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ASSESSMENT REPORT TEMPLATES

The SELPA is committed to ensuring that any individual assessment of a student results in a written report which contains all elelments required by the IDEA and Code of Federal Regulations as well as California Education Code and its Regulations. The report must always be shared at an IEP meeting.  Parents must be given a written copy of the report no later than the IEP meeting.

Included below are reports for teachers and specialists to use for individual assessment reports.  All elements in yellow must be contained in the assessment report.  However, if specialists submit their assessment findings to the psychologist for a combined Multidisciplinary Psychoeducational Reprt, then only that report must contain all required elements. 

 enlightened It is recommended that you make a copy of the template  that you will use most often, insert your school or district letterhead, add other information about yourself (name, title, phone), and save on your computer in the word processing format that you use.  There are many areas that require you to DELETE options given- such as EL level-  delete all that DON'T APPLY

These reports are also available in the SIRAS IEP software 

 

Click here for Spanish Reports

  

SAMPLE LANGUAGE FOR ALL REPORTS
Sample Language for All Reports 
Sample Language for Indicators of a Possible Disability-All Reports
 
ACADEMIC 

Academic Assessment Report 

Sample Descriptions of Academic Assessment Instruments
    
ADAPTED PHYSICAL EDUCATION

Adapted Physical Education Assessment Report 

    
ASSISTIVE TECHNOLOGY

Assistive Technology Report 

 

DEAF/HARD OF HEARING 

Deaf/Hard of Hearing Assessment Report - 

 

EDUCATIONALLY RELATED SOCIAL-EMOTIONAL SERVICES (ERSES)

ERSES Assessment Planning Form

Initial Assessment Report

Triennial-Exit Assessment Report

 

OCCUPATIONAL THERAPY

Occupational Therapy Assessment Report 

Descriptions of OT Assessments   
OT School Performance Checklist for Students with Mild/Moderate Disabilities 

OT School Performance Checklist for Students with Moderate/Severe Disabilities  

OT Developmental Motor Skills Guidelines (0-72 Months)
    

ORIENTATION AND MOBILITY

Orientation and Mobility Report 

 
ORTHOPEDIC IMPAIRMENTS
Orthopedic Impairments/TBI Teacher Input Form  
Orthopedic Impairments/TBI Input to Multidisciplinary Assessment Report 
 

PHYSICAL THERAPY 

Physical Therapy Assessment Report 

Physical Therapy Referral Checklist   

 

PRESCHOOL TO KINDERGARTEN TRANSITION 

Preschool to Kindergarten Transition Assessment Report 

 

PSYCHOEDUCATIONAL ASSESSMENT 

Psychoeducational Assessment Report (Multidisciplinary or Psychologist Only)

Sample Descriptions of Psychological Assessment Instruments  

Specialist input for Multidisciplinary Psychoeducational Report 

Psychoeducational Report Template-Dehn

Psychoeducational Report Template- Cross-Battery Assessment (XBA)

 

RESIDENTIAL TREATMENT 

Consideration of Need for Residential Treatment Services Assessment Report 

 

SPECIAL CIRCUMSTANCES EDUCATIONAL SUPPORT

Need for Special Circumstances Educational Support
 

SPECIAL EDUCATION ANNUAL PROGRESS REVIEW (Not required in all districts)

Special Education Annual Review 
 

SPEECH-LANGUAGE

Speech/Language Assessment Report 

Sample Descriptions of Speech-Language Assessment Instruments   

 
TRANSITION TO ADULT LIFE
Descriptions of Transition Assessments
Transition Report 
Transition Input for Multidisciplinary Psycho Ed Report 
 

BLIND/LOW VISION

Vision Specialist Assessment Report 

 

 

Spanish Assessment Report Templates   
 

ACADEMIC  

Academic Assessment Report 
 

ADAPTED PHYSICAL EDUCATION

APE Assessment Report 

 

ASSISTIVE TECHNOLOGY  

Assistive Technology Report        

 

DEAF/HARD OR HEARING 

Deaf/Hard of Hearing Assessment Report 

 

EDUCATIONALLY RELATED SOCIAL/EMOTIONAL SERVICES (ERSES)  

Assessment Report for ERSES 

 

OCCUPATIONAL THERAPY  

Occupational Therapy Assessment Form
 

ORIENTATION AND MOBILITY

Orientation and Mobility Report 

 
QRTHOPEDIC IMPAIRMENTS
Orthopedic Impairments Input Form  
 

PHYSICAL THERAPY

Physical Therapy Assessment Report 
 

PRESCHOOL TO KINDERGARTEN TRANSITION

Preschool to Kindergarten Transition Assessment 

 

PSYCHOEDUCATIONAL

Psychoeducational Assessment Report 

 

RESIDENTIAL TREATMENT

Consideration of Need for Residential Treatment Services 

 

SPECIAL EDUCATION ANNUAL REPORT (Not required in all districts) 

Special Education Annual Report 

 
SPEECH-LANGUAGE

Speech/Language Assessment Report 

 
TRANSITION TO ADULT LIFE 
Transition Report 
 
BLIND/LOW VISION

Vision Specialist Assessment Report