A guide to using the worksheet:
- Column 1: List your concern briefly.
- Column 2: What data can you provide to support your concern?
- Column 3: If you think your concern may be related to any disability or condition, identify that in 3. If you're not sure what is causing a problem, leave this column blank.
- Column 4: If you want the school to evaluate or test your child, describe the type of testing that is needed to provide information that addresses your concern. You do not need to know the names of specific tests.
- Column 5: List the services you think your child needs using the terms described below.
Accommodations — Changes in presentation (e.g., repeat directions, read aloud, use of larger bubbles on answer sheets, etc.), response (e.g., mark answers in book, use reference aids, point, use of computer etc.), timing/scheduling (e.g., extended time, frequent breaks, etc.) or setting (e.g., study carrel, special lighting, separate room, etc.).
Instructional Intervention — Change in instruction that attempts to improve student learning in area of difficulty.
Remedial services — Supplemental instruction available through programs such as Title I, IDEA.
- Column 6: When you meet with school personnel, note any agreements you have reached with them, who made the agreement and when.
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From NCLD's IDEA Parent Guide, Chapter 3: Referral/Request for Evaluation.Adapted with permission from Leslie E. Packer, Ph.D., http://www.tourettesyndrome.netCandace Cortiella is Director of The Advocacy Institute, a nonprofit focused on improving the lives of people with disabilities through public policy and other initiatives. The mother of a young adult with learning disabilities, she lives in the Washington, D.C., area.