Attachment 4 Exclusionary Factors Checklist A child will not be learning disabled IF his/her learning problems are: “Primarily the result of Environmental, Cultural or Economic Disadvantage.” Environmental Yes /No Cultural Yes /No Economic Yes /No Factors Factors Disadvantage 1. Limited Schooling Yes/No 1. Language Issues Yes/No 1. Yes/No 2. Poor SST Yes/No 2. Cultural values Yes/No 2. Agricultural Yes/No interventions (not and mismatch with evidenced-based) US public school system (Assimilation) 3. Multiple Schools Yes/No 3. Does Yes/No 3. Loss job, and Yes/No community support home.. integration into mainstream culture? 4. Excessive Absences Yes/No 4. New to the Yes/No 4. Nutrition Yes/No country? 5. Home educational Yes/No 5. Parents live in Yes/No 5. Access to Yes/No levels. another country? medical care 6. Lack of home Yes/No 6. Does school Yes/No 6. Access to Yes/No support appreciate culture technology of the student? outside of school 7. Poor teaching Yes/No 7. Why did the Yes/No 7. Cramped Yes/No history student immigrate living to US (forced v. conditions. voluntary)? 8. Lack homework Yes/No 8. Trust v. Mistrust Yes/No 8. Yes/No follow through (discrimination)? Personal/Care hygiene. 9. Lack of home Yes/No 9. Quality of Yes/No 9. Yes/No structure/Parent interpreter (helpful Transportation supervision v. hindrance)? to school. 10. Inappropriate Yes/No 10. Culturally Yes/No 11. Adult-like Yes/No language supports appropriate responsibilities (ELD) curriculum and interventions. 11. Other?? Yes/NO 11. Other? Yes/No Other?? Yes/No Is there reason to believe that learning problems are primarily attributed to the abovementioned factors? If so, how: Recommendations:
Attachment 4 Exclusionary Factors Checklist A child will not be learning disabled IF his/her learning problems are: “Primarily the result of Environmental, Cultural or Economic Disadvantage.” Environmental Factors Yes /No Cultural Factors Yes /No Economic Disadvantage Yes /No 1. Limited Schooling Yes/No 1. Language Issues Yes/No 1. Yes/No 2. Poor SST interventions (not evidenced-based) Yes/No 2. Cultural values and mismatch with US public school system (Assimilation) Yes/No 2. Agricultural Yes/No 3. Multiple Schools Yes/No 3. Does community support integration into mainstream culture? Yes/No 3. Loss job, and home.. Yes/No 4. Excessive Absences Yes/No 4. New to the country? Yes/No 4. Nutrition Yes/No 5. Home educational levels. Yes/No 5. Parents live in another country? Yes/No 5. Access to medical care Yes/No 6. Lack of home support Yes/No 6. Does school appreciate culture of the student? Yes/No 6. Access to technology outside of school Yes/No 7. Poor teaching history Yes/No 7. Why did the student immigrate to US (forced v. voluntary)? Yes/No 7. Cramped living conditions. Yes/No 8. Lack homework follow through Yes/No 8. Trust v. Mistrust (discrimination)? Yes/No 8. Personal/Care hygiene. Yes/No 9. Lack of home structure/Parent supervision Yes/No 9. Quality of interpreter (helpful v. hindrance)? Yes/No 9. Transportation to school. Yes/No 10. Inappropriate language supports (ELD) Yes/No 10. Culturally appropriate curriculum and interventions. Yes/No 11. Adult-like responsibilities Yes/No 11. Other?? Yes/NO 11. Other? Yes/No Other?? Yes/No Is there reason to believe that learning problems are primarily attributed to the abovementioned factors? If so, how: Recommendations:
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