Allegany County Public Schools

Assessment Report for

Student's Name:	Date:
School:	Grade:
Local Student ID:	Date of Birth:
State Student ID:
Parent(s) Name:
Examiner:	Title:

Background (including referral information)

Test(s) and/or Procedure(s) Administered

Assessment Findings

Relevant test behavior:

Description of student's overall performance in comparison to developmental milestones, achievement levels and/or behavior patterns of typical peers:

Instructional Implications for Student's Participation in General Curriculum

Documentation of Assessment Validity

Documentation of Assessment Validity

Does the student have Limited English Proficiency?
Yes
No
If yes, what language or mode of communication was used for assessment?

In the opinion of the evaluator, is this assessment an accurate reflection of the student's performance at this time?
Yes
No
Is this assessment felt to be culturally and linguistically valid for its intended purpose and for this student?
Yes
No

Examiner’s Signature	Title

Allegany County Public Schools Assessment Report	Page 1

Rick Metheny

2007-10-10

HP Authorized Customer

ATS