ELIGIBILITY DETERMINATION
(SPECIFIC LEARNING DISABILITY)
(Required as of the 2007-2008 School Year)
Instructional Need
Evidence in the Documentation of Evaluation Results should support the team’s answer to this question.
 
Are this student’s needs in any areas of concern significantly different from the needs of typical peers and of an intensity or type that exceeds general education resources?
(Select One)
No
Yes- The student’s instructional needs are significantly different and exceed general education resources.
 
If yes, in which area(s)?
 
 
If any of the boxes in this section (Inclusionary Criteria) are marked “No”, the student does not have a Specific Learning Disability and the team must complete the Eligibility Determination section accordingly. 
 
Optional Criteria
After determining that the criteria in the preceding section are met, the district may choose to use an IQ-achievement discrepancy model. If using this model, complete this section.
 
IQ-Achievement Discrepancy: 
Yes No NADoes a severe discrepancy exist between achievement and ability that is not correctable without special education and related services? (Please refer to evidence in Documentation of Evaluation Results)
 
If yes, in which area(s)?
 
 
 
ELIGIBILITY DETERMINATION