Re-Evalutation Educational Therapy Evaluation

Teacher Information Form

This student is due for an Educational Therapy Re-Evaluation in accordance with WV Policy 2419.

Please complete the information below to assist the IEP team in reviewing progress and determining continued need for services.

Step 1 of 4

Please select the therapy discipline(s) for which this evaluation is being considered.(Required)

Educational Occupational Therapy

Educational Physical Therapy

Educational Speech-Language Therapy

Current Classroom Performance - Educational Occupational Therapy

How is the student currently functioning with fine-motor tasks (writing, cutting, tool use)?(Required)

How is the student currently functioning with task completion and classroom participation?(Required)

How is the student currently functioning with routines and materials independence?(Required)

How is the student currently functioning with organization and work habits?(Required)

Progress Since Last Evaluation/IEP - Educational Occupational Therapy

Have you observed improvement in mobility or safety?(Required)

Significant improvement

Some improvement

Minimal improvement

No noticeable change

Other

Please describe your observations.(Required)

Are previous concerns still impacting the student’s ability to access and make progress in the general education curriculum?(Required)

Current Educational Impact - Educational Occupational Therapy

How do the student’s fine-motor or functional needs currently affect academic progress?(Required)

How do the student’s fine-motor or functional needs currently affect participation in classroom activities?(Required)

How do the student’s fine-motor or functional needs currently affect independence compared to peers?(Required)

Current Supports - Educational Occupational Therapy

What accommodations or supports are currently being used?(Required)

Classroom accommodations

Behavior supports

Modified assignments

Assistive tools

SAT interventions

None

Please describe accommodations and/or supports.(Required)

Continued Need Consideration - Educational Occupational Therapy

Do you believe occupational therapy services are still needed to support access and progress in the educational environment?(Required)

Yes

Unsure

Please explain your reasoning.(Required)

Dismissal Considerations - Educational Occupational Therapy

Based on your current observations, does the student’s motor and functional performance allow them to:(Required)

Complete fine-motor tasks required for grade-level work (writing, cutting, tool use) without specialized occupational therapy support

Maintain appropriate posture and positioning for learning tasks

Manage classroom materials and routines independently

Participate in classroom activities at a level comparable to same-age peers

Access and demonstrate knowledge within the general education curriculum without specialized occupational therapy services

None of the above

Have previously identified fine motor, sensory, or functional concerns resolved or improved to a level that no longer adversely impacts educational performance?(Required)

Yes

Unsure

Please describe the evidence you observe in the classroom.(Required)

If motor or functional concerns remain, do you believe they can be addressed through general education strategies or classroom accommodations rather than specially designed occupational therapy instruction?(Required)

Yes

Unsure

Please explain your reasoning.(Required)

Current School Functioning - Educational Physical Therapy

How is the student currently functioning with mobility within the school building?(Required)

How is the student currently functioning with stair navigation?(Required)

How is the student currently functioning with playground participation?(Required)

How is the student currently functioning with balance and coordination?(Required)

How is the student currently functioning with endurance during the school day?(Required)

Progress Since Last Evaluation/IEP - Educational Physical Therapy

Have you observed improvement in mobility or safety?(Required)

Significant improvement

Some improvement

Minimal improvement

No noticeable change

Other

Please describe your observations.(Required)

Are physical concerns still impacting the student’s safe access and participation in school activities?(Required)

Current Educational Impact - Educational Physical Therapy

How do mobility or physical concerns affect classroom participation?(Required)

How do mobility or physical concerns affect safety within the school environment?(Required)

How do mobility or physical concerns affect access to campus (stairs, transitions, playground)?(Required)

Current Supports - Education Physical Therapy

What accommodations or supports are currently being used?(Required)

Mobility equipment

Seating adaptations

Supervision for safety

Modified PE

SAT supports

None

Please describe accommodations and/or supports.(Required)

Continued Need Consideration - Educational Physical Therapy

Do you believe physical therapy services are still necessary for safe access and educational participation?(Required)

Yes

Unsure

Please explain your reasoning.(Required)

Dismissal Considerations - Educational Physical Therapy

Based on your current observations, do the student's gross-motor skills and mobility allow them to:(Required)

Safely navigate the school environment (classroom, hallways, playground, cafeteria) without specialized physical therapy support

Transition between activities independently

Maintain appropriate positioning for learning tasks

Participate in classroom and school-related activities comparable to same-age peers

Access and engage in the general education curriculum without specialized physical therapy services

None of the above

Have previously identified mobility, strength, balance, or postural concerns resolved or improved to a level that no longer adversely impacts educational performance?(Required)

Yes

Unsure

Please describe the evidence you observe in the classroom.(Required)

If physical concerns remain, do you believe they can be addressed through general education supports, positioning strategies, or environmental accommodations rather than specially designed physical therapy instruction?(Required)

Yes

Unsure

Please explain your reasoning.(Required)

Current Classroom Communication Performance - Educational Speech-Language Therapy

How is the student currently functioning with speech-sound production/intelligibility in the classroom?(Required)

How is the student currently functioning with understanding classroom instruction and directions?(Required)

How is the student currently functioning with expressing ideas, answering questions, and participating in discussions?(Required)

How is the student currently functioning with social communication with peers and adults?(Required)

How is the student currently functioning with the ability to retell, summarize, or explain academic information?(Required)

Progress Since Last Evaluation/IEP - Educational Speech-Language Therapy

Have you observed improvement in previously identified communication areas?(Required)

Significant improvement

Some improvement

Minimal improvement

No noticeable change

Please describe your observations.(Required)

Are communication concerns still impacting the student’s ability to access, participate in, or make progress in the general education curriculum?(Required)

Current Educational Impact - Educational Speech-Language Therapy

How do the student’s communication needs currently affect academic performance (reading, writing, comprehension, testing, etc.)?(Required)

How do the student’s communication needs currently affect participation in classroom activities and discussions?(Required)

How do the student’s communication needs currently affect independence compared to same-age peers?(Required)

How do the student’s communication needs currently affect peer interactions and collaborative learning?(Required)

Current Supports - Educational Speech-Language Therapy

What accommodations and/or supports are currently being used?(Required)

Classroom accommodations

Small group instruction

Visual supports

Modified assignments

Behavior supports

SAT interventions

Social skills group

None

Please describe accommodations and/or supports.(Required)

Continued Need Consideration - Educational Speech-Language Therapy

Do you believe speech-language services are still needed to support the student’s access, participation, and progress in the educational environment?(Required)

Yes

Unsure

Please explain your reasoning.(Required)

Dismissal Consideration - Educational Speech-Language Therapy

Based on your current observations, does the student’s communication ability allow them to:(Required)

Participate in classroom instruction without specialized speech-language support

Communicate effectively with teachers and peers in academic settings

Complete grade-level tasks independently

Access and demonstrate knowledge within the general education curriculum

Function comparably to same-age peers in communication skills

None of the above

Have previous communication concerns resolved or improved to a level that no longer adversely impacts educational performance?(Required)

Yes

Unsure

Please describe the evidence you observe in the classroom.(Required)

If communication concerns remain, do you believe they can be addressed through general education strategies rather than specially designed instruction?(Required)

Yes

Unsure

Please explain your reasoning.(Required)

info@dtchuntington.org

(304) 523-1164

Re-Evalutation Educational Therapy Evaluation

Teacher Information Form

Student Information

Current Classroom Performance - Educational Occupational Therapy

Progress Since Last Evaluation/IEP - Educational Occupational Therapy

Current Educational Impact - Educational Occupational Therapy

Current Supports - Educational Occupational Therapy

Continued Need Consideration - Educational Occupational Therapy

Dismissal Considerations - Educational Occupational Therapy

Current School Functioning - Educational Physical Therapy

Progress Since Last Evaluation/IEP - Educational Physical Therapy

Current Educational Impact - Educational Physical Therapy

Current Supports - Education Physical Therapy

Continued Need Consideration - Educational Physical Therapy

Dismissal Considerations - Educational Physical Therapy

Current Classroom Communication Performance - Educational Speech-Language Therapy

Progress Since Last Evaluation/IEP - Educational Speech-Language Therapy

Current Educational Impact - Educational Speech-Language Therapy

Current Supports - Educational Speech-Language Therapy

Continued Need Consideration - Educational Speech-Language Therapy

Dismissal Consideration - Educational Speech-Language Therapy

Communication & IEP Planning