Section and Fields in the SLD form

Student Name

Name of the student for whom the meeting has been called.

No

Yes

Student Information

N.A.

Populated from Student Information Profile. Captured through the {StudentName} field.

ID

Student ID as per the Student Information System records.

No

Yes

Student Information

N.A.

Populated from Student Information Profile.
Captured through the {stateid} or {ID} field.

Date of Birth

DOB of the student as per the Student Information System records.

No

Yes

Student Information

N.A.

Populated from Student Information Profile.
Captured through the {BirthDate} field.

Age

Age of the student as of the birth date.

No

Yes

None

N.A.

Calculated as per the Date of Determination and DOB. Captured through the {AgeAsofDateOfDeterm} field.

Grade

The academic grade the student is enrolled in or would be enrolled in.

No

Yes

Student Information

N.A.

Populated from Student Information Profile.
Captured through the {Grade} field.

School/Site

The name of the School the student is enrolled in or would be enrolled in.

No

Yes

Student Information

N.A.

Populated from Student Information Profile.
Captured through the {School} field.

Date of Determination

The date cannot be greater than the current date.

Yes

Yes

N.A.

N.A.

Captured through the {DateOfDeterm} field.

Method of Eligibility Determination

You can only check one of the 3 checkboxes.

• Response to Intervention

• Severe Discrepancy

• Other Alternative Research-based Procedures (specify):

Note:

If you selected “Response to Intervention” then:

• You must respond to Question #2, #2A, #3 / #4.

• Select NA for Question #5, and skip Question #5A.

If you selected “Severe Discrepancy” then:

• You must fill Question #2 and #2A.

• Select NA for Question #3 / #4.

• And not respond to Question #5.

  • If you selected ‘Yes’ for Question #5, then respond to #5A.

If you selected “Other Alternative Research-based Procedures” then:

• You must respond to Question #2, #2A, #3 / #4.

• Select NA for Question #5, and skip Question #5A.

Yes

Yes

N.A.

N.A.

Depending on the response selected for this option, the value will be captured through one of the following fields:

• {ResponseInterventionCB}

• {DiscrepancyCB}

• {OtherARProcCB}

Others

A short text box is displayed when the user checks Other

Yes

Yes. Conditional

N.A.

N.A.

Captured through the {OtherARProc} field.

Question: #1

The child received appropriate instruction in regular education settings, and data-based documentation of achievement, reflecting formal assessments of student progress during instruction, was provided to the child's parents.

Yes / No check boxes to select.
Only one can be selected at a time.

If you selected ‘No’ for this question then:

• Always select ‘No’ for Question #3 / #4.

• Always select ‘NA’ for Question #5.

• Always select ‘No’ for Question #10

Yes

Yes

N.A.

N.A.

Captured through the {SLDSchAgeLearnExp} field.

Question: #2

The child does not achieve adequately for the child's age or to meet State-approved grade-level standards in one or more of the following areas, when provided with learning experiences and instruction appropriate for the child's age or State-approved grade-level standards:

Yes / No check boxes to select.
Only one can be selected at a time.

If you selected ‘No’ for this question then:

• Question #2A is disabled.

• Always select ‘NA’ for Question #3 / #4.

Yes

Yes

N.A.

N.A.

Captured through the {SLDSchAgeNotAch} field.

Question: #2A

If you have select ‘Yes’ for the above question, you can choose one or more from the following list:

• Written Expression

• Oral Expression

• Listening Comprehension

• Reading Comprehension

• Basic Reading Skills

• Reading Fluency Skills

• Math Problem Solving

• Math Calculation

If you have not selected any option for this Question, then you must select ‘No’ for Question #10 as well.

Yes

Conditional

N.A.

N.A.

Depending on the response selected for this option, the value will be captured through one of the following fields:

• {SLDSchAgeWritExpr}

• {SLDSchAgeOralExpr}

• {SLDSchAgeListComp}

• {SLDSchAgeReadComp}

• {SLDSchAgeBasicRead}

• {SLDSchAgeReadFlu}

• {SLDSchAgeMathProb}

• {SLDSchAgeMathCalc}

Question: #3

The child does not make sufficient progress to meet age or State-approved grade-level standards in one or more of the areas identified above when using a process based on the child's response to scientific, research-based intervention.

• For a child who participated in a process that assesses the child's response to scientific, research-based intervention, the instructional strategies used and student-centered data are documented, and the child's parents were notified about:

  • The state's policies regarding the amount and nature of student performance data that would be collected and the general education services that would be provided;

  • Strategies for increasing the child's rate of learning;

  • The parents' right to request an evaluation.

OR

Question: #4
The child exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative to age, State-approved grade-level standards, or intellectual development, that is determined by the group to be relevant to the identification of a specific learning disability using appropriate assessments, consistent with 34 CFR 300.304 and 300.305.

Yes / No/NA check boxes to select.
Only one can be selected at a time.

This question accepts a response only if you chose Response to Intervention or Other Alternative Research-based Procedures as ‘Method of Eligibity Determination’ previously.

If you have selected ‘No’ for this Question, then you must select ‘No’ for Question #10 as well.

Yes

Yes

N.A.

N.A.

Captured through either the {SLDSANoProgress} or {SLDSANoProgress} field.

Question: #5

The child meets criteria for a severe discrepancy between achievement and ability in one or more of the following areas:

Yes / No/NA check boxes to select.
Only one can be selected at a time.

This question accepts a response only if you chose Severe Discepancy as ‘Method of Eligibity Determination’ previously.

If you have selected ‘No’ for this Question, then you must select ‘No’ for Question #10 as well.

Yes

Yes

N.A.

N.A.

Captured through either the {SLDSchAgeMeetsCrit} or {SLDSchAgeMeetsCrit} field.

Question: #5A

If you have selected ‘Yes’ for the above question,

You can choose one or more from the following list:

• Written Expression

• Oral Expression

• Listening Comprehension

• Reading Comprehension

• Basic Reading Skills

• Reading Fluency Skills

• Math Problem Solving

• Math Calculation

Yes

Conditional

N.A.

N.A.

Depending on the response selected for this option, the value will be captured through one of the following fields:

• {DiscrepAreaWritExpr}

• {DiscrepAreaOralExpr

• {DiscrepAreaListComp}

• {DiscrepAreaReadComp}

• {DiscrepAreaBasicRead}

• {DiscrepAreaReadFlu}

• {DiscrepAreaMathProb}

• {DiscrepAreaMathCalc}

Question: #6

The observation(s) have been completed in each area of deficit and comply with state and federal regulations.

Yes/No checkboxes to select.
Only one can be selected at a time.

If you selected ‘No’ for this Question, then you must select ‘No’ for Question #10 as well.

Yes

Yes

N.A.

N.A.

Captured through the {AreaOfDeficits} field.

Question: #7

Was there any relevant behavior noted during the observation?

Yes/No checkboxes to select.
Only one can be selected at a time.

Yes

Yes

N.A.

N.A.

Captured through the {BehaviorCB} field.

Question: #7A

If yes, what is the relationship of the behavior to the child's academic functioning?

Long text box.
You can also narrate an answer and use the Speech to text option.

Yes

Yes.

Conditional

N.A.

N.A.

Captured through the {BehaviorRelationship} field.

Question: #8

Are there any medical findings that are educationally relevant?

Yes/No checkboxes to select.
Only one can be selected at a time.

Yes

Yes

N.A.

N.A.

Captured through the {MedicalCB} field.

Question: #8A

If yes, describe:

Long text box.
You can also narrate an answer and use the Speech to text option.

Yes

Yes. Conditional

N.A.

N.A.

Captured through the {MedicalFinding} field.

Question: #9

The deficits identified are not primarily the result of a visual, hearing, or motor disability; intellectual disability; emotional disturbance; cultural factors; environmental or economic disadvantage; or limited English proficiency.

Yes / No check boxes to select.
Only one can be selected at a time.

If you selected ‘No’ for this Question, then you must select ‘No’ for Question #10 as well.

Yes

Yes

N.A.

N.A.

Captured through the {DeficitIdentifyCB} field.

Question: #10

It is the determination of the group participants that this child has a specific learning disability as defined in state and federal regulations implementing IDEA as amended. The determination has been made in accordance with 34 CFR 300.306(c)(1).

Yes / No check boxes to select.
Only one can be selected at a time.

If ‘No’ is getting selected automatically, based selections made of other fields previously, this field cannot be edited, else you can choose either Yes/No.

Yes

Yes

N.A.

N.A.

Captured through the {GroupParticipantCB} field.

Parents / Guardian

• You can add multiple entries under the heading ‘Parents or Guardians’.

• To add an additional entry, click the icon and a new row will appear.

Each Parent must certify in writing (by selecting ‘Agree’ or ‘Disagree’ on whether the report reflects his or her conclusion. If it does not reflect his or her conclusion, the group member must submit a separate statement presenting that conclusion.

Yes

Yes

N.A.

N.A.

Captures Signatures through the {ParentESign} field and Signature Date through {ParentSignedDate) field.

The response to ‘Agree’ and ‘Disagree’ is captured through {ParentAgree:+} or {ParentAgree:-}

Student

To add a Student entry, click the icon and a new row will appear. Select ‘Student’ from the drop-down.

The Student must certify in writing (by selecting ‘Agree’ or ‘Disagree’ on whether the report reflects his or her conclusion. If it does not reflect his or her conclusion, the group member must submit a separate statement presenting that conclusion.

Yes

No. Conditional

N.A.

N.A.

Captures Signatures through the {StudentESign} field and Signature Date through {StudentSignedDate) field.

Others

• You can add multiple entries under the heading ‘Others’.

• To add an additional entry, click the icon and a new row will appear.

This is an ad-hoc entry. This entry is needed when you want to get signatures from any additional person, such as an emergency contact.

Each additional person added as ‘others’ must certify in writing (by selecting ‘Agree’ or ‘Disagree’ on whether the report reflects his or her conclusion. If it does not reflect his or her conclusion, the group member must submit a separate statement presenting that conclusion.

Yes

No.

Conditional

N.A.

N.A.

This is an ad-hoc entry. This entry is needed when you want to get signatures from any additional person, such as an emergency contact.

The response to ‘Agree’ and ‘Disagree’ is captured through {OtherAgree:+} or {OtherAgree:-}

Special Education Teacher

• Use Lookup or Non-Lookup to select the Special Education Teacher from the Staff Profile.

• After selection, the teacher must sign the document. The system records their signature, date, and time stamp.

The selected Special Education Teacher must certify in writing (by selecting ‘Agree’ or ‘Disagree’ on whether the report reflects his or her conclusion. If it does not reflect his or her conclusion, the group member must submit a separate statement presenting that conclusion.

Yes

Yes

Staff Profile

N.A.

Captured through the {SpEdTeacherLU},
{SpEdTeacherSignCB}, and
{SpEdTeacherSignDate} fields.

The response to ‘Agree’ and ‘Disagree’ is captured through {SpEDTeacherAgree:+} or {SpEDTeacherAgree:-}

General Education Teacher

• Use Lookup or Non-Lookup to select the General Education Teacher from the Staff Profile.

• After selection, the teacher must sign the document. The system records their signature, date, and time stamp.

The selected General Education Teacher must certify in writing (by selecting ‘Agree’ or ‘Disagree’ on whether the report reflects his or her conclusion. If it does not reflect his or her conclusion, the group member must submit a separate statement presenting that conclusion.

Yes

Yes

Staff Profile

N.A.

Captured through the {GenEdTeacherLU}, {GenEdTeacherSignCB}, and
{GenEdTeacherSignDate} fields.

The response to ‘Agree’ and ‘Disagree’ is captured through {GenEDTeacherAgree:+} or {GenEDTeacherAgree:-}

Local Education Agency Representative

• Use Lookup or Non-Lookup to select the LEA Representative from the Staff Profile.

• After selection, the representative must sign the document. The system records their signature, date, and time stamp.

The selected LEA Representative must certify in writing (by selecting ‘Agree’ or ‘Disagree’ on whether the report reflects his or her conclusion. If it does not reflect his or her conclusion, the group member must submit a separate statement presenting that conclusion.

Yes

Yes

Staff Profile

N.A.

Captured through the {LEARepresentativeLU}, {LEARepSignCB}, and
{LEARepSignDate} fields.

The response to Agree’ and ‘Disagree’ is captured through {LEARepAgree:+} or {LEARepAgree:-}

An individual qualified to conduct individual diagnostic examinations (School Psych, speech-language pathologist, or remedial reading teacher)

• Use Lookup or Non-Lookup to select the Interpreter from the Staff Profile.

• After selection, the interpreter must sign the document. The system records their signature, date, and time stamp.

The selected Interpreter must certify in writing (by selecting ‘Agree’ or ‘Disagree’ on whether the report reflects his or her conclusion. If it does not reflect his or her conclusion, the group member must submit a separate statement presenting that conclusion.

Yes

Yes

Staff Profile

N.A.

Captured through the {IndividualDiagExamLU}, {IntDiagExamSignCB}, and {IntDiagExamSignDate} fields.

The response to Agree’ and ‘Disagree’ is captured through {IntDiagExamAgree:+} or {IntDiagExamAgree:-}

Others

• You can add multiple entries under the heading ‘Others’.

• To add an additional entry, click the icon and a new row will appear.

Yes

Yes

N.A.

N.A.

N.A.

Mode of Delivery

The method used to send the document to the parent.

Yes

Yes

N.A.

Document Delivery Profile

Captured through the {DeliveryMethod) field.

Date of Delivery

The date on which the document was dispatched to the parent.

Yes

Yes

N.A.

Document Delivery Profile

Captured through the {DateProvided} field.