Pre-Evaluation Data Worksheet | Sped Hub

PRE-EVALUATION DATA WORKSHEET

Records review · RTI/MTSS synthesis · Exclusionary factors · Assessment planning · Diagnostician working document

Barber Sped Hub · barbersped.org

English Learner (EL) Data

Student is coded EL

Language Profile

Home Language:

Student Dominant Lang.:

Language of Instruction:

Years in US Schools:

OLPT Results:

TELPAS Ratings

Composite:

Listening:

Speaking:

Reading:

Writing:

EL Notes

STAAR / State Assessment Results

Year	READING / ELA				MATH				WRITING / SCI / SS (if applicable)
Year	Gr Tested	Did Not Meet	Approaches	Meets / Masters	Gr Tested	Did Not Meet	Approaches	Meets / Masters	Subject	Did Not Meet	Approaches	Meets / Masters
Yr 1
Yr 2
Yr 3

Curriculum, Screener & Grades Data

Screener / Progress Monitoring Data

Assessment: Data / Score:

Assessment: Data / Score:

Assessment: Data / Score:

Report Card Grades (current year)

Reading: Math: Writing:

Below avg in concern areas:

Y N

Failing or declining grades:

Y N

Page 2 — Interventions · Teacher Input · Eligibility & Planning

RTI / MTSS Intervention Data

Intervention #1

Program / Subject:

Frequency / Duration:

Fidelity Confirmed:

Y N

Results / ROI:

Intervention #2

Program / Subject:

Frequency / Duration:

Fidelity Confirmed:

Y N

Results / ROI:

Overall RTI Outcome

Adequate ROI

Instructional casualty?

Slow but Rising ROI

General low achievement?

Minimal ROI

SLD consideration?

N/A — No RTI data

Teacher Input — MTSS Meeting Summary

Teacher 1

Teacher Name

Grade / Subject

Performance stands out from peers?

Y N

Academic & Functional Concerns

Student Strengths & What Works

Teacher 2 (optional)

Teacher 2

Teacher Name

Grade / Subject

Performance stands out from peers?

Y N

Academic & Functional Concerns

Student Strengths & What Works

Work Samples

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