Educational Assessment: Part A printable pdf download

Educational Assessment: Part A

School District Name:

School District Address:

Educational Assessment: Part A

603 CMR 28.04(2)(a)(2)

Student Name: ___________________________________________________DOB: _____________Grade: _________________

School Personnel & Role: _____________________________________________________________Date: ___________________

SCHOOL HISTORY:

YEAR

GRADE

SCHOOL

Has the student received any instructional support services?

YES If YES, please explain.

Have there been any school-related events/issues (such as attendance, recognitions, special education referrals, behavioral

issues and medical problems) that have impacted upon the student’s learning?

YES If YES, please explain.

EDUCATIONAL PROGRESS AND POTENTIAL:

Is the student making progress in the general curriculum?

YES

NO If NO, explain why not and reference the

student’s educational history and state/district-wide assessment results when responding.

Has the student’s progress been:

a. similar to that of his/her peers?

YES

NO If NO, list the possible factors that have enhanced/ limited progress.

b. consistent over the student’s school history?

YES

NO If NO, list the possible factors that have enhanced or limited progress.

Provide any other comments related to the student’s educational and developmental potential.

Massachusetts Department of Education / Educational Assessment

Page 1 of 2

Recommended Form - 28R/1

Educational Assessment: Part A