Placement Criteria Evaluation Form for Adapted Physical Education Childs name: Rae Disability: Learning Disability Age:

8.4 Previous placement: General Physical Education Team members present: Delia Powell Adapted Physical Educator _____________________________________________________________________________ Variables considered before determining placement: Fitness scores: Not Assessed CV endurance: _________ Met standard / Did not meet standard Upper body strength: _________ Met standard / Did not meet standard Abdominal strength: _________ Met standard / Did not meet standard Flexibility: _________ Met standard / Did not meet standard BMI: _________ Met standard / Did not meet standard Please circle a rating for the following questions using the scale below 1 GPE appropriate 2 - GPE and APE needed 1) Fitness Recommendation 1 2

3-APE needed 3

Motor skill performance: Based on the TGMD2, Raes performance of motor skill performance is poor. She ranks at the 8th percentile as compared to others her age. 2) Motor Skill Recommendation 3) Social skills 4) Behavioral needs 5) Sensory needs 6) Ability to be in large class with others 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3

Average overall score from all areas: 1 2 3 Decision for placement and rationale: Based on her performance it is suggested that Rae receive APE services to address her significantly delayed gross motor skills, additional practice is needed in a more restricted environment. Currently Rae is attending physical education 3 times a week on Monday, Wednesday and Friday. It is suggested that Rae spend 2 days in GPE with accommodations and 1 day in APE. Rae will spend Monday in APE; and she will spend Wednesday and Friday GPE. Raes current level of performance of locomotor skills is at a 5-6 age range and a 0-7 age range for object control, which equates to poor performance for her age.

Rae does have the social and behavior skills for appropriate placement in general physical education GPE. GPE does meet Raes sensory needs. Rae does stay on task in a large class when working in small groups or partnered with a peer. However she may fall off task when the whole class is involved in a game situation involving large group activities. Because the General Physical Education teacher has made accommodations for Rea such as pairing her up with a buddy, placing her in small groups, using visual aids and providing visual demonstrations; Rea has been making improvements. She can follow 3 step directions, maintain social responsibility, and maintain proper behaviors in GPE. She would benefit socially and emotionally in GPE. However, Rae does need additional support in locomotor skills and object manipulation and would benefit from having more one on one instruction, more time allotted for practice, and the focus be on mastery of fewer skills. This would be done in adapted physical education setting.