stat. §§ 115.78 and 115.782.

The consideration of existing data is an IEP team function and parents are IEP team participants.

Documentation on the ED-1 of the parents’ involvement in the review of existing data must include the

date and method of involvement. The parent’s input should be documented on the ER-1 and reviewed

during the meeting to determine eligibility. If the review of existing data was conducted at a meeting,

the parent’s involvement is documented on the IEP Team Meeting Cover Page (Form I-3).

The review may be conducted without a parent’s participation if the LEA is unable to involve the

parent(s). If a parent did not participate, the LEA must document at least three reasonable attempts to

involve the parent(s). Examples of documentation include:

● detailed records of telephone calls and the results of those calls;

● copies of correspondence sent to the parent and any response received; and

● detailed records of visits made to the parent’s home or place of employment and results of the

visits.

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The requirement for involving parents in the review is the same as for IEP team participation. If the

parents did not participate in the review, the district should document three good faith attempts to

involve them. Often school personnel will attempt to contact parents by telephone. A telephone call

where there is no answer is not counted as an attempt. A telephone call where the phone is answered

and a message is left may be counted. A delivered e-mail message counts as an attempt.

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ER-1 Evaluation Report Including: Determination of Disability Category and Need for Specially Designed Instruction

As part of any initial evaluation or reevaluation, an IEP team must develop an evaluation report that includes documentation of a disability category and

need for specially designed instruction. Form ER-1 must be completed for all evaluations (including initial and reevaluations). Additional evaluation

report forms may be needed to document the evaluation results depending on the circumstances, e.g., disability criteria forms, Additional Documentation

Required for Specific Learning Disabilities (ER-2A or 2B), Evaluation for Determining Braille Needs (ER-3), etc. 34 CFR § 300.306; Wis. Stat. §

115.782.

Implementation Considerations:

The IEP team must include a review of the student’s reading achievement. This includes an analysis of data available at the time of the referral and

new information gathered from additional testing and other sources. The IEP team should also consider how the student’s functional performance

affects the student’s reading achievement. A thorough analysis includes how the student’s academic achievement and functional performance affect

access, engagement, and progress in the general education curriculum, instruction, and environment.

It is good practice for IEP team members who administer tests or other evaluation materials to prepare a written summary of their individual

assessment findings that may assist parents and other IEP team members in program planning; however, the determination of whether a student meets

criteria for a disability category, as well as the determination of services and placement must be made by the IEP team during the IEP team meeting.

DPI has eligibility criteria forms and evaluation guides to assist with meeting special education compliance requirements and recommended best

practices. Eligibility criteria resources may be accessed via the department’s website at http://dpi.wi.gov/sped/laws-procedures-bulletins/laws/eligibility.

Parent(s) must be provided with a copy of the IEP team’s evaluation report; however, neither federal nor state law specifies when parents must be

provided with a copy. Typically, the LEA provides the parents with a copy of the evaluation report with the student’s IEP and notice of placement. It is,

however, important LEAs ensure parents have the information they need to participate meaningfully in IEP team meetings. Parents may need to review

their student’s education records. A LEA must comply with a parent request to inspect and review existing education records, including IEP team

evaluation reports or summaries of IEP team participants’ findings, without unnecessary delay and before any meeting regarding an IEP or a due process

hearing and in no case longer than 45 days after the request. 34 C.F.R. § 300.613.

The ER-1 form is split into four sections. Section I describes academic and functional information about the student provided by parents/family, teachers,

service providers and other sources; classroom-based, district-wide and state assessment results; and other evaluations and assessments that existed at

the time of the referral and was reviewed during the Existing Data Review to Determine if Additional Assessments or Evaluation Data are Needed (DPI

Model Form ED-1). It also includes information about interventions attempted before the special education referral (or reevaluation) and the effects of

those interventions. Section II covers the additional academic and functional assessment data and other evaluation materials gathered through the

evaluation process. Section III asks for confirmation that information regarding all areas of concern identified in the referral (or notice of reevaluation)

or during the review of existing data has been documented in the previous sections. Section IV.A. is where the IEP team documents whether or not the

student meets the criteria for one or more of the disability categories. If so, the team must attach the appropriate Criteria for Disability Category form(s)

to the evaluation report. If impairments were considered and rejected, the team must document how the student did not meet the criteria or attach the

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Criteria for Disability Category form(s). If the student does not meet criteria in any of the identified disability categories, the student is not eligible for

special education and the team does not need to proceed to Section IV.B. In Section IV.B., the team considers and documents how the student’s disability

affects their access, engagement and progress in age-appropriate activities or in grade-level general education curriculum; conducts a root cause analysis

and identifies the student’s academic and/or functional disability-related needs; and determines if the student’s disability-related needs require specially

designed instruction. The team documents if, by reason of the student’s disability, the student needs special education. 34 CFR §§ 300.8 and 300.305;

Wis. Stat. § 115.782.

Many individuals wonder under which section to place their “observations.” Observations can either be general comments about a student by a teacher,

related service provider or parent. In that case, they would be included in Section I: Information from Existing Data. Formal observations may also be

conducted in the context of the evaluation, which is an individual assessment to determine eligibility for special education and related services, consistent

with the evaluation procedures and for which parental consent was sought. Comments to the Regulations, p. 46639. In this case, formal observations as

part of the evaluation belong in Section II: Information from Additional Assessments and Other Sources.

FORM CONTENT

CLARIFICATION/EXPLANATION

Type of evaluation

34 CFR §§ 300.301 and 300.303;

Wis. Stat. § 115.782.

The IEP team identifies whether the evaluation being completed is an initial evaluation or a

reevaluation. Check the appropriate box. See the comments under ‘Implementation Considerations’

on forms RE-1 and RE-2 for a discussion of when an evaluation is an initial evaluation and when it is

a reevaluation.

Date when the determination of disability

category and need for specially designed

instruction was made. 34 CFR §§ 300.301

and 300.303; Wis. Stat. § 115.782.

Enter the date the IEP team determined if the student met the criteria for a disability category and

needed specially designed instruction. The date of the eligibility determination is the date the IEP

team meets and determines whether the student is or continues to be a “child with a disability.”

In the case of an initial evaluation or a reevaluation,

the IEP team must make the eligibility

determination within 60 calendar days of receiving parent consent for administering tests and other

evaluation materials (see form IE-3 or RE-5) or provide the parent notice that no additional

assessments are needed (see form IE-2 or RE-4).

There are three exceptions to the 60-calendar-

day evaluation timeline. The exceptions include

situations in which (1) the parent of a student repeatedly fails or refuses to produce the student for the

evaluation; (2) a student enrolls in a school of another LEA after the 60-calendar-day timeline has

begun, but prior to a determination of eligibility or continuing eligibility by the student’s previous

LEA (see form M-2); or (3) there is a written agreement with the parent to extend the timeline to

complete the evaluation of a student suspected of having a specific learning disability (see form M-

3).

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The date of eligibility determination also begins the 30-calendar-day timeline within which the IEP

team must meet to develop an IEP and determine a student’s placement.

Section I

Information from existing data.

34 CFR §§ 300.301 and 300.303; Wis. Stat. §

115.782.

In this section, the IEP team documents information from existing data. Refer to the existing data

review (DPI Model Form ED-1) when completing this section. The IEP team must include existing

information related to all concerns identified in the referral (Form R-1) (or notice of reevaluation, RE-

1) or during the review of existing data (Form ED-1). During the IEP team meeting to determine if a

student meets the criteria for a disability category and needs specially designed instruction, document

and analyze the relevant data and information that existed prior to the current evaluation. Any data

from additional testing or other evaluation materials administered as part of the current evaluation is

documented in Section II, under “Information from Additional Assessments and Other Evaluation

Materials.” When interpreting evaluation data to determine

if a student meets the criteria for a

disability category and requires specially designed instruction, IEP teams are required to document

and carefully analyze data from a variety of sources.

The IEP team must include information about both academic achievement and functional

performance. Academic achievement includes information in reading, mathematics, written

language, communication, science and social studies. For preschool children, academic achievement

includes information about the child’s acquisition and use of knowledge and skills (including early

language/communication and early literacy and other pre-academic skills). Functional performance

includes social and emotional skills, activities, and nonacademic skills needed for independence and

performance at school, in the home, in the community, for leisure time, and for post-secondary and

lifelong learning. Examples include activities of everyday living, school/work/play habits,

expressing needs and desires, the ability to problem solve and ask for help, and other social and

emotional skills. For preschool children, functional performance includes positive social and

emotional skills and use of appropriate behavior to meet their needs. As part of a comprehensive

evaluation, IEP teams are encouraged to include information from any relevant areas identified from

the referral and during the review of existing data such as achievement in content areas, cognitive

learning, communication, independence and self-determination, physical and health, social and

emotional learning.

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A. Information provided by parent(s)/family:

34 CFR §§ 300.304, 300.305, and 300.306;

Wis. Stat. § 115.782.

Information provided by teachers, related

service providers. 34 CFR §§ 300.304,

300.305, and 300.306; Wis. Stat. § 115.782.

Information provided by other sources:

34 CFR §§ 300.304, 300.305, and 300.306;

Wis. Stat. § 115.782.

B. Summary of previous evaluations and

assessments

Classroom-based, district-wide or state

assessment results.34 CFR §§ 300.305 and

300.306; Wis. Stat. § 115.782).

Document information provided by the parent(s) and family in reading and other areas. LEAs should

encourage parents’ participation by encouraging family members to describe their student’s strengths

and abilities and what they view as their student’s challenges. For example, is the student able to read

and comprehend classroom texts and materials? Encourage the parent to share information about what

and how their student is reading at home and in the community as well as their beliefs about their own

skills and their passions and desires. LEAs may want to provide resources and encourage the

parent(s)/family to access other tools before the IEP team meeting to prepare to participate. If the

parent(s)/family have no information to provide, document that no additional information was

provided. The IEP team should ask the parent for information about the concerns identified in the

referral (or notice of reevaluation) and during the review of existing data.

Document information provided by teachers and related service providers about the student’s

academic and functional performance in the classroom and school environment. IEP team members

may share how the student is achieving in reading, mathematics and other content areas; observations

regarding social/emotional behavior, health status, self-determination, communication skills or

cognitive learning (making connections when learning new material). The IEP team should document

information from teachers and service providers about the concerns identified in the referral (or notice

of reevaluation) and during the review of existing data. Concerns may be in the areas of achievement

in content areas, cognitive learning, communication, independence and self-determination, physical

and health, social and emotional learning.

Include any other existing data here. This may include information pertaining to postsecondary

transition, pertinent medical information (including vision and hearing), information from the Birth

to 3 Program if the child is transitioning to early childhood, and any other pertinent data.

Document information in reading and any areas of concern. If no previous assessments or evaluations

exist, note this on the form.

Include the student’s performance on classroom tests, quizzes and district and state-wide assessments.

Include data in reading and other academic areas. The assessments may have been conducted in the

general education classroom or in a special education classroom. Local or district-wide assessments

include any standardized tests administered district-wide (e.g., Iowa Test of Basic Skills, STAR, PALS,

MAP). If no previous classroom-based, local, or state assessments exist, note this on the form.

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Other evaluations and assessments:

34 CFR §§ 300.305 and 300.306; Wis. Stat. §

115.782.

When applicable, include information from a reading teacher or specialist. For preschool children,

use the results of their Indicator 7 Child Outcomes Ratings. Document results from an independent

educational evaluation, whether at school district or parent expense. Include the results of any

previous functional performance assessments or evaluations.

C. Previous interventions and the effects of

those interventions table:

Wis. Stat. § 115.782(2)(b)1.

Identify any previous evidenced-based interventions, including instructional methodologies, provided

in the general education classroom or a special education setting. Include data on the effects of those

interventions on reading achievement/early literacy and other academic and functional areas.

Document any modifications or accommodations provided in any environment. Include data on how

the student responded to the interventions (e.g., Previous intervention: Direct instruction in reading

fluency for eight weeks; Effect: Increase of two words per minute.) These may include, among other

things, formal interventions as part of a multi-level system of supports or previous special education

services.

Prior interventions are required before an initial eligibility decision may be made for a Specific

Learning Disability (SLD).

In the rare case that no previous interventions have been provided, check “Not Applicable” box.

Section II

Information from additional assessments and

other evaluation materials. 34 CFR §§

300.304 and 300.306; Wis. Stat. § 115.782.

Academic:

In this section, the IEP team documents the new information gathered as part of the evaluation or

reevaluation. The IEP team must include information about the student’s academic and functional

early literacy or reading skills. Include any information collected during the evaluation related to

identified areas of concern in academic or functional skills such as achievement in content areas,

cognitive learning, communication, independence and self-determination, physical and health,

social and emotional learning. Identify whether information from additional assessments or other

sources was gathered during this evaluation/reevaluation by checking the “Yes” or “No” box. If yes,

document data and information about academic and functional performance.

Include data and information about early literacy or reading and other content areas of concern

identified in the referral (or notice of reevaluation) or during the review of existing data. Data and

information are obtained from assessments and other evaluation materials administered as part of

the current evaluation with consent from the parent. The data may include formal observations,

aptitude tests, and other newly conducted assessments determined to be needed as a result of the

review of existing data.

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Functional:

Include results from checklists, behavior rating scales and interviews related to the student’s

functional performance. Formal observations of the student’s functional performance conducted as

part of the student’s special education evaluation should be documented in this section. Document

the observations of professionals conducted outside the school environment. Document assessment

results of the student’s functional reading skills. Include information about areas of concern

identified during the referral (or notice of reevaluation) or review of existing data such as cognitive

learning, communication, independence and self-determination, physical and health, social and

emotional learning.

Section III.

Information regarding areas of concern

Section IV.

Determination of Disability Category and

Need for Specially Designed Instruction

The IEP team must verify they have included data or other information related to all areas of concern

identified in the referral (or notice of reevaluation) or during the review of existing data. The IEP team

should review the referral (R-1) (or notice of reevaluation, RE-1) and existing data review (ED-1)

forms to determine the concerns that were previously identified. Data or other information related to

each area of concern is documented under Section I, II or both. If data or other information related to

each area of concern is documented, the IEP team would check the “Yes” box. If the IEP team

neglected to consider or evaluate an area of concern, the “No” box should be checked, and the IEP

team should reconvene to consider the additional area(s) after data or information is obtained. This

will ensure the evaluation is sufficiently comprehensive to identify all the student’s disability-related

needs. If the IEP team considered an area of concern but determined the area did not need to be

evaluated, provide an explanation as to why in Section I and check the “Yes” box; the IEP team

considered the area of concern.

A. Determination of Disability Category

34 CFR §§ 300.8, 300.306, 300.309, 300.311,

and 300.503, Wis. Stat. §§ 115.76; 115.782

and 115.792.

When considering whether the student meets the criteria for one or more disability categories, the IEP

team may not find the student eligible if the determining factor is due to a lack of appropriate

instruction in reading or math, or due to limited English proficiency. The district must take steps to

address the lack of appropriate instruction or the student’s limited English proficiency. The IEP team

may provide recommendations (e.g., resources or supports) for the district to consider.

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To identify a student as a “child with a disability,” the IEP team must first determine the student meets

the criteria for one or more of the twelve disability categories and second determine if the student

requires specially designed instruction (see Section IV.B). In determining if the student meets criteria,

the IEP team should consider all suspected disability categories of concern and, using the eligibility

criteria in section PI 11.36, Wisconsin Administrative Code, document how the student meets (or

does not meet) the criteria. If the student meets eligibility criteria, check the box next to the disability

category in Section IV.A.3. on Form ER-1. Check each disability category where the student meets

criteria. For each disability category identified, document how the student meets the criteria. The IEP

team must attach the disability criteria form as documentation.

If the student did not meet criteria for any disability category that was considered by the IEP team,

document how the student did not meet the criteria for the rejected disability category. If the student

was not eligible under any disability category, document which ones were considered and how the

student did not meet the criteria. The IEP team may attach the disability criteria form as

documentation, if used.

A student must be found to have met criteria for a disability category before the IEP team considers

if the student needs specially designed instruction. If the student does not meet criteria for a disability

category, do not complete Section IV.B.: Need for Specially Designed Instruction. The IEP team may

include recommendations other than special education for the district and parent(s) to consider to

support the student.

If the student has a significant developmental delay (SDD), SDD must be the only disability category

checked. The IEP team must consider and dismiss all other disability categories before identifying a

student with SDD.

If the IEP team identifies a Specific Learning Disability, document the additional information required

for Specific Learning Disabilities on form ER-2A or 2B.

If the IEP team identifies a visual impairment, document the additional information required for

determining a student’s need for Braille on form ER-3.

If the student meets the criteria for at least one disability category defined in PI.11.36, then the IEP

team determines if the student needs specially designed instruction.

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B. Need for Specially Designed Instruction

34 CFR §§ 300.306, 300.503, and 300.8; Wis.

Stat. §§ 115.76, 115.782, and 115.792.

Describe how the student’s disability affects

their access, engagement and progress in the

grade-level general education curriculum,

including how the disability affects academic

or functional skills (e.g., achievement in

content areas including early

literacy/reading, cognitive learning,

communication, independence and self-

determination, physical and health, social

and emotional learning). 34 CFR §

300.320(a)(1)(i) and (ii); Wis. Stat. §

115.787(2)(a).

This section is completed if the student meets the criteria for one or more disability category. It is

possible for a student to meet criteria for a disability category and not need specially designed

instruction and, therefore, not be a “child with a disability.” Child with a disability means a child who

meets disability category criteria, and who, by reason thereof, needs special education and related

services.

In determining the effects of the disability, consider how the disability affects academic achievement

(e.g., early literacy/reading, math, science, social studies) and functional performance (e.g., cognitive

learning, communication, independence and self-

determination, physical and health, social and

emotional learning). Describe how the student’s disability affects the student’s access, involvement,

and progress in the general education curriculum, instruction, and environment, including how the

disability affects reading. The term “general education curriculum” refers to the same curriculum as

for nondisabled students in the same grade in which the student is enrolled. It is the standards-based

curriculum adopted by each LEA or schools within the LEA that applies to all students within each

general age grouping from preschool through secondary school.

For preschool children, describe how the disability affects participation in age-appropriate activities,

including language development, communication, and/or early literacy. “Age-appropriate activities”

means activities that children of that chronological age typically engage in as part of a formal

preschool program or in informal activities, for example coloring, pre-reading activities, play time,

sharing time, or listening to stories read by teachers or parents. Describe how the disability affects

functional performance (e.g., cognitive learning, communication, independence and self-

determination, physical and health, social and emotional learning).

A statement that a student’s disability impacts their performance, or a restatement of the eligibility

criteria is not sufficient. A suggested sentence starter when describing the effects of the disability

might be, “The student is not meeting grade-level standards/expectations in the area of X (effect).”

For more information on effects of the disability and disability-

related needs, visit

https://dpi.wi.gov/sped/college-and-career-ready-ieps/learning-resources.

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Based on a root cause analysis of the effects

of the student’s disability, describe the

student’s academic and/or functional

disability-related needs. What skills and/or

behaviors does the student need to develop

and/or improve so the student can meet

age/grade level standards and expectations

(e.g., decoding, identifying the main idea,

basic math calculations, and word

problems)? 34 CFR § 300.320(a)(2)(i)(A);

Wis. Stat. § 115.787(2)(b).

The disability-related needs are identified by asking why the student is not achieving grade-level

standards or functional expectations. The IEP team digs deep into this analysis, asking why multiple

times to identify the root cause(s). This includes why the student is not able to access, be involved in,

or make progress in the general education curriculum and why the student is not achieving grade-

level reading standards/early learning standards. Based on the root cause analysis of the effects of the

student’s disability, the IEP team determines the student’s disability-related needs. Disability-related

needs are specific skills impacted by the student’s disability that a student needs to learn in order to

access, engage and make progress in meeting early-childhood/grade level standards and expectations.

This may include needs related to the acquisition of academic skills such as phonemic awareness,

phonics/decoding, reading fluency, vocabulary development, reading comprehension, number sense,

and ability to manipulate numbers. A disability-related need may also relate to functional skill needs

such as social-emotional, behavioral, self-regulation, mobility, sensory, and others that affect access

and engagement in curriculum, instruction and other activities.

The team must consider and document the disability-related needs unique to each student, regardless

of their areas of impairment, including students who are “speech and language only.” It is important

to consider the effects of a speech and language impairment on reading achievement and other

academic areas and functional performance. If the student is reading below grade level, the IEP team

must consider why the student is not reading at grade level. If the IEP team determines the disability

adversely affe

cts reading (even if the student is identified solely with a speech and language

impairment), then the team must conduct a root cause analysis to identify the reasons. This will help

ensure everyone on the IEP team understands how the disability is affecting the student’s academic

achievement and functional performance and inform what goals and services are needed.

A suggested sentence starter for developing a statement of disability-related need might be, “The

student needs to develop/improve/increase X skill/behavior (related to root causes), so the student can

Y (addresses effect).” For more information on identifying the disability-related needs refer to Step 2

of the 5-Step Process at https://dpi.wi.gov/sped/college-and-career-ready-ieps/learning-resources.

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Can the student’s disability-related needs be

addressed without specially designed

instruction?

By reason of the identified disability

category(ies) that adversely affects the

student’s education performance, does the

student need specially designed instruction or

in the case of a reevaluation, continue to

need specially designed instruction?

34 CFR § 300.306.

The IEP team must determine if the student’s disability-related needs can be met solely by regular

education or if the student requires specially designed instruction. Special education means specially

designed instruction to meet the unique needs of a child with a disability.

Specially designed

instruction means adapting the content, methodology or delivery of instruction to address the unique

needs of the student that result from the student’s disability and ensure access of the student to the

general curriculum so that the student can meet the educational standards that apply to all students

within the jurisdiction of the LEA.

Check “Yes” if the student’s disability-related needs can be addressed by regular education. This

means the student does not require special education. Describe any supports the student may need

provided by regular education, such as preferential seating, etc. Note if the IEP team suggests the

student be considered for a Section 504 evaluation and supports via a Section 504 Plan. If the student

only requires modifications or accommodations that can be made by the regular education program,

the student does not need special education and no IEP is developed for the student.

Check “No” if the student’s disability-related needs cannot be addressed without specially designed

instruction. This means the student’s disability-related needs cannot be addressed solely by regular

education. Explain why the student requires specially designed instruction. Describe the student’s

needs that cannot be addressed by the regular education program. Describe the adaptations to

content, methodology or delivery of instruction needed to address the student’s disability-related

needs. If a student does not need specially designed instruction, the student is not eligible for special

education and an IEP is not developed.

This prompt is intended to be a concluding statement or determination as to whether the student needs

specially designed instruction and is therefore eligible to receive special education services. The IEP

team should consider the information discussed and documented in the preceding prompts and check

“Yes” if the student requires specially designed instruction to meet their disability-related needs, or

“No” if the student does not require specially designed instruction.

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ER-1-DIS Introduction to Disability Category Determinations as Part of a Comprehensive Evaluation

The department has developed criteria forms to assist IEP teams in review of disability category criteria under Wis. Admin. Code PI 11.36. These forms

are used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation.

The criteria forms will guide the IEP team’s consideration of disability category criteria during an evaluation. Checkboxes at the top of the forms indicate

the form sections the IEP must review. During an initial evaluation, select the “initial evaluation or considering new disability category” checkbox. If the

student has previously been identified as eligible for special education and the IEP team is considering a new category, the student must meet initial

criteria for the new disability category, so select the “initial evaluation or considering new disability category” checkbox. If the student has previously

been identified for the category being considered, select the “reevaluating category for continuing identification” checkbox and complete the sections

indicated.

The form has prompts to explain or reference data or evidence considered in the process of disability category determination. For any disability category

being considered, the IEP team must document whether or not the student meets the criteria. If a student meets criteria, the IEP team must attach the

criteria form to the evaluation report (form ER-1). If categories were considered and rejected, the team must document the process by either 1) explaining

how a student did not meet the criteria on the evaluation report or 2) attaching the applicable criteria for disability category form(s).

Disability criteria determination is part of a comprehensive special education evaluation. The Individuals with Disabilities Education Act (IDEA) requires

that special education evaluations be sufficiently comprehensive to make eligibility decisions and identify the student’s educational needs, whether or

not commonly linked to the disability category in which the student has been classified. 34 CFR § 300.304.

It is important to consider there may be effects of a disability that seem similar to another disability category. For example, an IEP team may find a

student meets the criteria of emotional behavioral disability when the behavior exhibited by the student may have been explained by a hearing loss and

would be addressed differently. In this case, including a teacher of the deaf and hard of hearing on the IEP team would be important. To ensure a

comprehensive special education evaluation of each student, it is important not to associate certain characteristics with one particular disability category,

but to consider if what the IEP team is observing may be due to another factor.

Comprehensive evaluations must provide information relevant to making decisions about how to educate the student. A comprehensive evaluation

provides the foundation for developing an IEP that promotes student access, engagement, and progress in age or grade level general education curriculum,

instruction and other activities, and environments. For more information on comprehensive evaluations, visit the comprehensive evaluation webpage at

the Wisconsin Department of Public Instruction.

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ER-1-AUT Criteria for Disability Category: Autism

This form is used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation. This form documents

the Individualized Education Program (IEP) team’s consideration of whether a student meets criteria for the disability category of autism as defined

under PI 11.36 (8)(a), Wis. Admin. Code. If a student meets criteria, the IEP team must attach the criteria form to the evaluation report. If this category

is considered and rejected, the team must document the process by either 1) explaining how a student did not meet the criteria on the evaluation report

or 2) attaching this criteria form to the evaluation report.

A medical diagnosis of an autism spectrum disorder is not required in order to determine whether a student meets the disability category criteria of

autism. If medical information is available, it should be considered as part of the Individualized Education Program (IEP) team’s evaluation but must not

be the sole component to determine if the student meets the disability category criteria for autism. School personnel may not require parents to obtain a

medical diagnosis of an autism spectrum disorder before proceeding with a comprehensive special education evaluation. For more information on how

to identify a student with autism, go to the autism webpage at the Wisconsin Department of Public Instruction.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date form completed

Initial evaluation or considering new

disability category

Reevaluating category for continuing

identification

Section I. Social Participation and

Communication

Enter the date of the meeting when the IEP team determined if the student met the disability category

criteria for autism.

Check if the student was not previously found to meet the disability category criteria for autism. The

IEP team must complete all sections of the criteria form.

Check if the student was previously found to meet the disability category criteria for autism. A

student must meet initial criteria during a reevaluation for this category. The IEP team must complete

all sections of the criteria form.

Both must be checked “yes” in order to be considered for the disability category of Autism. Data or

evidence should be briefly shared that support a “yes” or a “no”.

The data or evidence should be gathered from a variety of sources including observation, interview,

record review, developmental history, rating scales or checklists and other sources as deemed

necessary by the IEP team.

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The student displays difficulties or

differences or both in interacting with

people and events. The student may be

unable to establish and maintain reciprocal

relationships with people. The student may

seek consistency in environmental events to

the point of exhibiting rigidity in routines.

The student displays problems which extend

beyond speech and language to other

aspects of social communication, both

receptively, and expressively. The student’s

verbal language may be absent or, if

present, lacks the usual communicative

form which may involve deviance or delay

or both. The student may have a speech or

language disorder or both in addition to

communication difficulties associated with

autism.

Section II. Other Characteristics

The student exhibits delays, arrests, or

regressions in motor, sensory, social or

learning skills. The student may exhibit

precocious or advanced skill development,

while other skills may develop at normal or

extremely depressed rates. The student may

not follow developmental patterns in the

acquisition of skills.

Must be checked “yes.”

Evidence may include, but is not limited to, joint attention, social awareness, reciprocity or turn-

taking, imitation, social play, or social cognition.

Must be checked “yes.”

Evidence may include, but is not limited to, communicative intent, echolalia, topic maintenance,

reciprocity, or understanding of non-verbal communication. A variety of assessment tools may be

required to explore receptive and expressive speech and language that has an educational impact on a

student’s social communication. Norm referenced assessments may not identify more complex

pragmatic language difficulties, and other assessments such as language samples and observations may

be helpful when identifying communication difficulties associated with autism.

At least one must be checked “yes” in order to be considered for the disability category of autism. Data

or evidence should be briefly shared that support a “yes” or a “no.”

The data or evidence should be gathered from a variety of sources including observation, interview,

record review, developmental history, rating scales or checklists, and other sources as deemed

necessary by the IEP team.

May be checked “yes.” The student may exhibit advanced or precocious development in certain

concrete visual rote learning skills while exhibiting depressed rates in other areas. The student does

not follow a normal developmental pattern or progression in acquiring skills.

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The student exhibits abnormalities in the

thinking process and in generalizing. The

student exhibits strengths in concrete

thinking while difficulties are demonstrated

in abstract thinking, awareness, and

judgment. Perseverant thinking and

impaired ability to process symbolic

information may be present.

The student exhibits unusual, inconsistent,

repetitive, or unconventional responses to

sounds, sights, smells, tastes, touch or

movement. The student may have a visual

or hearing impairment or both in addition to

sensory processing difficulties associated

with autism.

The student displays marked distress over

changes, insistence on following routines,

and a persistent preoccupation with or

attachment to objects. The student’s

capacity to use objects in an age-appropriate

or functional manner may be absent,

arrested or delayed. The student may have

difficulty displaying a range of interests or

imaginative activities or both. The student

may exhibit stereotyped body movements.

Section III. Educational Performance

There is an adverse effect on the student's

learning, academic achievement, or

functional performance. Explain or

reference data or evidence:

May be checked “yes.” The student may process information in a concrete and literal manner with

difficulty understanding abstract and symbolic information or relationships. Student may demonstrate

a need with executive functioning skills, i.e., attending, problem solving, organizing, prioritizing,

and/or generalizing.

May be checked “yes.” The student may demonstrate hypersensitivity (over sensitivity or sensory

aversion) or hyposensitivity (under sensitivity or sensory seeking) to sensory input or unusual interest

in sensory aspects of the environment.

May be checked “yes.” The student may rely heavily on learned and predictable rules, routines, and

structures. Alterations in rules, routines, and structures may significantly impact the student. The

student may demonstrate rigidity and perseveration in pa

tterns of thinking, and may exhibit

preoccupation with topics, themes, objects, events, or people. The student may use objects or their

bodies in unconventional or repetitive ways.

Must be checked “yes.”

Data or evidence must document an adverse effect on the student’s educational performance. Assessing

an adverse effect requires the IEP team to consider all aspects of the student’s functioning at school,

including academic, cognitive, communication, physical and health, independence and self-

determination, and social and emotional functioning.

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Section IV. Exclusionary Factor

Section V. Disability Category Criteria

Determination

The documentation of the criteria above

demonstrates developmental disability

significantly affecting a student's social

interaction and verbal and nonverbal

communication, generally evident before

age 3, that adversely affects learning and

educational performance. The student meets

the disability category criteria for autism.

Check to confirm that the student’s educational performance is not primarily adversely affected due to

an emotional behavioral disability.

Students may be identified as meeting more than one disability category criteria area. However, if the

issues most significantly impacting educational performance for a particular student relate to an

emotional behavioral disability, the student cannot meet the disability category criteria for autism.

34 CFR § 300.8(c)(1)(ii).

Check “yes” or “no.” Must meet all criteria in order to check “yes.”

A student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to be eligible for special education. Document the need for

specially designed instruction on the ER-1 form.

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ER-1-BVI Criteria for Disability Category: Blind and Visually Impaired

This form is used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation. This form documents

the Individualized Education Program (IEP) team’s consideration of whether a student meets criteria for the disability category of blind and visually

impaired as defined under PI 11.36 (3)(a), Wis. Admin. Code. As a member of the IEP team, the licensed teacher of the blind and visually impaired

should attend all IEP team meetings, including initial evaluation and reevaluation meetings. If a student meets criteria, the IEP team must attach the

criteria form to the evaluation report. If this category is considered and rejected, the team must document the process by either 1) explaining how a

student did not meet the criteria on the evaluation report or 2) attaching this criteria form to the evaluation report.

For more information on how to identify a student who is blind or visually impaired go to the blind and visually impaired webpage at the Wisconsin

Department of Public Instruction.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date form completed

Initial evaluation or considering new

disability category

Reevaluating category for continuing

identification

Section I. Functional Vision Evaluation

A teacher of the blind and visually impaired

PI 34.051 conducted a functional vision

evaluation.

Enter the date of the meeting when the IEP team determined if the student met the disability category

criteria for blind and visually impaired.

Check if the student was not previously found to meet the disability category criteria for blind and

visually impaired. The IEP team must complete all sections of this form.

Check if the student was previously found to meet the disability category criteria for blind and

visually impaired. A student is not required to meet initial criteria during a reevaluation for this

category, but the disability must continue to have an adverse effect on education performance in

order to be considered for specially designed instruction. It is recommended that the IEP team

consider all sections on this form, but only Section III is required. For example, if the IEP team

decides to complete a functional vision assessment during reevaluation, document the results in

section I. If the IEP team decides to complete an orientation and mobility assessment during a

reevaluation, document the results in section II.

All must be checked “yes” to verify a functional vision evaluation took place. This does not directly

determine eligibility.

An individual licensed by the Department of Public Instruction to teach students who are blind or

visually impaired must conduct a functional vision evaluation. As a member of the IEP team, the

teacher of the blind and visually impaired should attend both initial and reevaluation meetings, as well

as annual IEP meetings.

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Review of medical information from an

ophthalmologist or optometrist.

Formal and informal tests of visual

functioning.

Determination of the educational

implications and curricular needs.

The student’s visual functioning adversely

affects educational performance.

The medical information assists the teacher of the blind and visually impaired in determining what

assessments will be conducted and alerts them to conditions that may be degenerative. A degenerative

condition may require braille instruction or other programming that the student will need in the coming

school years.

The eye report may include, but is not limited to etiology and pathology, visual acuity measures, field

loss information, refractive correction, and restrictions. DPI has developed a worksheet (PI-2015)

"Ocular Report for Children with a Known or Suspected Visual Impairment," which can provide

teachers and eye doctors with a way to communicate.

Formal tests of visual functioning can provide information based on recognized standards. The tests

come in a variety of formats such as checklists, eye charts, performance-based measurements or

criterion referenced assessments. Test selection may vary for each student and should be individually

determined.

Informal assessments should include observation, interviews and other informal activities with the

student. Informal testing may be the most reliable method of obtaining information from students with

multiple disabilities for whom traditional formal testing may prove ineffective.

The following areas need to be considered when determining what implications the student’s vision

has on the student’s access, engagement and progress in: general education curriculum educational

environments, learning media, including reading and writing modes, and expanded core curriculum

specific for students who are blind and visually impaired. All students may not exhibit difficulties in

all of these areas due to blindness or visual impairment; however, evaluation should consider all

potential implications.

There must be an adverse effect on the student’s educational performance in order for the student to

meet criteria. For example:

• A student may not be able to access a computer or tablet using their vision, impacting their

ability to access curriculum at the same time as their peers and meet grade level standards.

•

A student is unable to safely and independently navigate the classroom, navigate school

hallways or the lunch line, board a school bus, and cross streets. A student may also be observed

tripping over uneven surfaces, both indoors and outdoors. This may adversely impact the

student’s ability to meet grade-level standards.

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Section II. Orientation and Mobility Needs

An orientation and mobility specialist

evaluated the student to determine if there

are related orientation and mobility needs in

home, school, or community environments.

The student has orientation and mobility

needs. (Explain or reference data or

evidence and include a description of the

orientation and mobility needs)

Section III. Disability Category Criteria

Determination

Initial evaluation or considering new

disability category:

The documentation of the criteria above

demonstrates even after correction a

student’s visual functioning adversely

affects educational performance. The

student meets the disability category criteria

for blind and visually impaired.

Orientation and mobility needs must be evaluated.

Check “yes” to indicate if the student was assessed by an orientation and mobility specialist in home,

school, or community environments. An orientation and mobility specialist must evaluate the student;

however, a student may meet criteria for blind and visually impaired even if they do not have

orientation and mobility needs.

Check “yes” to indicate the student has orientation and mobility needs.

An orientation and mobility specialist documents in their assessment the findings and needs of the

student. In this section the orientation and mobility specialist must provide a summary of their report

that is understandable to the IEP team.

A student may meet criteria for blind and visually impaired even if they do not have orientation and

mobility needs.

A licensed teacher of the blind or visually impaired conducted a functional vision evaluation (FVE)

which included a review of medical records, formal and informal tests, educational implications and

curricular needs and determined the student’s visual fun

ctioning adversely affects educational

performance. The student was assessed by an orientation and mobility specialist.

A student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to be eligible for special education. Document the need for

specially designed instruction on the ER-1 form.

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Reevaluating category for continuing

identification:

The student was previously identified as

meeting the disability category criteria for

blind and visually impaired and continues to

have a disability that adversely affects the

student’s educational performance. A

student whose disability has an adverse

effect on educational performance must be

found to require specially designed

instruction in order to continue to be

eligible for special education (document the

need for specially designed instruction on

the ER-1).

A student who previously met criteria for the disability category of blind and visually impaired is not

required to meet initial identification criteria upon reevaluation. The student’s visual functioning must

continue to have an adverse effect on educational performance. Explain or reference data or evidence.

A student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to be eligible for special education. Document the need for

specially designed instruction on the ER-1 form.

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ER-1-DHH Criteria for Disability Category: Deaf and Hard of Hearing

This form is used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation. This form documents

the Individualized Education Program (IEP) team’s consideration of whether a student meets criteria for the disability category of deaf and hard of

hearing as defined under PI 11.36 (4)(a), Wis. Admin. Code. As a member of the IEP team, the licensed teacher of the deaf and hard of hearing should

attend all IEP team meetings, including initial evaluation and reevaluation meetings. If a student meets criteria, the IEP team must attach the criteria form

to the evaluation report. If this category is considered and rejected, the team must document the process by either 1) explaining how a student did not

meet the criteria on the evaluation report or 2) attaching this criteria form to the evaluation report.

For more information on how to identify a student who is deaf and hard of hearing, go to the deaf and hard of hearing webpage at the Wisconsin

Department of Public Instruction.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date form completed

Initial evaluation or considering new

disability category

Reevaluating category for continuing

identification

Section I. Hearing Evaluation

A teacher of the deaf or hard of hearing

licensed under s. PI 34.050 was a member of

the IEP team when determining eligibility.

Enter the date of the meeting when the IEP team determined if the student met the disability category

criteria for deaf and hard of hearing.

Check if the student was not previously found to meet the disability category criteria for deaf and

hard of hearing. The IEP team must complete all sections of this form.

Check if the student was previously found to meet the disability category criteria for deaf and hard of

hearing. A student is not required to meet initial criteria during a reevaluation for this category, but the

disability must continue to have an adverse effect on education performance in order to be considered

for specially designed instruction. It is recommended that the IEP team consider all sections on this

form, but only Section III is required.

All must be checked “yes.”

A DPI licensed teacher of the deaf and hard of hearing is required to be a member of the evaluation

team (including reevaluations).

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The IEP team considered a current

evaluation conducted by an audiologist

licensed under ch. 459, Wis.

Stats. when

determining if the student meets criteria.

Explain or reference data or evidence.

There is a decreased ability to detect sound

in one or both ears with or without

amplification, whether permanent or

chronically fluctuating. Explain or reference

data or evidence.

Section II. Educational Performance

There is an

adverse effect on academic

performance. Explain or reference data or

evidence.

Audiologist licensed under Ch. 459, refers to an audiologist who holds a license issued by the WI

Department of Safety and Professional Services (DSPS). All clinical audiologists and the majority of

DPI licensed school audiologists have this credential.

“Current” hearing evaluation is defined by the IEP team. Most often hearing assessments conducted

within the past 6-12 months are considered standard practice. There are situations where the IEP team

may decide to consider information from older assessments or other information gathered by the IEP

team, including information provided by the parent.

A comprehensive evaluation including an audiology report should be sufficiently broad to accurately

describe a student’s hearing status, with or without amplification or hearing assistive technology,

including evidence of a decreased ability to detect sounds (tones and/or speech). There are a variety of

audiology-based assessments and evaluations to represent a student’s auditory function that may vary

by age, etiology, area of concern, etc. An audiogram is only one measure of representing hearing

levels/auditory perception at different frequencies.

An adverse effect on educational performance must be demonstrated in at least one of the following

areas: academic performance, speech perception, speech production, or communication including

language acquisition or expression. For each area, check “yes” if the decreased ability to detect sound

adversely affects academic performance, speech perception, speech production, or communication and

explain or reference data or evidence under each prompt. Check “no” if not adversely affected. At least

one area must be checked “yes.”

This means an adverse effect on academic achievement such as phonemic awareness, vocabulary,

general word knowledge, independent reading with comprehension, reading for information, etc.

Data or evidence should identify how a student is able to access, engage and make progress in the

general education curriculum as well as areas of need associated with the Expanded Core Curriculum

specific to students who are deaf and hard of hearing. For all students, data identifying adverse effect

on academic achievement should not be solely based on grades, but rather academic skills and supports

students must demonstrate and know how to use independently in order to access the general education

curriculum.

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There is an adverse effect on speech

perception. Explain or reference data or

evidence.

There is an adverse effect on speech

production. Explain or

reference data or

evidence.

There is an adverse effect on

communication including language

acquisition or expression. Explain or

reference data or evidence.

This means an adverse effect on speech perception including the ability to listen with comprehension

to spoken messages in a variety of settings.

Data or evidence should identify how a student is able to hear and understand speech in different school

environments and conditions such as in quiet vs noise, close proximity vs distance, small vs large

group, face to face vs virtual formats, as well as various settings such as classroom, lunchroom, gym,

playground, etc.

This means an adverse effect on speech production including the ability to produce speech that is

intelligible to others.

Data or evidence should identify how a student is able to produce speech that can be understood by a

variety of communication partners including adults, peers, unfamiliar listeners, etc.

This means an adverse effect on communication including language acquisition or expression such as

vocabulary comparable to same age peers, general knowledge, ability to ask questions, apply

information, communicate effectively with peers and adults in a variety of situations in order to have

needs met, know the nuances of communication exchange (manners), etc.

Data or evidence should identify how a student communicates and acquires language most effectively

be that via listening and spoken language, American Sign Language (ASL), or while utilizing a

communication device or some combination of modes. For students who are deaf or hard of hearing,

communication effectiveness may vary depending on the student’s communication partners, listening

conditions, environments, and familiarity with the subject or content. Please see the WESP-DHH

Outreach expanded core curriculum.

Students who are deaf or hard of hearing may also have differences between their expressive and

receptive skills that can vary based on different circumstances.

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Section III. Disability Category Criteria

Determination

Initial evaluation or considering new

disability category:

The documentation of the criteria above

demonstrates a decreased ability to detect

sound in one or both ears with or without

amplification, whether permanent or

chronically fluctuating, which adversely

affects the student’s educational

performance. The student meets the

disability category criteria for deaf and hard

of hearing.

Reevaluating category for continuing

identification:

The student was previously identified as

meeting the disability category criteria for

deaf and hard of hearing and continues to

have a disability that adversely affects the

student’s educational performance. (Explain

or reference data or evidence.) A student

whose disability has an adverse effect on

educational performance must be found to

require specially designed instruction in

order to continue to be eligible for special

education (document the need for specially

designed instruction on the ER-1).

Check “yes” if the student meets the disability category criteria.

Check “no” if the student did not meet the disability category criteria.

A student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to be eligible for special education. Document the need for

specially designed instruction on the ER-1 form.

Check “yes” if the student’s disability continues to have an adverse effect on the student’s educational

performance.

Check “no” if the student’s disability does not continue to have an adverse effect on the student’s

educational performance.

A student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to be eligible for special education. Document the need for

specially designed instruction on the ER-1 form.

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ER-1-DB Criteria for Disability Category: Deafblind

This form is used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation. This form documents

the Individualized Education Program (IEP) team’s consideration of whether a student meets criteria for the disability category of deafblind as defined

under PI 11.36 (4m)(a), Wis. Admin. Code. If a student meets criteria, the IEP team must attach the criteria form to the evaluation report. If this category

is considered and rejected, the team must document the process by either 1) explaining how a student did not meet the criteria on the evaluation report

or 2) attaching this criteria form to the evaluation report.

For more information on how to identify a student who is deafblind, go to the deafblind webpage at the Wisconsin Department of Public Instruction.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date form completed

Initial evaluation or considering new

disability category

Reevaluating category for continuing

identification

Section I. Vision and Hearing Evaluation

Conducted a comprehensive evaluation that

includes completion of the criteria forms for

deaf and hard of hearing and blind and

visually impaired

The student meets one of the following

conditions:

Enter the date of the meeting when the IEP team determined if the student met the disability category

criteria for deafblind.

Check if the student was not previously found to meet the disability category criteria for deafblind. The

IEP team must complete all sections of this form.

Check if the student was previously found to meet the disability category criteria for deafblind. A

student is not required to meet initial criteria during a reevaluation for this category, but the disability

must continue to have an adverse effect on education performance in order to be considered for

specially designed instruction. It is recommended that the IEP team consider all sections on this

form, but only Section III is required.

Both must be checked “yes” to proceed.

Check “yes” if the team has conducted a comprehensive evaluation that has included completing the

disability criteria forms for both deaf and hard of hearing and blind and visually impaired. Both of

these forms should be filled out prior to going on to the next part of the worksheet. The entire team

should be involved when working through the deafblind criteria. All of the members of the team will

have important information to document, especially in Section II where the team will look at the

educational impact.

At this point, the team has still not made a disability determination for

deafblindness.

One of the four conditions must be met to check “yes.”

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Meets the criteria for deaf and hard of

hearing under PI 11.36(4) and blind and

visually impaired under PI 11.36(3).

Meets deaf and hard of hearing criteria and

has a documented clinical or functional

vision loss.

Meets the blind and visually impaired criteria

and has a documented clinical or functional

hearing loss.

Has a documented diagnosis of a progressive

medical condition that will result in

concomitant hearing and vision losses (e.g.,

Usher’s Syndrome).

Explain or reference data or evidence to

support (may reference deaf and hard of

hearing and blind and visually impaired

criteria forms).

Section II. Educational Impact

There is an adverse effect on communication

(e.g., apply information, communicate

effectively with peers and adults in a variety

of situations, express needs, and be able to

self-

advocate, understand the nuances of

communication exchange, etc.)

The student meets the eligibility criteria for both deaf and hard of hearing (DHH) and blind and visually

impaired (BVI).

The student meets the deaf and hard of hearing criteria. They did not meet the blind and visually

impaired criteria, but the student has a documented clinical or functional vision loss. An example of

documenting a functional vision loss could be the team documenting how a student’s functional vision

presents differently than what is documented on the ocular report.

The student meets the blind and visually impaired criteria. They did not meet the deaf and hard of

hearing criteria. However, the student has a documented clinical or functional hearing loss. An example

of this could be a student having a diagnosis of Central Auditory Processing Disorder.

The student has a documented diagnosis of a progressive medical condition that will result in both

hearing and vision losses that, without special education intervention, will adversely affect the

student’s educational performance. One example of a diagnosis of a progressive medical condition is

Usher’s Syndrome.

Documentation of losses may include the deaf and hard of hearing criteria form, the blind and visually

impaired criteria form, formal and informal assessment data, medical documentation, anecdotal

information, observation reports, checklists, screeners, etc. The information gathered from these tools

can be used to explain or reference data or evidence.

All three of the following must be checked “yes.”

A student who is deafblind cannot rely on their vision to access auditory information and individuals

with vision loss cannot rely on their hearing to access visual information. This can affect their access

to language, communication, and their access or awareness of communication partners. Areas that

could be impacted are the ability to apply information, communicate effectively with peers and adults

in a variety of situations, the ability to express needs and be able to self-advocate, understanding the

nuances of communication exchange, etc.

These examples are not exhaustive, and the IEP team may document additional ways communication

is adversely affected for a student.

Documentation of an adverse effect on communication may include formal and informal assessment

data, anecdotal information, observation reports, checklists, screeners, etc. The information gathered

from these tools can be used to explain or reference data or evidence.

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There is an adverse effect on developmental

performance (e.g., the ability to learn and

problem solve, concept development,

sensory awareness, etc.)

There is an adverse effect on educational

performance (e.g.,

academic achievement

measured by classroom performance,

standardized tests, etc., and functional

performance including engaging with peers

and adults, executive functioning skills,

sensory regulation, etc.)

An adverse effect on developmental performance means a student who is deafblind may demonstrate

delays or challenges in meeting developmental performance targets. Areas that may be impacted

include the ability to learn and problem solve. A student’s ability to develop concepts may be impacted

as their understanding and access to the world around them may be limited. Sensory awareness and

self-control may be delayed. A student’s fine and gross motor skills may be impacted. The entire team

should work together to document any developmental targets that are adversely affected.

These examples are not exhaustive, and the IEP team may document additional ways developmental

performance is adversely affected.

Documentation of an adverse effect on developmental performance may include formal and informal

assessment data, anecdotal information, observation reports, checklists, screeners, etc. The

information gathered from these tools can be used to explain or reference data or evidence.

This means a student who is deafblind may demonstrate delays or challenges related to academic or

non-academic achievement or both.

Academic achievement can be measured by classroom

performance, grades, standardized tests, etc. Functional performance can include engaging with peers

and adults, executive functioning skills, sensory regulation, functional performance, social and

emotional development, behavior, executive functioning skills, independent living skills, and self-help

skills.

These examples are not exhaustive, and the IEP team may document additional ways educational

performance is adversely affected.

Documentation of an adverse effect on educational performance may include formal and informal

assessment data, standardized testing, anecdotal information, observation reports, checklists, screeners,

etc. The information gathered from these tools can be used to explain or reference data or evidence.

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Section III. Disability Category Criteria

Determination

Initial evaluation or considering new

disability category:

The documentation of the criteria above

demonstrates concomitantly deaf or hard of

hearing and blind or visually impaired, the

combination of which causes severe

communication and other developmental

and educational needs such that the

individual disability-related needs of the

student extend beyond the instruction and

supports required for a student who is solely

deaf or hard of hearing or blind or visually

impaired. The student meets the disability

category criteria for deafblind.

A student whose disability has an adverse

effect on educational performance must be

found to require specially designed

instruction in order to be eligible for special

education (document the need for specially

designed instruction on the ER-1).

Check “yes” if the student meets the disability category criteria of deafblind.

In order to meet criteria for the disability category of deafblind, a student must need specially designed

instruction. This need for specially designed instruction needs to be documented on the ER-1.

Check” no” if the student did not meet the disability category criteria of deafblind.

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Reevaluating category for continuing

identification

The student was previously identified as

meeting the disability category criteria for

deafblind and continues to have a disability

that adversely affects the student’s

educational performance.

A student whose disability has an adverse

effect on educational performance must be

found to require specially designed

instruction in order to be eligible for special

education (document the need for specially

designed instruction on the ER-1). (Explain

or reference data or evidence.)

A student who previously met criteria for the disability category of deafblind is not required to meet

initial identification criteria upon reevaluation.

Check “yes” if the student’s disability continues to have an adverse effect on the student’s educational

performance.

Check “no” if the student’s disability does not continue to have an adverse effect on the student’s

educational performance.

The IEP needs to document that the student continues to have a disability that adversely affects the

student’s educational performance (including communication and developmental performance). This

documentation may include formal and informal assessment data, anecdotal information, observation

reports, checklists, screeners, etc. The information gathered from these tools can be used to explain or

reference data or evidence.

A student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to be eligible for special education. Document the need for

specially designed instruction on the ER-1 form.

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ER-1-EBD Criteria for Disability Category: Emotional Behavioral Disability

This form is used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation. This form documents

the Individualized Education Program (IEP) team’s consideration of whether a student meets criteria for the disability category of emotional behavioral

disability as defined under PI 11.36 (7)(a), Wis. Admin. Code. If a student meets criteria, the IEP team must attach the criteria form to the evaluation

report. If this category is considered and rejected, the team must document the process by either 1) explaining how a student did not meet the criteria on

the evaluation report or 2) attaching this criteria form to the evaluation report.

For more information on how to identify a student who is emotional behavioral disability, go to the emotional behavioral disability webpage at the

Wisconsin Department of Public Instruction.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date form completed

Initial evaluation or considering new

disability category

Reevaluating category for continuing

identification

Section I. Emotional Behavioral

Functioning

The student exhibits at least one of the

following:

Behaviors that interfere with the

development and maintenance of age and

grade appropriate interpersonal

relationships.

Enter the date of the meeting when the IEP team determined if the student met the disability category

criteria for emotional behavioral disability.

Check if the student was not previously found to meet the disability category criteria for emotional

behavioral disability. The IEP team must complete all sections of the criteria form.

Check if the student was previously found to meet the disability category criteria for emotional

behavioral disability. A student must meet initial criteria during a reevaluation for this category. The

IEP team must complete all sections of the criteria form.

All three yes/no questions must be checked “yes.”

Check all characteristics that apply. At least one must be checked to consider an emotional behavioral

disability. Include documentation and data collected from Section II Requirements for each

characteristic considered.

The student’s behavioral response interferes with the ability to demonstrate age and grade interpersonal

skills such as sympathy, warmth and empathy toward others, initiating positive interactions,

establishing and maintaining friendships, give and take in interactions, communicating wants and

needs, and other skills found demonstrated by the majority of their peers of similar age, background,

culture, race, ethnicity, gender, sexual orientation, abilities, and/or socioeconomic status.

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Observable affective or behavioral responses

during routine daily activities inconsistent

with the norms of the student or the student’s

community.

Pervasive unhappiness, depression or

anxiety.

Physical symptoms or fears associated with

personal or school problems.

Insufficient progress toward meeting age or

grade level academic standards that cannot

be explained by intellectual, sensory, or

health factors.

Isolation from peers or avoidance of social

interactions impacting the student’s access

and engagement in instructional activities.

Patterns of behaviors across settings and

individuals presenting risks to the physical

safety of the student or others.

The observable affective or behavioral response of concern should be compared to the response of

peers of similar age, background, culture, race, ethnicity, gender, sexual orientation, abilities, and/or

socioeconomic status. Developmental norms and comparisons with peers in similar circumstances

should be used to determine whether the affective or behavioral responses are unusual, inconsistent or

inappropriate. Consideration should also be given if the affective or behavioral response is atypical,

different or inconsistent for the student and for which no observable reason exists.

The student must demonstrate a consistent pattern of unhappiness, depression, or anxiety over a long

period of time. This pattern is not a temporary response to situational factors or due to a medical

condition. A diagnosis by a licensed mental health professional of depression or anxiety is not required

to meet this characteristic.

The physical symptoms or fears must be linked with personal or school problems with no known

medical cause. Any known biological or medical condition should be investigated and ruled out.

The IEP team would rule out intellectual, sensory, or health factors and determine if a decline in

progress or a lack of progress correlates to the student’s mental health or behavioral responses.

The isolation or avoidance must be frequent and intense such that it interferes with the student’s

learning, participation, relationships or sense of safety and belonging. The IEP team may need to

consider if the student prefers to work or be alone, or if the student demonstrates or expresses a sense

of distress and dejection. If the student prefers to be alone, the IEP team will need to consider the

impact of that preference on the student’s ability to access, engage or make progress in age or grade

level general education curriculum, instruction, environments, or activities. Instructional activities are

broadly defined, and can be activities where parents, family members or community members pass on

or teach skills and knowledge.

Documentation will indicate there is a pattern of behavior and not isolated incidents of a behavioral

response that presents a risk to the physical safety of the student or others. It does not refer to simple

conflict or incidents with one other individual or with certain peers. The IEP team must establish that

the behavior is not in response to a specific setting, individual or relationship.

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The behaviors must occur in an academic

setting in school, in a non-academic setting

in school, and in the student’s home or

community.

The student demonstrates frequent and

intense observable behaviors which

adversely affects the student’s educational

performance, either:

Over a long period of time; or

Of sudden onset due to an emerging mental

health condition which includes a diagnosis

by a licensed mental health professional.

All three must be checked to answer “yes.” Explain or reference data or evidence for each of the three

settings.

Check “yes” if the behaviors occur in an academic setting at school, a non-academic setting at school,

and in the student’s home or community.

Check “no” if the behaviors occur in none, one or two of the three settings.

Evidence will include, but is not limited to, observational data from an academic setting in school, and

a non-academic setting in school.

Academic settings are settings in which state academic standards or functional skill competencies, such

as Social Emotional Learning Competencies, are taught and assessed, such as direct instruction,

independent work completion, group projects, classroom-based activities; community-based

instruction; content areas, art, music, physical education; field trips.

Non-academic settings are settings in which state academic standards or skill competencies, such as

Social Emotional Learning Competencies, are not systematically taught or assessed. Non-academic

settings in school may include: recess periods, meals, transition times, school bus (transportation to

and from school, to and from field trips or any school related function), field trips, play time, on school

grounds before and after school, while waiting for transportation or after arriving to school,

extracurricular activities, and school sponsored social events.

At least one must be checked to consider an emotional behavioral disability.

Data or evidence must document frequent and intense observable behaviors. The observable behaviors

of concern must be more frequent and intense than the normal or typically expected range of behavior

for students of a similar age, grade, background, culture, race, ethnicity, gender, sexual orientation,

and/or socioeconomic status. The scope and intensity must be outside of the typical developmental

expectations and the norms of the student’s family, community or culture.

Data or evidence must document an adverse effect on the student’s educational performance. Assessing

an adverse effect requires the IEP team to consider all aspects of the student’s functioning at school,

including academic, cognitive, communication, physical and health, independence and self-

determination, and social and emotional functioning.

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Section II. Requirements

The IEP team conducted a comprehensive

evaluation and considered current data from

all of the following:

The results of evidence-

based positive

behavioral interventions implemented within

general education settings.

Systematic observations of the student in

both academic and non-

academic settings

documenting intensity, frequency, rate or

duration of observable target behaviors, as

well as other ecological factors that may be

impacting the student’s behavior.

Interviews of the student and parent or

family that include gathering information

regarding the student and family’s norms and

values, as well as other ecological factors

that may impact the student’s behavior.

Interviews of the

student’s teachers that

include gathering information regarding the

student’s strengths and ecological factors

that may impact the student’s behavior.

Interview of an LEA staff member, identified

Data or evidence must document over a long period of time or of sudden onset due to an emerging

mental health condition.

If documenting “over a long period of time”, data or evidence must include that the student exhibits

one or more of the characteristics long enough to be considered chronic, habitual, or persistent.

Determining whether a behavior has occurred over a long period of time depends on multiple factors

including the individual student, chronological age, ecological factors, and intensity of the behavior.

If considering sudden onset due to an emerging mental health condition, data or evidence must include

written documentation of the diagnosis from the community-based licensed mental health professional.

Check “yes” if the IEP team considered current data from all of the assessment requirements. To check

“yes,” all must be checked.

Reference current data documented in Section I.

Document evidence-based positive behavioral interventions under previous interventions and their

effects on the evaluation report, ER-1.

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by the student, when possible, as having the

most positive or a positive relationship with

the student, that includes gathering

information regarding the student’s strengths

and ecological factors that may impact the

student’s behavior. The LEA staff member

may have been

interviewed as one of the

interviews of the student’s teachers, above.

Review of educational information

maintained by the LEA, including health,

academic and disciplinary records.

Results of standardized behavior rating

scales, which are normed using nationally

representative samples:

From a minimum of two sources from

school OR documented why the team

was unable to gather valid rating scale

results from two sources on the ER-1.

From at least one source from the home

or community.

The IEP team confirmed that normative

data reflects the student

’s background

OR documented that it did not in the ER-

If needed, explain or reference data or

evidence not already provided in Section I.

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Section III. Additional Requirements

The IEP team considered the effects of any

known history of trauma or mental health

disorder on the student’s functioning and

did not identify or refuse to identify

emotional behavioral disability based solely

on a known history of trauma or mental

health disorder.

The IEP team discussed and determined,

based on information and data collected,

whether behaviors are a result of a

difference between the norms of the

student’s family and community or an

emotional behavioral disability. The IEP

team did not identify a student as a student

with an emotional behavioral disability

when there is evidence that the difference is

the primary causal factor of the behaviors.

Section IV. Disability Category Criteria

Determination

The documentation of the criteria above

demonstrates a condition in which the

student demonstrates frequent and intense

observable behaviors, either over a long

period of time or of sudden onset due to an

emerging mental health condition which

adversely affects the student’s educational

performance. The student meets the

disability category criteria for emotional

behavioral disability. Yes must be checked

in all boxes, and all of the additional

requirements met, before a student may be

identified for the disability category.

Both must be checked.

The IEP team must summarize the discussion for each item.

Must meet all criteria in order to check “yes.”

Check “yes” if:

Section I: All three sections of emotional behavioral functioning are checked “yes”

Section II: Requirements is checked “yes”

Section III: Both boxes for additional requirements are checked.

Initial criteria must be met for an initial or reevaluation when considering an emotional behavioral

disability. A student whose disability has an adverse effect on educational performance must be found

to require specially designed instruction in order to be eligible for special education. Document the

need for specially designed instruction on the ER-1 form.

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ER-1-ID Criteria for Disability Category: Intellectual Disability

This form is used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation. This form documents

the Individualized Education Program (IEP) team’s consideration of whether a student meets criteria for the disability category of intellectual disability

as defined under PI 11.36(1), Wis. Admin. Code. If a student meets criteria, the IEP team must attach the criteria form to the evaluation report. If this

category is considered and rejected, the team must document the process by either 1) explaining how a student did not meet the criteria on the evaluation

report or 2) attaching this criteria form to the evaluation report.

For more information on how to identify a student with an intellectual disability, go to the intellectual disability webpage at the Wisconsin Department

of Public Instruction.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date form completed

Initial evaluation or considering new

disability category

Reevaluating category for continuing

identification

Section I. Intellectual Functioning

The student has a standard score of 2 or more

standard deviations below the mean on at

least one individually administered

intelligence test that takes into account the

student’s mode of communication and is

developed to assess intellectual functioning

using this mode.

Enter the date of the meeting when the IEP team determined if the student met the disability category

criteria for intellectual disability.

Check if the student was not previously found to meet the disability category criteria for intellectual

disability. The IEP team must complete all sections of this form.

Check if the student was previously found to meet the disability category criteria for intellectual

disability. A student is not required to meet initial criteria during a reevaluation for this category, but

the disability must continue to have an adverse effect on education performance in order to be

considered for specially designed instruction. It is recommended that the IEP team consider all

sections on this form, but only Section IV is required.

Must be checked “yes.”

More than one intelligence test may be used to produce a comprehensive result.

Assessment must be completed by a qualified examiner as outlined noted by in the publisher of the

assessment.

Explain or reference data by listing the assessment name and the scores from assessments or any

other scores that are relevant to showing 2 standard deviations below the mean.

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Section II. Adaptive Functioning

The student has significant limitations in

adaptive behavior as demonstrated by a

standard score of 2 or more standard

deviations below the mean on standardized

or nationally normed measures, as measured

by comprehensive, individual assessments

that include interviews of the parents, tests,

and observations of the student in adaptive

behavior which are relevant to the student's

age, in at least one of the following:

Conceptual Skills (Explain or reference

data or evidence)

Social Adaptive Skills (Explain or

reference data or evidence)

Practical Adaptive Skills (Explain or

reference data or evidence)

An overall composite score on a

standardized measure of conceptual,

social, and practical skills

Section III. Educational Performance

The student is age 3 through 5 and has a

standard score of 2 or more standard

deviations below the mean on standardized

or nationally-normed measures, as

measured by comprehensive, individual

assessments, in each of the following areas:

At least one must be checked in order to mark “yes.”

Explain or reference data by listing the assessment name and the composite scores of each domain or

any other scores that are relevant to showing 2 standard deviations below the mean.

Note: An overall composite score or a composite score from of the three domains must be used. Do

not use only a scaled score from individual subtests.

Adaptive behavior should be evaluated using multiple respondents who know the student being

assessed and have the opportunity to observe the student on a daily or weekly basis in a variety of

settings over an extended period of time.

There may be times when a professional trained in the assessment may need to do a formal interview

to gain the information needed.

One yes/no question must be checked “yes.”

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Language Development and

Communication

Cognition and General Knowledge

The student is age 6 to 21 and has a

standard score of 2 or more standard

deviations below the mean on standardized

or nationally normed measures, as measured

by comprehensive, individual assessments

in each of the following areas:

Written language

Reading

Mathematics

Reliable and valid assessment results are not

possible due to functioning level or age (for

ages 3 to 5 or 6 to 21), and a standardized

developmental scale or body of evidence

including informal measures was used.

This refers to students developing the ability to understand and convey meaning through language.

Language development is reflected in students’ progress toward acquiring skills in the areas of

listening and understanding, speaking and communicating, and early literacy. Language development

occurs in the context of relationships, encompasses all forms of communication, both verbal and

nonverbal, and moves students along the continuum of early literacy.

Students learn to communicate in a variety of ways, such as using symbols; combining their oral

language, pictures, print, and play into a coherent mixed medium, and creating and communicating

meaning through both nonverbal and verbal language.

The components of cognition and general knowledge focus on the student’s ability to acquire,

organize, and use information in increasingly complex ways to satisfy that curiosity. Primary

components include mathematics and logical thinking, scientific thinking, and problem-solving.

Students acquire knowledge by linking prior experiences to new learning situations. As a student

applies and extends prior knowledge to new experiences, the student refines concepts or forms new

ones. Cognition is a fluid process by which students use thinking skills to conceptually develop a

construct of the world, thus enabling active learning. General knowledge is a product of cognition,

which expands and grows through learning and self-expression.

Explain or reference data by listing the assessment name or type and the composite scores or each

developmental area.

For each academic area, explain or reference data by listing the assessment name or type as well as

and the composite scores for each academic achievement area.

Use full composite scores for each subject area rather than scores from individual subtests. Refer to

the assessment’s manual to determine which subtests are needed to determine a composite score for

each subject area.

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Section IV. Disability Category Criteria

Determination

Initial evaluation or considering new

disability category

The documentation of the criteria above

demonstrates significant limitations both in

intellectual functioning and in adaptive

behavior as expressed in conceptual, social,

and practical adaptive skills and manifested

during the developmental period that

adversely affects the student’s educational

performance. The student meets the

disability category criteria for intellectual

disability.

Reevaluating category for continuing

identification

The student was previously found eligible

as meeting the disability category criteria

for intellectual disability and continues to

have a disability that adversely affects the

student’s educational performance. A

student whose disability has an adverse

effect on educational performance must be

found to require specially designed

instruction in order to continue to be

eligible for special education.

Check “yes” if all sections above are checked ”yes.”

A student whose disability has an adverse effect on educational performance must be found to

require specially designed instruction in order to be eligible for special education. Document the need

for specially designed instruction on the ER-1 form.

A student who previously met criteria for the disability category of intellectual disability is not

required to meet initial identification criteria upon reevaluation.

Explain or reference data or evidence that shows the student’s disability adversely affects the

student’s educational performance.

A student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to be eligible for special education. Document the need for

specially designed instruction on the ER-1 form.

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ER-1-OHI Criteria for Disability Category: Other Health Impairment

This form is used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation. This form documents

the Individualized Education Program (IEP) team’s consideration of whether a student meets criteria for the disability category of other health impairment

as defined under PI 11.36 (10), Wis. Admin. Code. If a student meets criteria, the IEP team must attach the criteria form to the evaluation report. If this

category is considered and rejected, the team must document the process by either 1) explaining how a student did not meet the criteria on the evaluation

report or 2) attaching this criteria form to the evaluation report.

For more information on how to identify a student with other health impairment, go to the other health impairment webpage at the Wisconsin Department

of Public Instruction.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date form completed

Initial evaluation or considering new

disability category

Reevaluating category for continuing

identification

Section I. Health Condition

Does the student have a health problem?

Explain or reference data or evidence.

Is the health problem chronic or acute?

Enter the date of the meeting when the IEP team determined if the student met the disability category

criteria for other health impairment.

Check if the student was not previously found to meet the disability category criteria for other health

impairment. The IEP team must complete all sections of the criteria form.

Check if the student was previously found to meet the disability category criteria for other health

impairment. A student must meet initial criteria during a reevaluation for this category. The IEP team

must complete all sections of the criteria form.

All “yes/no” questions must be answered “yes.”

The list of possible health conditions that may be seen in students with other health impairment

includes, but is not limited to, a heart condition, tuberculosis, rheumatic fever, nephritis, asthma,

sickle cell anemia, hemophilia, epilepsy, lead poisoning, leukemia, diabetes, or acquired brain

injuries caused by internal occurrences or degenerative conditions.

A prior diagnosis from a licensed physician is not required for the IEP team to consider other health

impairment.

A student may qualify for other health impairment if the health condition is either chronic or acute.

This information may help identify disability-related needs when developing an IEP.

Back to Table of Contents

If yes, check ALL that apply.

Chronic (long-standing, continuous over

time, or recurring frequently). Explain or

reference data or evidence.

Acute (severe or intense). Explain or

reference data or evidence.

Does the student’s health problem result in

limited strength, vitality, or alertness?

If yes, check ALL that apply.

Limited strength (inability to perform

typical or routine tasks at school).

Explain or reference data or evidence:

Limited vitality (inability to sustain effort

or endure throughout an activity).

Explain or reference data or evidence:

Limited alertness (inability to manage

and maintain attention, to organize or

attend, to prioritize environmental

stimuli, including a heightened

alertness). Explain or reference data or

evidence:

The information may come from a parent report, a medical or outside psychological report, or a

developmental history. Document when condition started, any periods of remission, and if it is

recurring. Documentation should also indicate intensity if available.

Information may be obtained from a parent report, a medical or outside psychological report, teacher

report, or direct observation of the student. Information may also be obtained from rating scales,

checklists and structured interviews.

It is important to focus on the student’s presenting problems or issues, rather than on possible

symptoms or stereotypical presentation of a given health disorder.

Back to Table of Contents

Section II. Educational Performance

Is the student’s educational performance in

one or more of the following areas

adversely affected as a result?

If yes, check ALL that apply.

Pre-academic or academic achievement

Adaptive behavior

Behavior

Classroom performance

Communication

Motor skills

Social/Emotional Functioning

Vocational skills

Other (Describe)

Explain or reference data or evidence.

Section III. Disability Category Criteria

Determination

The documentation of the criteria above

demonstrates limited strength, vitality or

alertness, due to chronic or acute health

problems which adversely affects the

student’s educational performance. The

student meets the eligibility criteria under

the disability category of other health

impairment.

Must be checked “yes.”

Consider both academic and nonacademic skills and progress. The use of multiple forms of

measurement and sources to document areas where the student has demonstrated difficulties can

increase the validity and reliability of the disability category determination.

All four yes/no questions must be checked “yes” in order for the student to meet criteria for other

health impairment.

A student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to be eligible for special education. Document the need for

specially designed instruction on the ER-1 form.

Back to Table of Contents

ER-1-OI Criteria for Disability Category: Orthopedic Impairment

This form is used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation. This form documents

the Individualized Education Program (IEP) team’s consideration of whether a student meets criteria for the disability category of orthopedic impairment

as defined under PI 11.36 (2)(a), Wis. Admin. Code. If a student meets criteria, the IEP team must attach the criteria form to the evaluation report. If this

category is considered and rejected, the team must document the process by either 1) explaining how a student did not meet the criteria on the evaluation

report or 2) attaching this criteria form to the evaluation report.

For more information on how to identify a student with an orthopedic impairment, go to the orthopedic impairment webpage at the Wisconsin Department

of Public Instruction.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date form completed

Initial evaluation or considering new

disability category

Reevaluating category for continuing

identification

Section I. Impairment

Does the student have a congenital anomaly

(including, but not limited to, clubfoot)?

Explain or reference data or evidence.

Does the student have impairments caused

by disease (including, but not limited to,

poliomyelitis or bone tuberculosis)? Explain

or reference data or evidence.

Enter the date of the meeting when the IEP team determined if the student met the disability category

criteria for orthopedic impairment.

Check if the student was not previously found to meet the disability category criteria for orthopedic

impairment. The IEP team must complete all sections of this form.

Check if the student was previously found to meet the disability category criteria for orthopedic

impairment. A student is not required to meet initial criteria during a reevaluation for this category,

but the disability must continue to have an adverse effect on education performance in order to be

considered for specially designed instruction. It is recommended that the IEP team consider all

sections on this form, but only Section III is required.

One must be checked.

A diagnosis from a licensed physician is not required for the IEP team to consider orthopedic

impairment. However, medical diagnosis and medical information are helpful.

A diagnosis from a licensed physician is not required for the IEP team to consider orthopedic

impairment. However, medical diagnosis and medical information are helpful.

Back to Table of Contents

Does the student have impairments from

other causes (including, but not limited to,

cerebral palsy, amputations, and fractures or

burns that cause contractures)? Explain or

reference data or evidence.

Section II. Educational Performance

Is the student’s educational performance in

one or more of the following areas

adversely affected as a result?

Maintaining and changing positions

Using classroom materials

Hygiene/self-care

Clothing management

Mobility

Eating

Classroom performance

Pre-academic or academic achievement

Social/Emotional functioning

Communication

Vocational skills

Behavior

Participation in physical education

Safety issues

Accessing the community

Examples of other conditions which may qualify a student for orthopedic impairment include, but are

not limited to, arthrogryposis, spina bifida, juvenile arthritis, muscular dystrophy, and osteogenesis

imperfecta. These examples are provided as those noted in federal and state law and have been

mostly eradicated in the United States.

A diagnosis from a licensed physician is not required for the IEP team to consider orthopedic

impairment. However, medical diagnosis and medical information are helpful.

What data/explanation would we expect to see? Medical reports, parent reports, perhaps an

explanation of what the diagnosis is and how the condition may impact student’s mobility and access

to the general curriculum.

Must be checked “yes.”

The IEP team must determine if the student’s educational performance is adversely affected as a

result of the impairment. If yes, the IEP team should identify all areas that are affected. The IEP team

should consider academic achievement and functional performance. The student’s educational

performance must be adversely affected in at least one area in order for the student to meet the

criteria for the disability category of orthopedic impairment.

How does the IEP determine if something is adversely affected? What data/explanation would we

expect to see?

Observation of the student in different classrooms or courses; information and interviews with

teachers and parents; information obtained from other measures such as adaptive skills and physical

ability.

Back to Table of Contents

Section III. Disability Category Criteria

Determination

Initial evaluation or considering new

disability category

The documentation of the criteria above

demonstrates a severe orthopedic

impairment that adversely affects the

student’s educational performance. The

student meets the disability category criteria

for orthopedic impairment.

Reevaluating category for continuing

identification

The student was previously found to meet

the disability category criteria for

orthopedic impairment and continues to

have a disability that adversely affects the

student’s educational performance.

Must meet criteria in at least one part of the impairment section in order to check “yes”. A student

may meet more than one criterion in the impairment section.

A student whose disability has an adverse effect on educational performance must be found to

require specially designed instruction in order to be eligible for special education. Document the need

for specially designed instruction on the ER-1 form.

Check “yes” if the student’s disability continues to have an adverse effect on the student’s

educational performance.

Check “no” if the student’s disability does not continue to have an adverse effect on the student’s

educational performance.

A student whose disability has an adverse effect on educational performance must be found to

require specially designed instruction in order to be eligible for special education. Document the need

for specially designed instruction on the ER-1 form.

Back to Table of Contents

ER-1-SDD Criteria for Disability Category: Significant Developmental Delay

This form is used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation. This form documents

the Individualized Education Program (IEP) team’s consideration of whether a student meets criteria for the disability category of significant

developmental delay as defined under PI 11.36 (11)(a), Wis. Admin. Code. If a student meets criteria, the IEP team must attach the criteria form to the

evaluation report. If this category is considered and rejected, the team must document the process by either 1) explaining how a student did not meet the

criteria on the evaluation report or 2) attaching this criteria form to the evaluation report.

For more information on how to identify a student who has a significant developmental delay, go to the significant developmental delay webpage at the

Wisconsin Department of Public Instruction.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date form completed

Initial evaluation or considering new

disability category

Reevaluating category for continuing

identification

Section I. Developmental Delay

Age: Is the student age 3 through 9 years old?

Enter the date of the meeting when the IEP team determined if the student met the disability category

criteria for significant developmental delay.

Check if the student was not previously found to meet the disability category criteria for significant

developmental delay. The IEP team must complete all sections of this form.

Check if the student was previously found to meet the disability category criteria for significant

developmental delay. A student is not required to meet initial criteria during a reevaluation for this

category, but the disability must continue to have an adverse effect on education performance in

order to be considered for specially designed instruction. It is recommended that the IEP team

consider all sections on this form, but only Section III is required.

All questions must be checked ”yes”.

“Significant developmental delay means children ages 3 through 9 years of age who are experiencing

significant delays in the areas of physical, cognition, communication, social-emotional, or adaptive

development.”

Ages 3 through 9 is the statutory age limit allowable to identify a student

with a significant

developmental delay.

Back to Table of Contents

Other suspected impairments: Have all other

suspected impairments been considered

before identifying the category of significant

developmental delay?

Significance of delays: Are delays of at least

1.5 standard deviations below the mean

present that significantly challenge the

student

in 2 or more of the following life

activities?

Physical activity in gross motor skills, such

as the ability to move around and interact

with the environment with appropriate

coordination, balance and strength; or fine

motor skills, such as manually controlling

and manipulating objects such as toys,

drawing utensils, and other useful objects in

the environment.

Cognitive activity, such as the ability to

acquire, use and retrieve information as

demonstrated by the level of imitation,

discrimination, representation, classification,

sequencing, and problem-solving skills often

observed in a student's play.

Communication activity in expressive

language, such as the production of age-

appropriate content, form and use of

language; or receptive language, such as

listening, receiving and understanding

language.

The IEP team will discuss and document any other suspected impairments (i.e., disability categories)

considered based on the referral and other concerns. The IEP team will then document why significant

developmental delay is the most appropriate. Note: Considering other suspected disability categories

does not mean to rule them out. There is no requirement to complete additional criteria forms as part

of the consideration of other suspected disability categories.

Delays are evidenced by administering a comprehensive developmental assessment or assessments

specific to the life activities.

A delay in the physical activity domain can be assessed by either or both gross or fine motor skills.

Physical activity can be assessed as a domain of a comprehensive developmental assessment or using

a specific test for physical activity administered by a qualified examiner per the publisher. Explain or

reference data or evidence.

Measuring a student’s cognition assesses

ability to reason logically, problem solve, and make

judgments about information. This includes thinking, reasoning, or remembering. IQ testing or rote

memorization, such as reciting the alphabet or identifying colors, are not tests of cognition for young

students. Cognition can be assessed as a domain of a comprehensive developmental assessment or

using a specific test for cognition administered by a qualified examiner per the publisher. Explain or

reference data or evidence.

Communication is both understanding and using words so that young students can gain skills to express

thoughts, feelings, and information. This also includes the ability to communicate needs and wants.

Communication can be measured as a domain of a comprehensive developmental assessment or using

a specific test for speech language administered by a qualified examiner per the publisher. Explain or

reference data or evidence.

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Emotional activity such as the ability to feel

and express emotions and develop a positive

sense of oneself; or social activity, such as

interacting with people, developing

friendships with peers, and sustaining bonds

with family members and other significant

adults.

Adaptive activity, such as caring for their

own needs and acquiring independence in

age-

appropriate eating, toileting, dressing

and hygiene tasks.

The delays demonstrate an adverse effect on

the student

's daily life, including learning,

academic achievement or functional

performance.

Section II. Assessment Requirements

Are all of the following qualitative and

quantitative measures being used to

document delays and their detrimental effect

upon the student’s life?

Developmental and health history, including

results from vision and hearing screening and

other pertinent information from parents and,

if applicable, other caregivers or service

providers. Describe source of information.

Social and emotional activity is measured by a young student’s ability to interact with peers and adults

in a developmentally appropriate way. Social and emotional activity can be measured as a domain of

comprehensive developmental assessment or using a specific test for social and emotional

development administered by a qualified examiner per the publisher. Explain or reference data or

evidence.

Adaptive activity can be measured as a domain of a comprehensive developmental assessment or using

a specific test for adaptive behaviors administered by a qualified examiner per the publisher. Explain

or reference data or evidence.

The IEP team should address each of the 5 developmental domains above and have identified at least

2 that have an adverse effect (measured at 1.5 standard deviation below the mean respectively) on the

student’s daily life activities. Explain or reference data or evidence.

All must be checked in order to check “yes.”

The IEP team uses all information, including both qualitative and quantitative to document the delays.

Note: Teams need to make sure there is not an overreliance on identifying standardized test scores as

the basis for eligibility determination.

The

developmental and health information must include the results from a vision and hearing

screening. This can be provided by the parent, provided by other programs (such as Head Start or

childcare), or staff may have the parent sign a release to collect the vision and hearing screening results

from a physician, or other health care provider. Additionally, the district may administer the screening.

Note: asking a parent how well they think the student hears or sees, or if they have any concerns, are

NOT considered the actual results of a vision and hearing screening. It is optional if the district includes

a physical copy of the screenings and must document that the screening results were reviewed by the

team, as well as the source documented.

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Observation of the student in their daily

living environment such as the student's

home, with a parent or caregiver, or an early

education or care setting which includes

peers who are typically developing. Include

dates and settings of observations.

Results from norm-

referenced instruments

were used to document significant delays of

at least 1.5 standard deviations below the

mean in 2 or more of the developmental areas

which correspond to the major life activities.

Describe source of information.

If it clearly was not appropriate to use norm-

referenced instruments, other instruments,

such as criterion referenced measures, were

used to document the significant delays.

If a norm-

referenced instrument was not

used, explain why:

Section III. Disability Category Criteria

Determination

Initial evaluation or considering new

disability category

The documentation of the criteria above

demonstrates the student is experiencing

significant delays in the areas of physical,

cognition, communication, social-

emotional, or adaptive development that

adversely affects the student's major life

activities. The student meets the disability

category criteria for significant

developmental delay.

If observation in these settings is not possible, observation in an alternative setting is permitted.

The IEP team reviews the results of the norm-

referenced assessment and identifies 2 or more

developmental domains in which significant delays of at least 1.5 standard deviations below the mean

have been measured.

The norm-referenced assessment must at be attempted. The evaluator should use professional judgment

when deciding when to stop the testing due to lack of responses by the student. It is not the intent to

frustrate the student just to complete the test. The evaluator only needs to document the attempt of

administering the norm-referenced test, and then document if another type of assessment, whether that

be criterion referenced or play based, was used instead. If the evaluator still is not able to gather the

quantitative data, the IEP team should use the qualitative data that was collected for the comprehensive

evaluation. If this is the case, the team may want to include additional qualitative data.

How does the IEP team know that the student meets the criteria? Check “yes” if the team has collected,

discussed, and integrated the results from the norm-

referenced (or other) assessments, the

observation(s), the developmental and health history, the vision and hearing screening results, and any

other information from the parent, caregivers, and other providers, to make a determination that delays

in the student’s development is having a detrimental effect in their daily life.

A student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to be eligible for special education. Document the need for

specially designed instruction on the ER-1.

Back to Table of Contents

Reevaluating category for continuing

identification

The student was previously found to meet

the disability category criteria for

significant developmental delay and

continues to have a disability that adversely

affects the student’s educational

performance.

In conducting the reevaluation, the IEP team shall consider all other suspected disability categories

before continuing to identify the student’s disability category as significant developmental delay. A

student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to continue to be eligible for special education. Document the

need for specially designed instruction on the ER-1. Explain or reference data or evidence.

Back to Table of Contents

ER-1-SLI Criteria for Disability Category: Speech or Language Impairment

This form is used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation. This form documents

the Individualized Education Program (IEP) team’s consideration of whether a student meets criteria for the disability category of speech or language

impairment as defined under PI 11.36 (5)(a)4, Wis. Admin. Code. If a student meets criteria, the IEP team must attach the criteria form to the evaluation

report. If this category is considered and rejected, the team must document the process by either 1) explaining how a student did not meet the criteria on

the evaluation report or 2) attaching this criteria form to the evaluation report.

For more information on how to identify a student who has a speech or language impairment, go to the speech or language impairment webpage at the

Wisconsin Department of Public Instruction.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date form completed

Initial evaluation or considering new

disability category

Reevaluating category for continuing

identification

Enter the date of the meeting when the IEP team determined if the student met the disability category

criteria for speech or language impairment.

Check if the student was not previously found eligible as meeting the disability category criteria for

speech or language impairment. The IEP team must complete the appropriate sections for I-V as well

as all of sections VI-IX.

Check if the student was previously found eligible as meeting the disability category criteria for speech

or language impairment. A student is not required to meet initial criteria during a reevaluation for this

category, but the disability must continue to have an adverse effect on education performance in order

to be considered for specially designed instruction. It is recommended that the IEP team consider all

appropriate sections on this form, but the IEP team must complete sections VIII and IX.

Section I. Language

Not applicable

Yes/No

Following consideration of the student’s

age, culture, language background and

dialect, the student demonstrates a language

impairment in the area of language form,

content, or use.

For initial evaluations: one or more of the first five areas must be addressed: language, speech sound

production, phonology, voice, fluency.

Not applicable means no concerns with this area of communication. If one or more sections within

language are checked “no,” this section would be marked “no.” Data/evidence should be briefly shared

that support a “yes” or a “no”.

Must be checked “yes” in order to be considered for speech or language impairment in the area of

language.

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As evidenced through an observation in a

natural environment.

At least two of the following measurements

were used:

Language sample

Dynamic assessment

Criterion-referenced assessment, such as

developmental scales

Norm-referenced assessment** of

comprehensive language.

There is a delay in communication that

adversely impacts the student’s educational

performance or social, emotional or

vocational development.

Section II. Speech Sound Production -

Articulation

Not applicable

Yes/No

Following consideration of the student’s

age, culture, language background and

dialect, the student demonstrates a language

impairment in the area of language form,

content, or use.

As evidenced through an observation in a

natural environment.

The speech-language pathologist (SLP) must conduct an observation in a natural environment. For

school-age students the natural environment includes school.

Please explain or reference data for each measurement used.

Explain or reference data or evidence for all measurement boxes checked above. If norm-referenced

assessment was used, explain whether the student demonstrated a significant discrepancy.

If a norm-referenced assessment was used, explain whether the student demonstrated a significant

discrepancy. For further clarification of the term “significant discrepancy,” please review the

significant discrepancy and consideration of speech or language impairment webpage at the Wisconsin

Department of Public Instruction.

Must be checked “yes” to be considered for speech or language impairment in the area of language.

Data/evidence should be briefly shared that support a “yes” or a “no.”

Documentation of this impact cannot indicate that it “may” occur. IEP teams must report impact on

educational performance in the classroom, which includes academic tasks, social-

emotional or

vocational development.

For initial evaluations: one or more of the first five areas must be addressed: language, speech sound

production, phonology, voice, fluency.

Not applicable means no concerns with this area of communication. If one or more sections within

Speech are checked “no,” this section would be marked “no.” Data/evidence should be briefly shared

that support a “yes” or a “no”.

Must be checked “yes” in order to be considered for Speech or Language Impairment in the area of

speech sound production.

The speech-language pathologist must conduct an observation in a natural environment. For school-

age students the natural environment includes school.

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At least one of the following measurements

was used:

Criterion-referenced assessment, such as

a developmental scale or phonetic

inventory.

Norm-referenced assessment**

The student’s intelligibility is below the

expected range for their age. Intelligibility

ratings as documented by school staff or

caregivers indicate an impact across

environments.

The student is less than 30% stimulable for

speech sounds found in error.

There is a delay in communication that

adversely impacts the student’s educational

performance or social, emotional or

vocational development.

Section III. Speech Sound Production –

Phonology

Not applicable

Yes/No

Following consideration of the student’s

age, culture, language background and

dialect, the student demonstrates a language

impairment in the area of language form,

content, or use.

As evidenced through an observation in a

natural environment.

Please explain or reference data for each measurement used.

If a norm-referenced assessment was used, explain whether the student demonstrated a significant

discrepancy. For further clarification of the term “significant discrepancy,” please review the

significant discrepancy and consideration of speech or language impairment webpage at the Wisconsin

Department of Public Instruction.

Must be checked “yes” in order to find the student meets criteria for speech or language impairment in

the area of speech sound production. If checked “no,” data/evidence should be briefly shared that

support a “yes” or a “no.”

Must be checked “yes” in order to find the student meets criteria for speech or language impairment in

the area of speech sound production. If checked “no,” data/evidence should be briefly shared that

support a “yes” or a “no.”

Must be checked “yes” in order to find the student meets criteria for speech or language impairment in

the area of speech sound production. If checked “no,” data/evidence should be briefly shared that

support a “yes” or a “no.”

For initial evaluations: one or more of the first five areas must be addressed: language, speech sound

production, phonology, voice, fluency.

Not applicable means no concerns with this area of communication. If one or more sections within

Speech are checked “no”, this section would be marked “no”. Data/evidence should be briefly shared

that support a “yes” or a “no.”

Must be checked “yes” in order to be considered for speech or language impairment in the area of

speech sound phonology.

The speech-language pathologist must conduct an observation in a natural environment. For school-

age students the natural environment includes school.

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At least one of the following measurements

was used:

Presence of one of more disordered

phonological processes occurring at

least 40%.

Norm-referenced assessment of

phonology

The student’s intelligibility is below the

expected range for their age and not due to

influences of home languages or dialect.

Intelligibility ratings as documented by

school staff or caregivers indicate an impact

across environments.

There is a delay in communication that

adversely impacts the student’s educational

performance or social, emotional, or

vocational development.

Section IV. Voice

Not applicable

Yes/No

There is documentation of a vocal

impairment not due to temporary physical

factors (such as allergies, short-term vocal

abuse or puberty) and not due to an acute

respiratory virus or infection.

Please explain or reference data for each measurement used.

For further clarification of the term “significant discrepancy,” please review the significant discrepancy

and consideration of speech or language impairment webpage at the Wisconsin Department of Public

Instruction.

Must be checked “yes” in order to be considered for speech or language impairment in the area of

phonology. Data/evidence should be briefly shared that support a “yes” or a “no.”

Must be checked “yes” in order to be considered for speech or language impairment in the area of

phonology. Data/evidence should be briefly shared that support a “yes” or a “no.”

Documentation of this impact cannot indicate that it “may” occur. IEP teams must report impact on

educational performance in the classroom, which includes academic tasks, social-

emotional or

vocational development.

For initial evaluations: one or more of the first five areas must be addressed: language, speech sound

production, phonology, voice, fluency.

Not applicable means no concerns with this area of communication. If one or more sections within

Speech are checked “no,” this section would be marked “no”. Data/evidence should be briefly shared

that support a “yes” or a “no.”

Must be checked “yes” in order to be considered for speech or language impairment in the area of

voice.

Please explain or reference data for each measurement used.

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As evidenced through an observation in a

natural environment

Following consideration of the student’s

age, culture, language background, or

dialect, the student demonstrates

characteristics of a voice impairment, which

include any of the following (must check at

least one):

The student’s vocal volume, including

loudness.

The student’s vocal pitch, including

range, inflection, or appropriateness.

The student’s vocal quality, including

breathiness, hoarseness, or harshness.

The student’s vocal resonance,

including hypernasality.

This impairment in communication

adversely impacts the student’s educational

performance or social, emotional or

vocational development.

Section V. Fluency

Not applicable

Yes/No

The speech-language pathologist must conduct an observation in a natural environment. For school-

age students the natural environment includes school.

At least one item must be checked in order to answer “yes” to be considered for speech or language

impairment in the area of voice. Data/evidence should be briefly shared that support a “yes” or a

“no.”

Must be checked “yes” in order to be considered for speech or language impairment in the area of

voice. Data/evidence should be briefly shared that support a “yes” or a “no.”

Documentation of this impact cannot indicate that it “may” occur. IEP teams must report impact on

educational performance in the classroom, which includes academic tasks, social-

emotional or

vocational development.

For initial evaluations: one or more of the first five areas must be addressed: language, speech sound

production, phonology, voice, fluency.

Not applicable means no concerns with this area of communication.

Must be checked “yes” in order to be considered for speech or language impairment in the area of

fluency. Data/evidence should be briefly shared that support a “yes” or a “no.”

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Following consideration of the student’s

age, language background, culture, and

dialect, the student has speaking behaviors

characteristic of a fluency disorder.

At least one of the following measurements

was used:

Observation in a natural environment

Case history

Norm-referenced assessment

Disfluency analysis

Explain or reference data or evidence for all

measurement boxes checked above. If a

norm-referenced assessment was used,

explain whether the student demonstrated a

significant discrepancy.

The presence of one or more of the

following characteristics indicates a fluency

disorder :

Speech disfluencies

Speech rate

The evaluation must include a variety of measures, including case history, observation in natural

environment, norm-referenced assessment or disfluency analysis, and result in evidence of atypical

fluency.

Check all that apply; at least one must be checked.

The speech-language pathologist SLP must conduct an observation in a natural environment.

For further clarification of the term “significant discrepancy,” please review the significant discrepancy

and consideration of speech or language impairment webpage at the Wisconsin Department of Public

Instruction.

Check all that apply; at least one must be checked in order to be considered for speech or language

impairment in the area of fluency. Data/evidence should be briefly shared.

Speech disfluencies associated with stuttering or atypical disfluency, which include repetitions of

phrases, words, syllables, and sounds or dysrhythmic phonations such as prolongations of sounds or

blockages of airflow typically in excess of 2% of total syllables, one second of duration, and two or

more iterations in a repetition. Non-verbal physical movements, such as eye blinking or head jerking,

may accompany the stuttering. Negative feelings about oral communication may be significant enough

to result in avoidance behaviors in an attempt to hide or diminish stuttering.

A speech rate that is documented to be rapid, irregular, or both and may be accompanied by sound or

syllable omissions, sequencing errors, or a high number of non-stuttering speech disfluencies such as

interjections, phrase and whole word repetitions, and revisions. The resulting speech fluency pattern is

considered to be significantly disruptive to efficient communication. Negative feelings and attitudes

about oral communication may or may not be present under this disfluency profile.

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This impairment in communication

adversely impacts the student’s educational

performance or social, emotional, or

vocational development.

Section VI. Augmentative and Alternative

Communication (AAC)

Section VII. Exclusionary Factors

The IEP may not identify a speech or

language impairment when differences in

speech or language are based on home

languages, culture, or dialect unless the

student has a speech or language

impairment within the student’s home

languages, culture or dialect.

Section VIII. Documentation of Required

IEP Team Members

A speech-language pathologist was an IEP

team participant and attended IEP meetings

when the team discussed identification

eligibility of for a speech or language

impairment or identified the student’s

speech or language needs (or both).

Must be checked “yes” in order to be considered for speech or language impairment in the area of

fluency. Data/evidence should be briefly shared that support a “yes” or a “no.”

Documentation of this impact cannot indicate that it “may” occur. IEP teams must report impact on

performance in the classroom, which includes academic tasks, social-

emotional or vocational

development.

This prompt would be marked “N/A” unless the student required an alternate means of assessment.

Provide justification for checking “yes” or “N/A.” Question to consider: Is the student able to

effectively communicate with others without AAC?

Check “yes” if exclusionary factors apply. If “yes,” list exclusionary factors present (i.e., differences

in speech or language are based on home languages, culture, or dialect).

In determining whether the student has a speech or language impairment, the IEP team must consider

the following: the student’s background knowledge, stage of language acquisition, experience with

narratives, and exposure to vocabulary to discern speech or language ability from speech or language

difference, such as differences due to lack of exposure, stage of language acquisition, cultural or

behavioral expectations.

Based on information and data collected, the IEP team must determine whether the student’s speech or

language skills are a result of a speech or language impairment or a difference due to culture, language

background, or dialect.

Complete this section for both initial evaluations and reevaluations.

Must be checked “yes.” A speech-language pathologist is a required IEP team member when speech

or language impairment is being considered as part of an initial evaluation or reevaluation.

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An educator with foundational knowledge in

first and second language instruction and

second language acquisition if the student is

identified as an English Learner.

Yes/No/Not Applicable.

Section IX. Disability Category Criteria

Determination

Initial evaluation or considering new

disability category

The documentation of the criteria above

demonstrates an impairment of speech or

sound production, voice, fluency, or

language that adversely affects educational

performance or social, emotional or

vocational development. The student meets

the disability category criteria for Speech or

Language Impairment

Reevaluating category for continuing

identification

The student was previously found to meet

the disability category criteria for speech or

language impairment and continues to have

a disability that adversely affects the

student’s educational performance or social,

emotional, or vocational development.

When an English Learner (EL) is being evaluated, it is strongly recommended that the ESL (English

as Second Language) teacher be an IEP team member. However, the speech-language pathologist may

fulfill the role outlined formally in the rule, as speech-lang

uage pathologists have foundational

knowledge in first and second language instruction and second language acquisition. Students are not

designated as EL until kindergarten and therefore ESL teachers are not required to support preschool

students who are potentially English Learners. Speech-language pathologists would fill this role during

the IEP meeting in this situation.

Must meet all criteria in at least one section (I-V) and have no exclusionary factors in order to check

yes. A student may meet all criteria in more than one section.

A student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to be eligible for special education. Document the need for

specially designed instruction on the ER-1.

A student who previously met criteria for the disability category of speech or language impairment is

not required to meet initial identification criteria upon reevaluation.

A speech-language pathologist must be an IEP team member during a reevaluation.

The IEP team does not have to consider or complete the initial criteria prompts during a reevaluation

(although they may, and best practice might be to do so). If the prompts above are not completed,

provide justification as to how the student’s disability continues to adversely affect the student’s

educational performance. Consider and document the continued need for specially designed instruction

on the ER-1.

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ER-1-TBI Criteria for Disability Category: Traumatic Brain Injury

This form is used in conjunction with the evaluation report (Form ER-1) as part of a comprehensive special education evaluation. This form documents

the Individualized Education Program (IEP) team’s consideration of whether a student meets criteria for the disability category of traumatic brain injury

as defined under PI 11.36 (9)(a), Wis. Admin. Code. If a student meets criteria, the IEP team must attach the criteria form to the evaluation report. If this

category is considered and rejected, the team must document the process by either 1) explaining how a student did not meet the criteria on the evaluation

report or 2) attaching this criteria form to the evaluation report.

For more information on how to identify a student with a traumatic brain injury, go to the traumatic brain injury webpage at the Wisconsin Department

of Public Instruction.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date form completed

Initial evaluation or considering new

disability category

Reevaluating category for continuing

identification

Section I. Traumatic Brain Injury

Does the student have an acquired injury to

the brain that occurred following a period of

normal development?

If medical information from a licensed

physician is available, it was considered by

the IEP team.

Enter the date of the meeting when the IEP team determined if the student met the disability category

criteria for traumatic brain injury.

Check if the student was not previously found eligible as meeting the disability category criteria for

traumatic brain injury. The IEP team must complete all sections of this form.

Check if the student was previously found eligible as meeting the disability category criteria for

traumatic brain injury. A student is not required to meet initial criteria during a reevaluation for this

category, but the disability must continue to have an adverse effect on education performance in

order to be considered for specially designed instruction. It is recommended that the IEP team

consider all sections on this form, but only Section IV is required.

Must be checked “yes” in order to meet disability category criteria for traumatic brain injury.

The acquired injury may not be due to congenital causes (such as PKU or Down Syndrome) or

degenerative causes (such as Multiple Sclerosis or Muscular Dystrophy) or induced by birth trauma

(such as a perinatal stroke). Students whose educational performance is adversely affected as a result

of acquired injuries to the brain caused by internal occurrences, such as vascular accidents,

infections, anoxia, tumors, metabolic disorders and the effects of toxic substances or degenerative

conditions may meet the criteria of one of the other disability categories.

If available, the IEP team must consider it.

Note: it is not required in order for a student to meet disability category criteria for traumatic brain

injury.

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Describe the nature of the acquired injury

and source(s) of evidence.

Was the student’s acquired brain injury

caused by an external physical force from a

strike or blow to the head or from movement

of the brain within the skull?

Section II. Educational Performance

Is the student’s educational performance

adversely affected due to total or partial

functional disability or psychosocial

impairment, or both, in one or more of the

following areas? If yes, check ALL areas

that apply:

Cognition

Speech and Language

Memory

Attention

Reasoning

Abstract Thinking

Communication

Judgment

Problem Solving

Sensory, Perceptual, and Motor Abilities

Physical Functions

Information Processing

Psychosocial Behavior (psychological or

social functioning)

Executive Functions (e.g., organizing,

evaluating, and goal-directed activities)

Section III. Exclusionary Factors

The student does not have a brain injury that

is congenital or degenerative, or a brain

injury induced by birth trauma.

For example: due to a bike or car accident, a fall, a sports injury, an object like a nail penetrating the

brain, or whiplash to the head.

Must be checked “yes” in order to meet disability category criteria for traumatic brain injury.

In other words, is the student’s educational performance in one or more of the areas below partially

or totally affected by the acquired brain injury? When examining the student’s educational

performance, consider both academic and nonacademic skills and progress.

Note: Standardized and norm-referenced testing instruments used to evaluate and identify a student

with traumatic brain injury may not be valid or reliable. Alternative means of evaluation should be

considered such as achievement assessments, observation, work samples, and criterion referenced

assessment. The use of multiple assessment measures can help increase the validity or reliability of

the identification of a student with a traumatic brain injury.

Check to indicate the student does not have a brain injury that is congenital or degenerative, or a

brain injury induced by birth trauma.

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Section IV. Disability Category Criteria

Determination

Initial evaluation or considering new

disability category

The documentation of the criteria above

demonstrates an acquired injury to the brain

caused by an external physical force

resulting in total or partial functional

disability or psychosocial impairment, or

both, that adversely affects the student’s

educational performance. The student meets

the eligibility criteria for the disability

category of traumatic brain injury.

Reevaluating category for continuing

identification

The student was previously found to meet

the disability category criteria for traumatic

brain injury and continues to have a

disability that adversely affects the student’s

educational performance.

All three sections need to be checked “yes.” The exclusionary factors box also needs to be checked.

A student whose disability has an adverse effect on educational performance must be found to

require specially designed instruction in order to be eligible for special education. Document the need

for specially designed instruction on the ER-1.

A student who previously met criteria for the disability category of traumatic brain injury is not

required to meet initial identification criteria upon reevaluation.

A student whose disability has an adverse effect on educational performance must be found to require

specially designed instruction in order to be eligible for special education. Document the need for

specially designed instruction on the ER-1. Explain or reference data or evidence.

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ER-2A Documentation for Specific Learning Disability (SLD) – Initial Evaluation

Form ER-2Ais used only for initial SLD eligibility decisions for all enrolled public-school students.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date of Eligibility Determination

34 CFR §§ 300.301 and 300.309; Wis. Stat.

§ 115.78.

Documentation of eligibility

34 CFR §§ 300.306-307 and 300.309-311;

Wis. Stat. § 115.782).

Enter the date the IEP team meets and determines whether the student is or continues to be a student

with a disability.

In the case of an initial evaluation or a reevaluation,

the IEP team must make the eligibility

determination within 60 calendar days of receiving parent consent for administering tests and other

evaluation materials (see form IE-3 or RE-5) or

providing the parent notice that no additional

assessments are needed (see form IE-2 or RE-4).

There are three exceptions to the 60-calendar-

day evaluation timeline. The exceptions include

situations in which (1) the parent of a student repeatedly fails or refuses to produce the student for the

evaluation; (2) a student enrolls in a school of another LEA after the 60-calendar-day timeline has

begun, but prior to a determination of eligibility or continuing eligibility by the student’s previous

LEA, sufficient progress is being made to ensure a prompt completion of the evaluation, and the parent

and district agree to a specific time when the evaluation will be completed (see form M-2); or (3) there

is a written agreement with the parent to extend the timeline to complete the initial evaluation of a

student suspected of having a specific learning disability (see form M-3).

The date of eligibility determination also begins the 30-calendar-day timeline within which the IEP

team must meet to develop an IEP and determine a student’s placement.

These forms provide prompts to ensure IEP teams address all state and federal SLD eligibility criteria

requirements. Additional guidance regarding SLD eligibility criteria is available at

http://dpi.wi.gov/sped/program/specific-learning-disabilities.

1. Insufficient Progress 34 CFR §§ 300.307,

300.309, and 300.311.

This section must be completed. Check “Yes” if the student met this criterion in any area(s) of concern.

Check “No” if the student did not meet this criterion in any area.

If “Yes”, check each area considered in which the student was found to meet this criterion in the Data

Used to Support Insufficient Progress Determination chart. Then check the decision rule that applied

to the analysis of progress monitoring data leading to the finding that the student met the criterion.

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The instructional strategies used with the

student, including intensive intervention,

were applied in a manner highly

consistent…

The student’s parents were informed about

the amount and nature….

Additional Notes (if any):

2. Inadequate Classroom Achievement

34 CFR §§ 300.309 and 300.310.

In the Progress Monitoring Data section, summarize the progress monitoring data collected during

SRBIs. Supporting documentation, such as data graphs, may be attached. Documentation must be

sufficient to support the decision rule checked. For example, it would be appropriate to include a chart

of baseline and weekly data points with a normative comparison line showing the gap between the

student’s growth and expected rates for same age/grade peers. Additional information may be provided

here or below in “additional notes” to explain why the decision rule applied. An example would be to

provide a brief explanation of why growth may be the same or greater, but the student was found to

meet the criterion.

The box must be checked to ensure compliance with these requirements. IEP teams may wish to

document the dates and methods of informing the parents. IEP teams may document the interventions

provided on the ER-1 under “Previous interventions and the effects of those interventions” or in the

“Additional Notes “section below.

The box must be checked to ensure compliance with this requirement. IEP teams may wish to add

information about the particular interventions used including names of interventions, dates used, etc.,

if not documented elsewhere in the report. Districts should put systems in place to ensure SRBIs and

Progress Monitoring data meet the standards in the rule whenever the data will be used to make an

SLD eligibility decision. Information should be made available to the team as needed to document

SRBIs were appropriately implemented prior to the IEP team evaluation meeting. This information can

also be included in the “Additional Notes “section below.

If not included in other sections, the IEP team may wish to include other information such as the

specific SRBIs and progress monitoring probes used, descriptions of student’s relative performance

during the first and second interventions, how the student’s performance during intervention compared

to classroom performance in the same areas, etc.

This section must be completed. Check “Yes” if the student scores at or below the 1.25 SD cut score

in any area (81.25 on tests with a mean of 100 and SD of 15). If the test has a mean other than 100 use

the SD for the test and determine the cut score. Check each area in which the student met this criterion:

Oral Expression, Basic Reading Skill, Mathematics Calculation, Listening Comprehension, Reading

Comprehension, Mathematics Problem Solving, Written Expression, and Reading

Fluency Skills.

Check “No” if the student scores above the 1.25 SD cut score (Note: The IEP team may consider scores

within 1 standard error of the 1.25 SD cut score to meet the inadequate classroom achievement

criterion, if the IEP team determines the student meets all other criteria). Academic achievement scores

must correspond to the area(s) of achievement under consideration.

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Data Used To Support Determination:

If the 1.25 standard deviation (SD)

requirement was not used:…

Additional Notes (if any):

3. Exclusionary Factors DO NOT apply.

34 CFR §§ 300.309 and 300.310.

Additional Considerations (complete

whether or not an exclusionary factor

applies)—The IEP team considered:

Data demonstrating, prior to or as part of

the evaluation, the student was or was not

provided appropriate instruction.

This section must be completed whether the student did or did not meet this criterion. Provide a

summary of the data. This minimally includes the names of tests/subtests and the student’s standard

scores. Additional information may be appropriate to include, such as percentile scores, score ranges,

etc. It could also be appropriate to attach the student's test score printout or score chart generated from

the test’s computer scoring software and note, “see attached scores.” Provide additional information if

the printout does not include sufficient information for the reader to determine if the student did or did

not meet the cut score as per the SLD rule. Including additional summary information such as area(s)

of concern in which the student’s scores fell above the cut score is recommended.

This section must be completed if the IEP team did not use the 1.25 cut score requirement for one or

more of the areas of concern. A brief explanation supporting why a valid score could not be obtained

is required (For example: Despite several attempts on different days, the student did not maintain

sufficient attention during testing to complete the items according to test administration directions). In

addition, note the IEP team determination of whether the student does or does not demonstrate

inadequate achievement (relative to same age peers) in the area(s) and specify the alternate empirical

data used to support the decision. State test scores and anecdotal teacher reports are not sufficient.

This section is optional. Any additional notes regarding the student’s performance on the standardized

achievement test(s) may be added, such as relative strengths and weaknesses, comparison to observed

classroom achievement, etc.

This section must be completed. Check “Yes” if no exclusionary factors apply, or check “No” if one

or more factors apply. If “No,” check the factor(s) that apply in the list provided on the form.

The following items must be completed in all cases, whether or not “No” is checked. The IEP team

may wish to add additional descriptive information. We suggest documenting additional information

if any exclusionary factor is found to apply and the student will therefore not meet criteria.

The box must be checked to ensure compliance with this requirement. Additional description is

optional but may be useful to support IEP team decisions. The IEP team may wish to provide a

summary of the general education instruction provided, particularly if the appropriate instruction

exclusionary factor applies. This information can also be included in the “Additional Notes” section

below.

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Evidence the student received repeated

assessments of achievement reflecting

student progress.

The student’s parents were informed of such

assessments.

Additional Notes (if any):

ADDITIONAL DOCUMENTATION

REQUIRED WHEN STUDENT IS

EVALUATED FOR SLD:

34 CFR §§ 300.309, 300.310, and 300.310.

Relevant behavior noted during observation

of the student…

Educationally relevant medical findings

The box must be checked to ensure compliance with this requirement. Additional description is

optional but may be useful to support IEP team decisions. The IEP team may wish to include a

summary of ongoing general education assessments provided as part of general education instruction

if not included elsewhere. This information can also be included in the “Additional Notes “section

below.

The box must be checked to ensure compliance with this requirement. Additional description is

optional but may be useful to support IEP team decisions. The IEP team may wish to include how the

parents were informed of the results of on-going general education assessment as part of appropriate

instruction if not addressed earlier. This item may also be addressed in the prior section on Insufficient

Progress.

This section is optional. The IEP team may wish to provide a summary of information discussed

regarding potential exclusionary factors that may be relevant whether or not the student met this

criterion. For example, the effect of having English as a second language or cultural differences of a

recent immigrant may be relevant. Elaboration is recommended if any exclusionary factor is found to

apply, and the student will therefore not meet criteria.

This section must be completed. The IEP team should summarize the observation data collected during

the two required observations (or more if student was observed in more than two settings): during

general education classroom instruction and during at least one of the required SRBIs. The information

should be specific to how the student performed in the area(s) of achievement concern when observed.

Information comparing the student’s observed learning behavior to other students in the class can be

helpful.

This section must be completed. Check “Yes” OR “No” as appropriate. If “Yes” is checked, additional

information is required. The IEP team should summarize the relevant medical findings and their effect

on the student’s achievement, particularly in the area(s) of concern.

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SUMMARY OF ELIGIBILITY CRITERIA

CONSIDERATION

34 CFR §§ 300.304 and 300.311.

The IEP team decision of whether the

student has a specific learning disability was

based on information from a variety of

sources and not on any single measure or

assessment as the sole criterion:

DISABILITY CATEGORY

DETERMINATION

Each IEP team participant must sign….

Additional Notes (if any):

If #1, #2, and #3 are marked “YES", the student meets the eligibility criteria for the disability category

of specific learning disability (SLD). If any item is marked "No”, the student does not meet eligibility

criteria for the disability category of SLD. Prompts for additional information must be completed as

appropriate. If such information is addressed elsewhere in the IEP team evaluation report, please

reference where the information can be found. If there are more areas of concern, add rows to the chart.

The box must be checked to ensure compliance with this requirement. When determining whether a

student has a specific learning disability, the IEP team must base its decision on information from a

variety of sources and not on any single measure or assessment as the sole criterion.

Check “yes” if the documentation of the criteria above demonstrates the student meets the disability

category criteria for specific learning disability. A student whose disability has an adverse effect on

educational performance must be found to require specially designed instruction in order to be eligible

for special education. Document the need for specially designed instruction on the ER-1.

Each IEP team participant, including the parents, signs the form and indicates if they agree with the

team’s conclusion about whether or not the student has a specific learning disability. If any IEP team

participant, including the parent, does not agree with the team’s conclusions, then they must also attach

a statement reflecting their conclusions. If a parent disagrees with the conclusions of the team and

refuses to submit a statement, the LEA cannot compel the parent to do so. The LEA may summarize

the parent’s position in writing and indicate the parent refused to submit a separate statement.

The IEP team may wish to include additional information relevant to the eligibility decision here, if

not included elsewhere. It may be particularly appropriate to include additional information if the

student was not found to meet eligibility criteria to explain why the student was not found eligible and

summarize the student’s strengths and relative weaknesses.

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ER-2B Documentation for Specific Learning Disability (SLD) – Reevaluation

Form ER-2B is used only when a student is being reevaluated in the area of Specific Learning Disabilities (SLD). This form is used for reevaluations of

students previously found to meet disability category criteria for SLD. If a student was not already identified as having SLD at the time of the reevaluation,

and SLD will be considered for the first time, the IEP team should use form ER-2A to document the SLD eligibility decision.

All sections and items on this form must be completed. Check each statement with “Yes” or “No” and provide addition supporting information as noted.

FORM CONTENT

CLARIFICATION/EXPLANATION

Date of Eligibility Determination

34 CFR § 300.306 and 300.309-

311; Wis.

Stat. § 115.782.

Information specific to reevaluations

Enter the date the IEP team meets and determines whether the student is or continues to be a student

with a disability.

In the case of an initial evaluation or a reevaluation the IEP team must make the eligibility

determination within 60 calendar days of receiving parent consent for administering tests and other

evaluation materials, (see form IE-3 or RE-

5) or providing the parent notice that no additional

assessments are needed (see form IE-2 or RE-4).

There are three exceptions to the 60-calendar-

day evaluation timeline. The exceptions include

situations when (1) the parent of a student repeatedly fails or refuses to produce the student for the