Classification Criteria Form for II

Name of Participant: ______________________________________ Age: _______________

Date of Birth: ____________________ Gender: _____________ Country: _____________
List of Sports Participating:
1.______________________ 2. _____________________ 3. _______________________

Full Eligibility Classification Criteria: (Please Fill in Clearly)

1.   A Full Psychological Assessment Report with Diagnosis with the following:
§   Report must be valid for up to 3 years from the date of assessment
§   Report must show all details of subscale or global scale scores, percentile scores and
ability classification
(Note: WISC, WIPPSI, WAIS or similar can be used)

Name of Psychological Test: ________________________ Date of Assessment: ____________

Global Subscale Scores Percentile Ability

Global Scale
(95% Confidence Limit) Rank Classification
Verbal Comprehension
Perceptual Reasoning
Other Domains (indicate below)

Full Scale IQ Score

2.   An Adaptive Behaviour Assessment Report with the following:

§   Report must be valid for up to 3 years from the date of assessment
§   Report must show all details of standard scores and adaptive level
(Note: Vineland or similar can be used)

Name of Adaptive Test: ________________________ Date of Assessment: ____________

Adaptive Behaviour
Standard Score Adaptive Level
Domain
Communication
Daily Living Skills
Socialisation
Motor Skills
Adaptive Behaviour Composite

3.   A Clear Diagnosis of Intellectual Impairment with Intelligence Quotient 70 or below

What is the Diagnosis? _______________________

Conditional Eligibility Classification Criteria:

1.   When the participant does not meet all the criteria for Full Eligibility
2.   Submission of any document endorsed by the Principal to prove that the participant was
from a special school on the school’s letter head Submitted (Circle: YES or NO)
3.   A Letter from a Certified Medical Doctor diagnosing the child as having Intellectual
Impairment with IQ below 70 Submitted (Circle: YES or NO)

Official Classifier Remarks and Conclusion (Full Eligibility, Conditional Eligibility or Rejected)