Ed 1108.01(b)(2) Yes Yes For determination of eligibility, provide the evidence that the composition No No of the IEP team also included an individual knowledgeable the child as a result of having had personal contact with the child in the school or, if the NA—Only if NA—Only if current child is below school age, at another setting. current eligibility eligibility was not was not completed completed by this this may include an early intervention provider, childcare For preschool children, by this district district provider or other personnel who have knowledge of the child. Provide the individual who signed in on the meeting participant form who is considered to be knowledgeable about the child. 34 CFR 300.304(c)(1)(iv); Ed 1107.04(b) Yes Yes Provide the trained and knowledgeable personnel who administered the No No assessment. NA—Only if NA—Only if current Provide the names and credentials of personnel who administered the assessments. current eligibility eligibility was not was not completed completed by this The NHDOE will verify the evaluations entered into NHSEIS to document the summary by this district district of evaluation results. The reviewers will bring a printout from the NHSEIS system. 34 CFR 300.306(c)(1)(i); Ed 1108.01(a) Yes Yes Provide the evidence that the team drew upon, carefully considered and No No documented information from a variety of sources, including aptitude and achievement tests, parent input, and teacher recommendations, as well as NA—Only if NA—Only if current information about the child’s physical condition, social or cultural current eligibility eligibility was not background, and adaptive behavior. was not completed completed by this by this district district Provide the location in the file where the evaluation written summary report, which includes the required assessments per Table 1100.1of the NH Rules, is located.
Ed 1108.01(b)(2) For determination of eligibility, provide the evidence that the composition of the IEP team also included an individual knowledgeable the child as a result of having had personal contact with the child in the school or, if the child is below school age, at another setting. For preschool children, this may include an early intervention provider, childcare provider or other personnel who have knowledge of the child. Provide the individual who signed in on the meeting participant form who is considered to be knowledgeable about the child. Yes No NA—Only if current eligibility was not completed by this district Yes No NA—Only if current eligibility was not completed by this district 34 CFR 300.304(c)(1)(iv); Ed 1107.04(b) Provide the trained and knowledgeable personnel who administered the assessment. Provide the names and credentials of personnel who administered the assessments. The NHDOE will verify the evaluations entered into NHSEIS to document the summary of evaluation results. The reviewers will bring a printout from the NHSEIS system. Yes No NA—Only if current eligibility was not completed by this district Yes No NA—Only if current eligibility was not completed by this district 34 CFR 300.306(c)(1)(i); Ed 1108.01(a) Provide the evidence that the team drew upon, carefully considered and documented information from a variety of sources, including aptitude and achievement tests, parent input, and teacher recommendations, as well as information about the child’s physical condition, social or cultural background, and adaptive behavior. Provide the location in the file where the evaluation written summary report, which includes the required assessments per Table 1100.1of the NH Rules, is located. Yes No NA—Only if current eligibility was not completed by this district Yes No NA—Only if current eligibility was not completed by this district
2016_2017_self_assessment_form_fillable.docx