FREDERICK COUNTY, MARYLAND, PUBLIC SCHOOLS

CONFIDENTIAL EDUCATIONAL ASSESSMENT

NAME: DATE (S) OF EVALUATION:

GRADE/TEACHER: PARENTS:

DOB: ADDRESS:

SCHOOL: AGE:

PRIMARY LANGUAGE: EXAMINER:

I. BACKGROUND:

II. ASSESSMENTS GIVEN: Brigance Comprehensive Inventory of Basic Skills

III. EDUCATIONALLY RELAVANT MEDICAL FINDINGS:

IV: SUMMARY OF LEARNING PROFILE BASED ON EDUCATIONAL TEST DATA, OBSERVATIONS, AND
TEACHER JUDGEMENT:

RELATIVE STRENGTHS RELATIVE NEEDS

V. TEST RESULTS ON THE BRIGANCE INVENTORY

VI: CONCLUSIONS FROM THE ASSESSMENT

A. Documentation of assessment validity: (If the response to either question is No, the evaluator must explain in Section B.)

YES NO

___ ___ In the opinion of the evaluator, this assessment is an accurate reflection of the students performance at this time.

___ ___ This assessment is felt to be culturally and linguistically valid for its intended purpose and for this student.

B. Relevant test behavior:

C. Description of student’s overall performance as it deviates from developmental milestones, achievement levels
and/or behavior of non-disabled age-mates:

D. Recommendations:
1. The IEP Team should review this information in comparison to other assessment information to determine the
existence of an educational disability.

Evaluator: _______________________________________
Signature of Special Education Teacher

Date: _______________________________________