Eligibility Criteria for Multiple Disabilities Multidisciplinary Team Summary Name: School: Birth date: Grade: Parent(s): ID #: Address: Date of meeting: Phone/cell#: Psychologist: Multiple disabilities means co-existing disabilities, one of which must be a significant cognitive disability. The co-existing disabilities are lifelong and interfere with independent functioning, and it is difficult to determine which disability most adversely affects educational performance. The term does not include deaf-blind (DB). Eligibility for special education as a student with multiple disabilities shall be determined by the student’s case conference committee (CCC). The determination shall be based on the multidisciplinary team’s educational evaluation report, which includes the following: An assessment of cognitive ability and functioning. An assessment of current academic achievement. A functional skills or adaptive behavior assessment across various environments from multiple sources. A social and developmental history (doc 6.6) A systematic observation of the student across various environments. Available medical information that is educationally relevant. Any other assessments and information, collected prior to referral or during the educational evaluation. Student does meet the criteria for multiple disabilities. Student does not meet the criteria for multiple disabilities (attach action plan). Multidisciplinary team members: School psychologist: Special education teacher: General education teacher: Behavior consultant: Speech therapist: Occupational therapist: Other: Other:
Eligibility Criteria for Multiple Disabilities Multidisciplinary Team Summary Name: School: Birth date: Grade: Parent(s): ID #: Address: Date of meeting: Phone/cell#: Psychologist: Multiple disabilities means co-existing disabilities, one of which must be a significant cognitive disability. The co-existing disabilities are lifelong and interfere with independent functioning, and it is difficult to determine which disability most adversely affects educational performance. The term does not include deaf-blind (DB). Eligibility for special education as a student with multiple disabilities shall be determined by the student’s case conference committee (CCC). The determination shall be based on the multidisciplinary team’s educational evaluation report, which includes the following: An assessment of cognitive ability and functioning. An assessment of current academic achievement. A functional skills or adaptive behavior assessment across various environments from multiple sources. A social and developmental history (doc 6.6) A systematic observation of the student across various environments. Available medical information that is educationally relevant. Any other assessments and information, collected prior to referral or during the educational evaluation. Student does meet the criteria for multiple disabilities. Student does not meet the criteria for multiple disabilities (attach action plan). Multidisciplinary team members: School psychologist: Special education teacher: General education teacher: Behavior consultant: Speech therapist: Occupational therapist: Other: Other:
8.17_Eligibility_Criteria_for_Multiple_Disabilities_Multidisciplinary_Team_Summary.docx