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* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
BOARD OF EDUCATION OF WICOMICO COUNTY CONSENT FOR ASSESSMENT Student: ________________________________________________________ DOB: ______________ School: _____________________________________________________________________________ In considering the information presented at the IEP Team meeting on _____________, the IEP Team has recommended the following assessment(s). All assessments will be completed by personnel certified and trained to conduct the assessments indicated. _____ AUDIOLOGICAL: may include instruments and observations which are designed to measure outer, middle, and sensorineural function, hearing acuity for pure tones and speech as well as speech discrimination abilities. Instruments and observations may include those sensitive to central auditory processing abilities, performance with hearing aids/FM auditory trainers, electroacoustic analysis of hearing aids and fit/design of ear molds. _____ EDUCATIONAL: may include instruments which are designed to measure achievement in readiness skills (e.g. alphabet knowledge, number concepts), basic reading skills, reading comprehension, mathematics calculation, mathematics reasoning, and written language (e.g., grammar, sentence/paragraph construction, spelling). _____ FUNCTIONAL VISION: determines the quantity and quality of vision the child functionally uses. _____ HEALTH/MEDICAL: may include a physical examination, interview, and test by a qualified physician. _____ LANGUAGE: may include instruments and observations which are designed to measure vocabulary development, language processing, sentence structure, expressive/receptive language, and hearing. _____ OBSERVATION: includes classroom/school environmental observation of the student’s behaviors as they relate to his/her functioning and academic performance. If the student is not enrolled in school, the observation will occur in the appropriate environment. _____ OCCUPATIONAL THERAPY: may include instruments and observations designed to measure fine motor skills, sensory-motor development, balance, reflex integration, and eye-hand coordination. _____ PHYSICAL THERAPY: may include a neuro-muscular examination and developmental evaluation. _____ PRE-VOCATIONAL/VOCATIONAL: may include instruments and observations designed to measure a student’s vocational interests, aptitudes, and areas of need related to development of general or specific job skills and attitudes. _____ PSYCHOLOGICAL: may include instruments which are designed to measure cognitive functioning, perceptual/motor functioning, memory, developmental patterns, social/emotional development, adaptive behavior, and academic achievement. _____ SPEECH: may include testing and observations which are designed to measure formation of speech sounds, voice quality, stuttering, hearing, and visual inspection of the mouth (tongue, lips, teeth, hard/soft palate). _____ OTHER: ____________________________________________________________________________________ I grant my permission for the assessment(s) indicated above. I understand that my consent is voluntary and may be revoked at any time. Signature: ________________________________________________ Date: ______________ 9/2003