Behavior/performance Review Results
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1
2BEHAVIOR/PERFORMANCE REVIEW RESULTS
Student Name:
ID#:
School:
Date:
I.
DECISION
The Behavior/Performance Review Team responded to the following four statements after reviewing the student’s academic and behavioral data
listed below.
1. The student’s academic performance and/or behavior is significantly interfering with his/her learning, indicating s/he may need a Multi-Disciplinary
Evaluation (MDE).
Yes
No
2. The student’s history of academic performance and/or behavior indicates that the student may need a Multi-Disciplinary Evaluation (MDE).
Yes
No
3. There is previous evidence of verbal or written expression of concern from parent/surrogate parent and/or teachers that the student may have a disability.
Yes
No
4. The parent/surrogate parent has requested a Multi-Disciplinary Evaluation PRIOR TO DISCIPLINARY INCIDENT.
Yes
No
If the response to ANY of the above statements is YES, then the BPR team has decided that the student is thought to have a disability. Child will remain in
current placement until the evaluation is completed.
.
If the response to ALL of the above statements is NO, then the BPR team has decided that the student is NOT thought to have a disability
II.
CUMULATIVE RECORDS REVIEWED
Yes
No
Not Available
Pink Slips
Suspensions
Lateral transfers (EH 21) and Alternative Educational Settings
Report card student conduct rating:
Report card grades and last documented reading level
Documentation of verbal/written expression of concern from Parent/Surrogate Parent and/or teachers that the student may have a
disability:
TerraNova and PSSA results
MTSS Log: Behavioral and academic Interventions
Attendance/Lateness/Truancy history:
Student history with special education process
Conversations with current and past teachers
Conversations with parent/surrogate parent:
1 of 2
School District of Philadelphia
Behavior/Performance Review
OSR-7 (Rev.8/2013)
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