Seneca Highlands Intermediate Unit Nine
Early
Intervention
RD#3
Box 311 A Smethport, PA 16749 (814)887-9287
Comprehensive
Evaluation Report (CER)
________ Initial
Evaluation
________ Re-evaluation
Date Permission to Evaluate or Re-evaluate Received
Date of Completion of MDE (last assessment)
Date of Comprehensive Evaluation Report
Child's Name DOB
Parent/Guardian/Surrogate
Phone
Address School District
Other Information (as needed)
____________________________________________________
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I. Reason(s) for
Referral
__________________
age, ___________, has been referred for an evaluation to determine eligibility
for Early Intervention services and to develop an appropriate program for
_______________________.
II. Early
Intervention History (previous programs and services)
________________________ has received early intervention services since _________. The following services have been provided:
XX
-2-
CER
III. Information from the Family (parents or
other persons with whom the child lives)
A. Child's strengths and needs including
physical history and current health status and needs, vision and hearing
status, cultural and language considerations and adaptive behavior.
______________________ lives with
________________________________. The
family expresses no specific cultural preferences or considerations and would
be comfortable having ______________ participate in all school activities. Special considerations for ___________ were
addressed. (His/her) vision and hearing
are within normal limits. (His/her)
behavior does not impede (his/her) learning or that of others. English is the primary language spoken in
the home, and _____________’s communication skills are adequate. (He/she) is able to function without
assistive technology services or devices.
____________________is not of transition age, and (his/her) health is
not a concern.
XX -3- CER
B. At the family's discretion, the family's
perceived strengths and needs which will
enhance the development of child.
IV. Summary of
Findings
A. For re-evaluation, include review of current
IEP
B. Developmental
Assessment
1. Test/Assessment Results
_____________________’s
chronological age was ______________months at the time of this assessment. A score of _______________months would
indicate a 25% delay.
Testing Date Procedures Results Given by
observation
review of
records
parent interview
speech/language
evaluation
Preschool
Language Scale-3
Auditory Comprehension:
Expressive
Communication:
Total Language Age:
Goldman Fristoe Test of Articulation:
developmental
evaluation
Learning
Accomplishment Profile-D
Cognition
Communication
Fine
Motor
Gross
Motor
Self
Help
Social
2. Narrative (including, but not limited to,
physical development, cognitive and
sensory development, learning strengths
and educational needs,
language and speech development, social
and emotional development, behavior,
self-help skills, health considerations.)
Social (include information regarding attention span and behavior)
C. Observations
(Information from observations during daily activities such as play
with other children and interaction with
family members and/or other adults.)
D. Area(s) of
Delay
_____________________
demonstrates delays in
E. Skills needed by the child to function
successfully in variety of settings,
including the home, school, and community.
A. Recommendations of Eligibility for E.I.
Services and Programs:
1. _______ Team recommends eligibility for early intervention
services.
Child has a disability and requires special education, which
may include related services.
The
following services or programs should be considered by the IEP team.
2. _______ Team recommends continued eligibility (attach IEP).
Child has a
disability and continues to require special education, which may include
related services. The following
programs or services should be considered by the IEP team.
3. _______ Team does not recommend eligibility for early
intervention services.
Recommendations for follow-up activities (if any) are:
B.
Recommended services to meet the family's needs:
Individual support will be provided to
__________________ by the I.U. 9 Early Intervention staff through communication
notebooks, telephone calls, and prearranged visits.
(Please indicate your agreement or
disagreement with the conclusion or content of this report. If you disagree, please write the reasons for
disagreement and attach them to this report.)
SIGNATURE TITLE DATE AGREE DISAGREE
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This
report is a draft until
all
MDT members (including
parents)
have reviewed _______________________
and
signed the report. (date
draft CER sent/given to parents)
Any
dissenting opinions _______________________
must
be included. (date
final report sent/given to parents)