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    Speech or Language Impairment Eligibility Determination

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    1. This document is an eligibility determination form for speech or language impairment (SLI) that must be attached to an Admissions and Release Committee (ARC) conference summary. 2. It requires documentation of whether the student has a communication disorder in areas like language, articulation, or voice that adversely affects their educational performance. 3. Factors like lack of instruction or limited English proficiency must be ruled out as determinants in the eligibility decision. Evaluation data from multiple sources must confirm the existence of the disability and its significant negative impact on the student's educational performance compared to peers.

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    Speech or Language Impairment Eligibility Determination

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    1. This document is an eligibility determination form for speech or language impairment (SLI) that must be attached to an Admissions and Release Committee (ARC) conference summary. 2. It requires documentation of whether the student has a communication disorder in areas like language, articulation, or voice that adversely affects their educational performance. 3. Factors like lack of instruction or limited English proficiency must be ruled out as determinants in the eligibility decision. Evaluation data from multiple sources must confirm the existence of the disability and its significant negative impact on the student's educational performance compared to peers.

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    1. This document is an eligibility determination form for speech or language impairment (SLI) that must be attached to an Admissions and Release Committee (ARC) conference summary. 2. It requires documentation of whether the student has a communication disorder in areas like language, articulation, or voice that adversely affects their educational performance. 3. Factors like lack of instruction or limited English proficiency must be ruled out as determinants in the eligibility decision. Evaluation data from multiple sources must confirm the existence of the disability and its significant negative impact on the student's educational performance compared to peers.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    96 views2 pages

    Speech or Language Impairment Eligibility Determination

    Uploaded by

    api-539726271
    1. This document is an eligibility determination form for speech or language impairment (SLI) that must be attached to an Admissions and Release Committee (ARC) conference summary. 2. It requires documentation of whether the student has a communication disorder in areas like language, articulation, or voice that adversely affects their educational performance. 3. Factors like lack of instruction or limited English proficiency must be ruled out as determinants in the eligibility decision. Evaluation data from multiple sources must confirm the existence of the disability and its significant negative impact on the student's educational performance compared to peers.

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    Enter District Name Here

    Speech or Language Impairment (SLI)


    Eligibility Determination Form
    Attachment to Admissions and Release Committee (ARC) Conference Summary
    This form documents the student’s eligibility for SLI as a disability category only. This form is not required for
    speech or language as a related service.

    Initial Determination of Eligibility for this Category Re-Determination of Eligibility for this Category of
    of Disability Disability
    Student’s Full Name: SSID:
    Date of Birth: Date of Eligibility Determination:
    School:

    The ARC determines a student to have a speech or language impairment and is eligible for specially designed
    instruction and related services when:

    Complete
    During The ARC compared and analyzed evaluation data and documents the following interpretation.
    ARC

    Y N 1. Communication disorder in one or more of the following:


    absence of language
    delayed acquisition of language
    impaired articulation
    language impairment
    stuttering
    voice impairment

    Y N 2. Evaluation information confirms there is an adverse effect on educational performance.

    Y N 3. Evaluation information confirms lack of instruction in reading and math is not a


    determinant factor in the eligibility decision.

    Y N 4. Evaluation information confirms limited English proficiency is not a determinant factor in


    the eligibility decision.

    On the following page provide supporting documentation that demonstrates the ARC:
    • Used multiple sources to triangulate the data and substantiate the existence of the disability; and
    Confirmed the progress of the student is impeded by the disability to the extent the student’s educational
    performance is significantly and consistently below the level of similar age peers.

    Page |1 Speech or Language Impairment Eligibility Determination Form


    Revised 2016
    Speech or Language Impairment
    Eligibility Determination Form

    Student’s Full Name: SSID:


    Supporting Documentation:

    *Note: The guidelines in the Kentucky Eligibility Guidelines - Revised for Students with Speech Language
    Impairment, 2009 may be used as supporting evidence to verify speech language impairment.

    The ARC used the interpretation of the evaluation data documented above to determine:
    The student meets the eligibility criteria for a speech or language impairment, which adversely impacts his/her
    education, and is eligible for specially designed instruction and related services.
    The student does not meet the eligibility criteria for a speech or language impairment and is not eligible for
    specially designed instruction and related services.
    The student has a speech or language impairment, but it does not adversely impact his/her education; therefore,
    the student is not eligible for specially designed instruction and related services.
    Evaluation data are insufficient to determine eligibility. Additional assessments and data will be obtained in
    the area(s) of:

    The ARC will reconvene by to review and determine eligibility.


    Page |2 Speech or Language Impairment Eligibility Determination Form
    Revised 2016

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