ED-1-Eligibility Determination.doc

School District Name:

Auburn

School District Address:

5 West Street, Auburn, MA 01501

School District Contact Person/Phone #:

Special Education Eligibility/Initial and Reevaluation Determination

Student Name:

DOB:

ID#:

Date:

A. Proceed through the flowchart until an eligibility determination is reached..

B. Answer this question for all students.

Student is not eligible for Special Education but may be eligible for other services in other programs.

no

yes

no

If yes, indicate disability type(s):

KEY EVALUATION FINDINGS
AND/OR NEXT STEPS

yes

2. a) is the student making effective progress in school?
(For reevaluations: Would the student continue to make progress in school without the provided special education services?)

yes

no

Student is not eligible for Special Education but may be eligible for accommodation(s) for disability(ies) under Section 504 of the Rehabilitation Act or may be eligible for other services in other programs.

2. b) is the lack of progress a result of the student's disability?

no

yes

2. c) does the student require specially designed instruction in order to make effective progress in school or does the student require related services in order to access the general curriculum?

no

yes

THE STUDENT IS ELIGIBLE FOR SPECIAL EDUCATION.

Massachusetts DOE / Special Education Eligibility Determination - REVISED (9/1/00)

ED 1