Nocona ISD District Dyslexia Plan

2015-2018

Source – Dyslexia Handbook Revised 2014

Table of Contents I.

Definition of Dyslexia………………………………………………………….3

II.

State and Federal Law regarding Early Identification and Intervention Prior to Formal Assessment……………………………………………………………..3

III.

Procedures for Assessment……………………………………………………..4

IV.

Procedures for Assessment of Dyslexia………………………………………..6

V.

Identification of Students with Dyslexia……………………………………….8 Assessment under Section 504…………………………………………………10 Assessment under Special Education…………………………………………..10 Assessment of Special Education Students…………………………………….10 Assessment of Students Identified Outside the District………………………..12

VI.

Instruction for Students with Dyslexia…………………………………………13

VII.

Timeline………………………………………………………………………..13

VIII. Student Monitoring and Program Exit Criteria………………………………….14 Appendices.…………………………………………………………………………….16

2 Source – Dyslexia Handbook Revised 2014

I. Definition of Dyslexia As defined in Texas Education Code §38.003 (1) “Dyslexia” means a disorder of constitutional origin manifested by a difficulty in learning to read, write, or spell, despite conventional instruction, adequate intelligence, and sociocultural opportunity. (2) “Related disorders” includes disorders similar to or related to dyslexia such as developmental auditory imperceptions, dysphasia, specific developmental dyslexia, developmental dysgraphia, and developmental spelling disability. The current definition from the International Dyslexia Association states the following: Dyslexia is a specific learning disability that is neurological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge. (Adopted by the International Dyslexia Board of Directors, November 12, 2002). Students identified as having dyslexia typically experience primary difficulties in phonological awareness and manipulation, single-word reading, reading fluency, and spelling. Consequences may include difficulties in phonological awareness are unexpected for the student’s age and educational level, and are not primarily the result of language difference factors. Additionally, there is often a family history of similar difficulties. II. State and Federal Law Regarding Early Identification and Intervention Prior to Formal Assessment Both state and federal legislation emphasize early identification and intervention for students who may be at risk for reading difficulties, such as dyslexia. In accordance with TEC §28.006 Reading Diagnosis, Nocona ISD administers early reading instruments in kindergarten, first, and second grades to determine students’ reading development and comprehension. Additionally, the law requires a reading instrument from the commissioner’s approved list to be administered at the beginning of grade 7 to any student who did not demonstrate proficiency on the reading assessment administered under TEC§39.023(a). If, on the basis of the reading instrument results, students are determined to be at risk for dyslexia and other reading difficulties, the students’ parents/guardians are notified. In addition, an accelerated (intensive) reading 3 Source – Dyslexia Handbook Revised 2014

program that appropriately addresses students’ reading difficulties and enables them to “catch up” with their typically performing peers is implemented. The information from reading instruments administered under TEC §28.006 will be one source of information in deciding whether or not to recommend a student for assessment for dyslexia. The provisions offered to students who are reported to be at risk for dyslexia or other reading difficulties should align to the requirements of Elementary and Secondary Education Act (ESEA) legislation, Nocona ISD will implement reading programs using scientifically based reading research as well as evidence proven effective results. Under the Equal Education Opportunity Act (EEOA), Nocona ISD ensures that all students are given equal access to educational services regardless of race, color, sex, religion, or national origin. Therefore, research-based interventions are to be provided to all students experiencing difficulties in reading, including English language learners (ELL), regardless of their proficiency in English. III. Procedures for Assessment At any time (from kindergarten through grade 12) a student continues to struggle with one or more components of reading, Nocona ISD will collect additional information about the student. Data Gathering: Information will be used to evaluate the student’s academic progress and determine what actions are needed to ensure the student’s improved academic performance. This information should include data that demonstrates the student was provided appropriate instruction and data-based documentation of repeated assessments of achievement at reasonable intervals (progress monitoring), reflecting formal assessment of student progress during instruction. Additional information to be considered includes the results from some or all of the following: ● Vision screening ● Hearing screening ● Teacher reports of classroom concerns ● Classroom reading assessments ● Accommodations or interventions provided ● Academic progress reports (report cards) ● Gifted/Talented assessments ● Samples of schoolwork ● Parent conference notes ● Testing for limited English proficiency (all years available) ● Speech and language screening through a referral process (English and native language, if possible) ● The K-2 reading instrument as required in TEC §28.006 (English and native language, if possible) ● 7th-grade reading instrument results as required in TEC§28.006 4 Source – Dyslexia Handbook Revised 2014

● ● ● ● ● ● ● ●

State student assessment program as described in TEC §39.002 Observations of instruction provided to the student Full Individual Evaluation (FIE) Outside evaluations School attendance Curriculum-based assessment measures Instructional strategies provided and student’s response to the instruction Universal screening

Data that support the student received conventional (appropriate) instruction and that the difficulties are not primarily the result of sociocultural factors which include language differences, irregular attendance, or lack of experiential background. Among the actions that Nocona ISD has available for the student is a recommendation that the student be assessed for dyslexia. Nocona ISD recommends assessment for dyslexia if the student demonstrates the following: ● Poor performance in one or more areas of reading and/or the related area of spelling that is unexpected for the student’s age/grade ● Characteristics and risk factors of dyslexia Primary Reading/Spelling Characteristics of Dyslexia: ● Difficulty reading words in isolation ● Difficulty accurately decoding unfamiliar words ● Difficulty with oral reading (slow, inaccurate, or labored) ● Difficulty spelling It is important to note that students demonstrate differences in degree of impairment. The reading/spelling characteristics are most often associated with the following: ● Segmenting, blending, and manipulating sounds in words (phonemic awareness) ● Learning the names of letters and their associated sounds ● Holding information about sounds and words in memory (phonological memory) ● Rapid recalling the name of familiar objects, colors, or letters of the alphabet (rapid naming) Consequences of dyslexia may include the following: ● Variable difficulty with aspects of reading comprehension ● Variable difficulty with aspects of written language ● Limited vocabulary growth due to reduced reading experiences If a student continues to struggle with reading, the identification of reading disabilities, including dyslexia, will follow one of two procedures. Nocona ISD will typically evaluate for dyslexia through §504. If however, a student is suspected of having a disability within the scope of IDEA 2004, all special education procedures will be followed. 5 Source – Dyslexia Handbook Revised 2014

IV. Procedures for Assessment of Dyslexia Students enrolling in Nocona ISD shall be assessed for dyslexia and related disorders at appropriate times (TEC §38.003(a)). The appropriate time depends upon multiple factors including the student’s reading performance, reading difficulties, poor response to supplemental, scientifically based reading instruction, teachers’ input, and parents’ or guardians’ input. Additionally, the appropriate time for assessing is early in a student’s school career (19 TAC §74.28), the earlier the better. While earlier is better, students will be recommended for assessment for dyslexia even if the reading difficulties appear later in a student’s school career. When formal assessment is recommended, Nocona ISD completes the evaluation process as outlined in §504 (Form 4, Appendix A) unless a referral to special education is indicated. Through §504 process, Nocona ISD will complete the evaluation using the following procedures: 1. Notify parents or guardians of proposal to assess student for dyslexia (§504) (Form 5, Appendix B). 2. Inform parents or guardians of their rights under §504 (Form 6, Appendix C). 3. Obtain parent or guardian permission to assess the student for dyslexia (Form 4, Appendix B). 4. Assess student, being sure that individuals/professionals who administer assessments have training in the evaluation of students for dyslexia and related disorders (19 TAC §74.28). In compliance with §504 and IDEA 2004, test instruments, and other evaluation materials must meet the following criteria: • Be validated for the specific purpose for which the tests, assessments, and other evaluation materials are used • Include material tailored to assess specific areas of educational need and not merely materials that are designed to provide a single general intelligence quotient • Be selected and administered so as to ensure that, when a test is given to a student with impaired sensory, manual, or speaking skills, the test results accurately reflect the student’s aptitude or achievement level, or whatever other factor the test purports to measure, rather than reflecting the student’s impaired sensory, manual, or speaking skills • Be selected and administered in a manner that is not racially or culturally discriminatory • Include multiple measures of a student’s reading abilities such as informal assessment information (e.g., anecdotal records, district universal screenings, progress 6 Source – Dyslexia Handbook Revised 2014

• • •

monitoring data, criterion referenced assessments, results of informal reading inventories, classroom observations) Be administered by trained personnel and in conformance with the instructions provided by the producer of the evaluation materials Be used for the purpose for which the assessment or measures are valid or reliable Be provided and administered in the student’s native language or other mode of communication and in the form most likely to yield accurate information regarding what the child can do academically, developmentally, and functionally, unless it is clearly not feasible to provide or administer

Domains to Assess Nocona ISD administers measures that are related to the student’s educational needs. Depending upon the student’s age and stage of reading development, the following are the areas related to reading that should be assessed: Academic Skills Letter knowledge (name and associated sound) • Reading words in isolation • Decoding unfamiliar words accurately • Reading fluency (both rate and accuracy are measured) • Reading comprehension • Spelling Cognitive processes that underlie the reading difficulties Phonological/phonemic awareness • (Difficulties in phonological and phonemic awareness are typically seen in students with dyslexia and impact a student’s ability to learn letters and the sounds associated with letters and letter combinations, learn the alphabetic principle, use the sounds of the letters and letter combinations to decode words and to accurately spell.) • Rapid naming (Difficulties in rapid naming may or may not be weak, but if deficient, will impact a student’s ability to automatically name letters and read words and to read connected text at an appropriate rate. • Orthographic processing (Memory for letter patterns, letter sequences, and the letters in whole words may be selectively impaired or may coexist with phonological processing weaknesses.) • Various language processes (Language processes such as morpheme and syntax awareness, memory and retrieval of verbal labels, and the ability to formulate ideas into grammatical sentences, may also be factors affecting reading.) Based on the student’s academic difficulties and characteristics, additional areas that may be assessed include the following: • Vocabulary • Listening comprehension • Verbal expression 7 Source – Dyslexia Handbook Revised 2014

• Written expression • Handwriting • Memory for letter or symbol sequences (Orthographic processing) • Mathematical/calculation reasoning • Phonological memory Verbal working memory Processing speed English Language Learners: This refers to students served in Bilingual and ESL programs as well as students designated Limited English Proficient (LEP) whose parents have denied services. Much diversity exists among English Language Learners (ELLs). The identification and service delivery process for dyslexia must be in step with the student’s linguistic environment and educational background. Involvement of the Language Proficiency Assessment Committee (LPAC) in the decision making process is required. Additional data to be gathered when assessing English Language Learners: • Language Proficiency Assessment Committee (LPAC) documentation which includes the following: o Home language survey o Assessment related to identification for limited English proficiency (oral language proficiency tests and norm-referenced tests) o State student assessment data results when available o Texas English Language Proficiency system (TELPAS) information (Reading Proficiency Test in English (RPTE)) o Type of language programming provided and language of instruction o Linguistic environment and second-language acquisition development o Previous schooling in and outside of the United States Additional assessment when assessing English Language Learners: • Comprehensive oral language proficiency testing should be completed for a dyslexia evaluation due to the importance of the information for o consideration in relation to academic challenges, o planning the assessment, and o interpreting assessment results. Interpretation: Test results of English Language Learners (ELL) will be interpreted in light of the student’s: language development (in both English and the student’s native language, educational history, linguistic background, socioeconomic issues, nature of the writing system and any other pertinent factors that affect learning.

8 Source – Dyslexia Handbook Revised 2014

V. Identification of Students with Dyslexia The identification of dyslexia is made by a §504 committee or, in the case of a special education referral, the admission, review, and dismissal (ARD) committee. In order to make an informed determination, either committee must include members who are knowledgeable about: • The student being assessed • The reading process • Dyslexia and related disorders • Dyslexia instruction • District or charter school, state, and federal guidelines for assessment • The assessments used • The meaning of the collected data The (§504 or ARD) committee will review all accumulated data to determine whether the student demonstrates a pattern of evidence for dyslexia. This data will include the following: • The observations of the teacher, district or charter school staff, and/or parent/guardian (Forms 7 & 8, Appendix D) • Data gathered from the classroom (including student work and the results of classroom measures) and information found in the student’s cumulative folder (including the developmental and academic history of the student) • Data-based documentation of student progress during instruction/intervention • The results of administered assessments • Language Assessment Proficiency Committee (LPAC) documentation, when applicable • All other accumulated data regarding the development of the student’s learning and his/her educational needs §504 or ARD Committee Decision Points for Dyslexia Identification: • The pattern of evidence for the primary characteristics of dyslexia with unexpectedly low performance for the student’s age and educational level in some or all of the following areas: o Reading words in isolation o Decoding unfamiliar words accurately and automatically o Reading fluency for connected text (both rate and/or accuracy) o Spelling (an isolated difficulty in spelling would not be sufficient to identify dyslexia) • Based on the data, if the committee determines weaknesses are indicated in the listed academic skills, the committee will look next at the underlying cognitive processes for the difficulties seen in the student’s word reading and written spelling. These difficulties will typically be the result of a deficit in phonological or phonemic awareness. Additionally, there is often a family history of similar difficulties. 9 Source – Dyslexia Handbook Revised 2014

•

•

•

The student may also demonstrate difficulties in other areas of cognitive processing, including one or more of the following: o Rapid naming o Orthographic processing o Phonological memory o Verbal working memory o Processing speed If the student exhibits reading and written spelling difficulties and currently has appropriate phonological/phonemic processing, it is important to examine the student’s history to determine if there is evidence of previous difficulty with phonological/phoneme awareness. NOTE: Because previous effective instruction in phonological/phonemic awareness may remediate phonological awareness skills in isolation, average phonological awareness scores alone do not rule out dyslexia. Ongoing phonological processing deficits can be exhibited in word reading and/or written spelling. If the committee (§504 or ARD) determines the student exhibits weaknesses in reading and written spelling, the committee will then examine the student’s data to determine whether these difficulties are unexpected for the student in relation to the student’s other cognitive abilities (the ability to learn in the absence of print) and unexpected in relation to the provision of effective classroom instruction.

Many students with dyslexia will have difficulty with the secondary characteristics of dyslexia, including reading comprehension and written composition. The §504 or ARD Committee will also incorporate the following guidelines from TEC §38.003 and 19 TAC §74.28: • The student has received conventional (appropriate) instruction • The student has an unexpected lack of appropriate academic progress (in the areas of reading and spelling) • The student has adequate intelligence (an average ability to learn in the absence of print or in other academic areas) • The student exhibits characteristics associated with dyslexia • The student’s lack of progress is not due to socio-cultural factors such as language differences, irregular attendance, or lack of experiential background Assessment under Section 504 Based on the above information and guidelines, the committee first determines whether the student has dyslexia. If the student has dyslexia, the committee also determines whether the student has a disability under §504 (Form 16, Appendix E). Whether a student is eligible for §504 accommodations is a separate determination from the determination that the student has dyslexia. A student is disabled under §504 if the physical or mental impairment substantially limits one or more major life activities, such as the specific activity of reading. Additionally, the §504 committee, in determining 10 Source – Dyslexia Handbook Revised 2014

whether a student has a disability that substantially limits the student in a major life activity, must not consider the ameliorating effects of any mitigating measures that student is using. If the committee does not identify dyslexia, but the student has another condition or disability that substantially limits the student’s learning, eligibility for §504 services related to the student’s other condition or disability should be considered. Students with additional factors that complicate their dyslexia may require additional support or referral to special education. If a student is already qualified as a student with a disability under special education, the Admission, Review, and Dismissal (ARD) committee should determine the least restrictive environment for delivering the student’s dyslexia intervention. Assessment under Special Education At any time during the assessment for dyslexia, identification process, or instruction related to dyslexia, students may be referred for evaluation for special education. At times, students will display additional factors/areas complicating their dyslexia that requires more support than what is available through dyslexia instruction. At other times, students with severe dyslexia or related disorders will be unable to make adequate academic progress within any of the programs for dyslexia or related disorders. In such cases, a referral to special education for evaluation and possible identification as a child with a disability within the Individuals with Disabilities Improvement Act of 2004 (IDEA) will be made as needed. Students with additional factors that complicate their dyslexia may require additional support or referral to special education. Assessment of Special Education Students If a student is already in special education, but exhibits the characteristics of dyslexia or related disorders and is referred for assessment, assessment procedures for students under the Individuals with Disabilities Act (IDEA 2004) will be followed. Assessment data from prior special education assessments may be utilized, and/or additional assessment may be conducted by personnel trained in assessment to evaluate students for dyslexia and related disorders. In this case, the ARD committee will make determinations for those students. If the student with dyslexia is found eligible for special education in the area of reading, and the ARD committee determines the student’s instructional needs for reading are most appropriately met in a special education placement, the student’s Individualized Education Program (IEP) must include appropriate reading instruction. Appropriate reading instruction includes the components and delivery of dyslexia instruction listed in The Dyslexia Handbook ~ Revised 2014, Chapter III, “Instruction for Students with Dyslexia.” 11 Source – Dyslexia Handbook Revised 2014

Assessment of Students Identified Outside the District Students identified as having dyslexia or related disorders from an outside source will be evaluated for eligibility in the district’s program. Nocona ISD may choose to accept the outside assessment, or may re-assess the student. In either situation, the committee (§504 or ARD) will determine the identification status of a student enrolled in Nocona ISD, and the placement of the student in the dyslexia program(s). VI. Instruction for Students with Dyslexia Once it has been determined that a student has dyslexia, Nocona ISD shall provide an appropriate instructional program for the student as required in TEC §38.003: The board of trustees of each school district shall provide for the treatment of any student determined to have dyslexia or a related disorder. http://www.statutes.legis.state.tx.us/Docs/ED/htm/ED.38.htm#38.003 The following procedures must be followed: • Instructional decisions for a student with dyslexia are made by a team that is: knowledgeable about the student, the meaning of the evaluation information, and instructional components and delivery of instruction for students with dyslexia. • Nocona ISD shall purchase or develop a reading program for students with dyslexia and related disorders that is aligned with the descriptors found in this handbook. The descriptors include the components of phonemic awareness, sound-symbol association, syllabication, orthography, morphology, syntax, reading comprehension, and reading fluency. Instructional approaches include simultaneous, multisensory, systematic and cumulative, explicit, diagnostic teaching to automaticity, synthetic and analytic instruction (19 TAC §74.28). The components of instruction and instructional approaches are described in the next section of the Nocona ISD plan. • Nocona ISD must provide each identified student access at his/her campus to an instructional program that meets the requirements in 19 TAC §74.28(c) and to the services of a teacher trained in dyslexia and related disorders. The school district may, with the approval of each student’s parents or guardians, offer additional services at a centralized location. Such centralized services shall not preclude each student from receiving services at his or her campus (19 TAC §74.28). • Parents/guardians of students eligible under §504 must be informed of all services and options available to the student under that federal statute. • Teachers who provide the appropriate instruction for students with dyslexia must be trained in instructional strategies that utilize individualized, intensive, multisensory, phonetic methods and a variety of writing and spelling components specified in the next section of this plan. (19 TAC §74.28). • Teachers who provide the appropriate instruction for students with dyslexia must be trained in the professional development activities specified by Nocona ISD, and/or campus planning and decision-making committee, which shall include the instructional strategies indicated above (19 TAC §74.28). 12 Source – Dyslexia Handbook Revised 2014

Nocona ISD shall provide a parent education program for the parents/guardians of students with dyslexia and related disorders. The program should include the following: • Characteristics of dyslexia and related disorders • Information on assessment and diagnosis of dyslexia • Information on effective strategies for teaching students with dyslexia • Awareness of information on classroom modifications and especially of modifications allowed on standardized testing (19 TAC §74.28) Instructional decisions for a student with dyslexia, must be made by a committee (§504 or ARD) that is knowledgeable about the instructional components and approaches for students with dyslexia. In accordance with 19 TAC §74.28(c), districts shall purchase or develop a reading program for students with dyslexia and related disorders that incorporates all of the following components of instruction and instructional approaches. Critical, Evidence-Based Components of Dyslexia Instruction • Phonological Awareness • Sound-symbol Association • Syllabication • Orthography • Morphology • Syntax • Reading Comprehension Delivery of Dyslexia Instruction • • • • • •

Simultaneous, multisensory (VAKT Instruction) Systematic and Cumulative Instruction Explicit instruction Diagnostic teaching to automaticity Synthetic instruction Analytic instruction

Both the teacher of dyslexia and the regular classroom teacher should provide multiple opportunities to support intervention and to strengthen these skills; therefore, responsibility for teaching reading and writing must be shared by classroom teachers, reading specialists, interventionists, and teachers of dyslexia programs. VII. Timeline When a referral for dyslexia assessment is made, Nocona ISD will ensure the evaluation procedure is followed in a reasonable amount of time. Section 504 does not require 13 Source – Dyslexia Handbook Revised 2014

specific timelines; therefore Nocona ISD will follow the timelines Texas has established for the completion of initial special education evaluations through TEC §29.004(a). Special education students shall follow the timelines required by federal law, under IDEA 2004. VIII. Student Monitoring and Dyslexia Program Exit Criteria Upon successful completion of Nocona ISDs program(s), as measured by program mastery checks (assessments) completed at regular intervals, students will be exited from the district dyslexia program(s). Additional criteria for exit may include but is not limited to: grades from progress reports or report cards, state assessment data, benchmarks, progress monitoring data, teacher and/or parent observations/checklists, and individual dyslexia program requirements. Students that have completed the Nocona ISD dyslexia program will receive regular monitoring during the first year. Monitoring may include, but is not limited to the collection/evaluation of: • Progress reports • Report cards • State assessment data • Teacher reports/checklists • Parent reports/checklists • Counselor reports • Other program reports • Additional assessment data Students qualifying for dyslexia services that are identified as §504 or special education will follow monitoring/re-evaluation requirements outlined in federal law. No one factor is sufficient to warrant exiting a student from direct dyslexia services. Dismissal from direct dyslexia services is determined by the §504 committee or the ARD committee. The committee considers the following factors when recommending exiting or reduction of dyslexic services: • Completion of the district dyslexia program • The reevaluation and/or post-testing of student shows student growth to be closer to grade level proficiency standards (NOTE: Reevaluation does not mean reassessing to establish the identification of dyslexia, but rather viewing data that supports student progress, and achievement.) • The student demonstrates self-monitoring/self-correction behaviors as evidenced through informal observation by teacher and/or dyslexia teacher • The student passed the reading portion of the state assessment (NOTE: passing the reading portion of the state assessment is never the sole source for exiting dyslexia services); • Committee recommendation 14 Source – Dyslexia Handbook Revised 2014

•

Parent request in writing that the student exit the program

If a student has shown substantial progress and the §504 committee, or ARD committee determines the student is ready to be dismissed completely from the program, the committee may recommend monitoring services instead of direct services. When a child is exited from the dyslexia program, a dismissal form (Appendix F) will be completed and placed in the child’s cumulative folder.

APPENDICES Appendix A 504 Referral FORM 4 Student: Student ID #: Date of Birth: Grade: Referral Date: Campus: Referred by: Position/Relation to Student: Reason for Referral (attach additional pages if necessary):

Attendance Is this student enrolled in Yes

No

If No, explain:

school? This student has been absent

days out of

This student was absent

days out of

school days this school year. Reason(s): school days last school year. Reason(s):

List schools previously attended: Student Grade Reports Current Year Grade Report by Grading Period Subject

1

2

3

4

5

6

Final

15 Source – Dyslexia Handbook Revised 2014

___ - ___ Year Grades Subject

___ - ___ Year Grades Subject

Over time, this student’s grades: have become higher each year dropped suddenly in ___ grade

(check the appropriate box) stayed about the same each year Data not available

have become lower each year

Compared with most of the other students in this school, this student’s grades: (check the box) are better are about the same are worse data not available Has the student ever been retained? reason for retention(s)

If YES, list grade level(s) where retention occurred and

Discipline Information (Attach copies of any behavioral plan or contract) Identify the behaviors exhibited by the student (check all that apply) Poor attention and concentration Shifts from one uncompleted task to another Often loses things necessary for tasks Interrupts or intrudes on others Excessively high/low activity level Difficulty working with peers Difficulty following directions Difficulty remaining seated Fidgets, squirms or seems restless Confrontational/assaultive Dress code violations Leaves class without permission Brings inappropriate items to school Other In response to these behaviors, what behavior management techniques have been attempted? Results of these techniques: Has this student been suspended, expelled or removed to DAEP during the previous or current school year? No Yes (see below) If yes, explain and attach copies of all disciplinary referrals (including those that resulted in discipline other than suspension, expulsion, or DAEP), and PEIMS report totaling removal days. Early Intervention & Alternative Programs (attach relevant plans or other documentation) What types of efforts have been attempted to meet the student’s needs? (check all that apply) 16 Source – Dyslexia Handbook Revised 2014

Alternative Learning Setting ESL/Bilingual Ed.

Title I

Summer School

Dyslexia

Tutoring

TAKS/STAAR

Gifted &

Remediation

Talented

Program Mentoring

Other

If the student received assistance from the campus’ early intervention team (CST, SST, Core Team), please attach plans created for the student and data gathered on student’s response. List services or programs considered and rejected for this student? Why? Has the student ever been special education eligible? Has the student ever been referred to special education?

No No

Yes, please attach dismissal ARD Yes, please attach eligibility ARD

Mitigating Measures (Identify any mitigating measures currently in use or provided for the student’s benefit. Check all that apply, describe the measure(s) in use. Medication: Medical supplies, equipment, or appliances: Low-vision devices (which do not include ordinary eyeglasses or contact lenses): Prosthetics including limbs and devices: Hearing aids and cochlear implants or other implantable hearing devices: Mobility devices: Oxygen therapy equipment and supplies: Assistive technology: Reasonable accommodations (includes early intervention, RTI, differentiated instruction and informal help from teachers): Auxiliary aids or services (includes health plans, emergency plans): Learned behavioral or adaptive neurological modifications (including dyslexia and remedial instruction): Other: Identify any mitigating measure checked above that is neither provided by the school nor implemented by the school: Evaluation Data from State Assessment (TAKS/STAAR) TAKS/STAAR TAKS/STAAR Previous Latest Administration School Year: School Year: Pass? Scaled Pass? Scaled Subject (Y/N) Score Subject (Y/N) Score 17 Source – Dyslexia Handbook Revised 2014

TAKS/STAAR Previous School Year: Subject

Pass? (Y/N)

Scaled Score

Reading Math Writing Science Social Studies English/ LA

Reading Math Writing Science Social Studies English/ LA

Reading Math Writing Science Social Studies English/ LA

Over time, this student’s test scores: (check the appropriate box) have become better each year have stayed about the same each year dropped suddenly in ___ data not available grade

have become worse each year

Compared to the mean of the district/campus/classroom, this student’s test scores: (circle comparison group and check the appropriate box) improved each stayed about the same worsened each Other: year each year year Health Information

Person conducting screening:

Attach information relating to any doctor’s order, diagnoses, or evaluation pertaining to disability (example, medical reports, psychological reports, ADD/ADHD diagnostic information, etc.) Does student exhibit any signs of health or medical problems? If yes, attach observations. Is there a need for further assessment of referral of a medical problem? If further assessment is necessary, please describe what new data is necessary. Is student receiving any medication at school? No Yes, list medications: Does the student require adaptive equipment or facility adaptation? Does the student currently have a health plan?

No

Yes

No

Yes

No

Yes, attach list of needs

No

Yes, attach a copy of the plan.

Does the student have a physical or mental impairment that is episodic? No Yes If yes, please describe the condition, when and how often it is active, and its impact on the student when it is active.

Does the student have a physical or mental impairment that is in remission? No Yes If yes, please describe the condition, when it was active, at what point it went into remission, and 18 Source – Dyslexia Handbook Revised 2014

its impact on the student when it was active.

Vision Type of screening: Date of screening (Vision examination must have been administered within a year from the date of referral) Visual acuity before correction: Right Left _ Visual acuity with correction: Right Left _ Interpretation of results: Does the student exhibit any known difficulty with near-vision? Yes. If Yes, attach explanation. Does student exhibit any signs of health or medical problems? If yes, attach observations. Is there a need for further assessment of a medical problem? If further assessment is necessary, please describe what new data is necessary.

No

Yes

No

Yes

No

Yes

As a result of the screening, is there any indication of a need for further assessment or adjustment? If Yes, please explain.

No

Yes

Has any follow-up treatment been recommended? If Yes, please explain.

No

Yes

Hearing

Date of most recent screening:

Type of screening:

Results: Interpretation of results: As a result of the screening, is there any indication of a need for further assessment or adjustment? If yes, please explain. Has any follow-up treatment been recommended? If Yes, please explain. Home Language Survey 1. Identify the language most frequently used in the student’s home: Spanish English and Other: English Spanish 2. Identify the language most frequently used by the student’s parents: Spanish English and Other: English Spanish 19 Source – Dyslexia Handbook Revised 2014

No

Yes

No

Yes

3. Identify the language most frequently used by the student: Spanish English and Other: English Spanish 4. Is an LPAC in place for this student? If yes, please attach relevant LPAC records for Section 504 Committee review during evaluation.

20 Source – Dyslexia Handbook Revised 2014

No

Yes

Remisión Section 504 (Form 4) Estudiante: Número ID #: Fecha de Nacimiento: Grado/Nivel: Fecha de Remisión: Escuela: Remisión iniciada por: Relación al estudiante: Razon para la remisión (Añada páginas si es necesario):

Asistencia: Esta registrado en una Si escuela? El estudiante ha estado ausente

No

Si responde No, explique:

días de

días escolares este año escolar. Razon(es):

El estudiante ha estado ausente

días de

días escolares el pasado año escolar. Razon(es):

Escuelas previamente asistidas: Reportes de Calificaciones Presente año escolar (por periodo escolar) Curso

1

2

3

4

5

6

Final

___ - ___ Año Escolar Curso

___ - ___ Año Escolar Curso

Con el tiempo, las calificaciones del estudiante: (indique en el espacio apropiado) Han subido cada año Siguen similares Han bajado cada año Bajaron de repente en: Datos no asequibles Comparado con estudiantes en su escuela, las calificaciones: (indique en el espacio apropiado) Son mejores Son similares Son peores 21 Source – Dyslexia Handbook Revised 2014

Datos no asequibles Ha sido retenido en un ano?

Si SI, indique el año de retencion y la(s) razon(es)

Comportamiento (Incluya copias de Plan de Comportamiento u otros datos) Indique el comportamiento del estudiante (indique todos los comportamientos presentados) Mala atención y concentración Va de una tarea incompleta a otra Pierde materiales escolares Interrupte o se entromete con otros Nivel de actividad alto/bajo Dificultad trabajando con otros Dificultad siguiendo instrucciones Dificultad quedándose sentado Inquietud Agresivo Violaciones de uniforme Sale de la clase sin permiso Trae artículos prohibidos a la escuela Otro Que intervenciones han sido implementadas para mejorar el comportamiento? Resultados: Ha sido suspendido, expulsado or puesto en programa disciplinario el año escolar pasado o presente? No Si Si SI, explique y incluya documentos u otros datos apropiados con éste documento Programas de Intervención Académica (Incluya documentos u otros datos) Cuales programas de intervencion han sido intentadas? (Indique todos los intentados) Programa Alternativo Title I Escuela de Verano Dislexia Programa Bilingüe

Tutoría

Mentor

Otro

Tutoría para el examen TAKS/STAAR

Programa Avanzado

Si el estudiante ha recibido asistencia de algun comité de intervencion en la escuela, incluya Planes de intervención y datos sobre los resultados de tales intervenciones. Indique los servicios o programas considerados y rechazados para el estudiante? Porque? Ha recibido educación especial?

No

Ha sido considerado para educación especial?

No

Si, incluya documentos, si existen Si, incluya documentos, si existen

Medidas Aliviantes (Indique cualquier medida para aliviar las dificultades del estudiante): 22 Source – Dyslexia Handbook Revised 2014

Indique cuales estan en efecto y explique. Medicamento: Equipo o aparatos médicos: Equipo o aparatos para la vista (no incluyendo anteojos o lentes de contacto): Miembros prostéticosn u otras prótesis: Audífonos u otros aparatos para el oido: Aparatos para asistir con la movilidad: Equipo de oxígeno: Otra tecnología de asistencia: Adaptaciones (incluyendo intervenciones, asistencia RTI, instrucción diferente, y ayuda del maestro): Planes de auxilio/emergencia o para condiciones médicas: Estrategias aprendidas o adquiridas por el estudiante Otro: Identifique las medidas que no sean proporcionadas por la escuela:

Datos de Exámenes Estatales (TAKS/STAAR) TAKS/STAAR TAKS/STAAR previo Última administración Año escolar: Año escolar: Pasó? Nota Pasó? Nota Asignatura (Si/No) Asignatura (S/N) Lectura Matemáticas Escritura Ciencia Estudios Sociales Ingles

Lectura Matemáticas Escritura Ciencia Estudios Sociales Ingles

Con el tiempo, las notas del estudiante: (Indique donde apropiado) Han mejorado cada año Son similares Bajaron de repente en el ___ año

TAKS/STAAR Previo Año escolar: Asignatura

Pasó? (S/N)

Nota

Lectura Matemáticas Escritura Ciencia Estudios Sociales Ingles Han empeorado cada año

Datos no asequibles

Comparado con el promedio de la escuela, las notas del estudiante: (Indique donde apropiado) Han mejorado Son similares Han empeorado Otro: Información de Salud: 23 Source – Dyslexia Handbook Revised 2014

Incluya documentación de órdenes de doctor, diagnosis, or evaluación de discapacidad (por ejemplo, reportes médicos, reportes psicológicos, diagnosis de ADD/ADHD, etc.) Muestra el estudiante señas de problemas médicos? Si SI, incluya observaciones. Hay causa para evaluación adicional del problema médico? Si se necesita mas evaluación, indique que información se necesita

No

Si

No

Si

Recibe medicamento en la escuela?

No

Si (indique los medicamentos):

Necesita equipo de adaptación or o modificación de medio ambiente escolar?

No

Si, (indique las necesidades)

Tiene el estudiante un Plan de Salud (Health Plan)?

No

Si, (incluya el Plan de Salud).

Tiene el estudiante una condición que va y viene con el tiempo? No Si Si SI, explique la condición, cuando se activa, con cual frecuencia, y el efecto al estudiante cuando era activa.

Tiene el estudiante alguna condición que presentemente esta en remisión? No Si Si SI, explique la condición, cuando fue activa, cuando cesó, y el efecto al estudiante cuando era activa.

Vista Tipo de evaluación: Fecha de evaluación: (Incluya evaluaciones de la vista, con preferencia a evaluaciones de menos de un año antes) Resultados de la evaluación de la vista: Tiene dificultad para ver de cerca? Si SI, explique.

No

Si

Tiene dificultad par aver de lejos? Si SI, explique

No

Si

Hay razon para mas evaluación de la vista? Si SI, explique.

No

Si

Se ha recomendado algun tratamiento para problema de la vista? Si SI, explique.

No

Si

24 Source – Dyslexia Handbook Revised 2014

Oido Tipo de evaluación: (Incluya evaluaciones del oido)

Fecha de evaluación:

Resultados: Interpretación de resultados: Hay indicación de necesidad de mas evaluación del oido? Si SI, explique.

No

Si

Se ha recomendado algun tratamiento para problema del oido? Si SI, explique.

No

Si

Lenguaje del Hogar 1. Indique el lenguaje utilizado con frecuencia en el hogar: Ingles Español Ingles y Español Otro: 2. Indique el lenguje utilizado con frecuencia por los padres: Ingles Español Ingles y Español Otro: 3. Indique el lenguaje utilizado con frecuencia por el estudiante: Ingles Español Ingles y Español Otro: 4. Se ha ordenado un comité LPAC? Si SI, incluya documentación apropriada.

25 Source – Dyslexia Handbook Revised 2014

No

Si

Appendix B Notice and Consent for Initial Section 504 Evaluation (Form 5) Date Sent/Mailed: Campus: Parents: Address: Home Phone:

Student’s Name: Grade:

Student ID #:

Work Phone:

We have carefully reviewed your child’s school records and information from teachers. Additional information is necessary to determine your child’s educational needs and whether he/she might be eligible for assistance in the regular classroom under Section 504. We ask that you consent to an evaluation under §504 for the following reasons________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ In many cases, the §504 evaluation may simply consist of the Section 504 Committee reviewing and interpreting existing school records, including anecdotal evidence, observations, prior testing, grades, standardized test scores, and other data, in order to determine if your child qualifies for accommodations in the regular classroom. For students who have been involved in the early intervention process, the §504 evaluation will include a review of the classroom assistance and interventions provided, the results of those efforts, and any other data generated by that process. In addition to reviewing the data described above, the district desires to conduct the following assessments: Dyslexia assessment (please describe below) Other (please describe below) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Please review the enclosed document entitled “Notice of Parent Rights,” which informs you of your rights under Section 504. If you CONSENT to the evaluation, please check the “consent” statement, sign and return one copy of this letter. If you REFUSE consent, please check the “refuse consent” statement, sign and return one copy of this letter. Keep the other copy of this letter and the Notice of Parent Rights for future reference. Please call (Coordinator) at if you have any questions.

26 Source – Dyslexia Handbook Revised 2014

As the parent/legal guardian of the above referenced student, I have received notice of my Section 504 parent rights, and I understand that this is not an offer of a Special Education evaluation. ___I hereby CONSENT to an evaluation under Section 504. ___I hereby REFUSE consent to an evaluation under Section 504. _____________________ _____________________ Parent/Guardian signature

____________________ Parent/Guardian printed name

27 Source – Dyslexia Handbook Revised 2014

Date

Aviso y Permiso para Evaluación Inicial Seccion 504 (Form 5) Fecha de Envio: Escuela: Padres: Dirección Teléfono (casa):

Nombre de Estudiante: Grado:

Numero ID #:

Teléfono (trabajo):

Hemos revisado cuidadósamente los archivos e información de los maestros de su estudiante. Se necesitan mas datos para determinar las necesidades educativas de su estudiante y si califica para recibir asistencia en sus clases regulares bajo la ley Seccion 504. Pedimos que nos de permiso para una evaluación en acuerdo con la ley Seccion 504 por las siguientes razones __________________________ En muchas situaciones, la evaluación Seccion 504 consistirá simplemente de un reviso e interpretación por un Comité de Seccion 504 de archivos escolares, incluyendo observaciones, calificaciones antiguas, calificaciones en cursos, datos de pruebas nomalizadas, y otros datos, para determinar si su estudiante califica para recibir asistencia y servicios bajo la ley Seccion 504. Para esos estudiantes que ya han recibido algunas intervenciones de asistencia, la evaluación Seccion 504 incluirá un reviso de esa asistencia, las intervenciones provistas, los resultados de tales intervenciones, y cualquier otros datos generados por el proceso de intervención. Ademas de revisar los datos aqui mencionados, el Districto desea administrarle a su estudiante las siguientes pruebas: Examen de dislexia (favor de explicar en el espacio siguiente) _______ Otro (favor de explicar en el espacio siguiente) _______ ______________________________________________________________________ ______________________________________________________________________ ____________ Por favor revise el documento incluido, con el título “Aviso a Padres de Estudiantes Incapcitados de sus Derechos Legales bajo la Seccion 504 del Decreto de Rehabilitación de 1973,” el cual le informa de sus derechos bajo la ley Seccion 504. Si da su permiso a la evaluación propuesta, favor de marcar en el espacio apropriado al final de esta carta, firmar, y regresar una copia. Si rechaza permiso, favor de marcar en el espacio apropiado, firmar, y regresar una copia. Retenga la otra copia de esta carta y de el Aviso de Derechos para su futura referencia. Favor de llamar a tiene alguna pregunta.

_

(Coordinador) al número

28 Source – Dyslexia Handbook Revised 2014

_

si

Siendo el padre or guardian legal del estudiante indicado, he recibido el aviso de mis derechos bajo la ley Seccion 504, y entiendo que esto no sera una evaluación para educación especial. Doy permiso para la evaluación de Seccion 504 Rechazo permiso para la evaluación Seccion 504 Firma

Nombre

29 Source – Dyslexia Handbook Revised 2014

Fecha

Appendix C Notice of Rights for Disabled Students and their Parents Under §504 of the Rehabilitation Act of 1973 (Form 6) The Rehabilitation Act of 1973, commonly known in the schools as “Section 504,” is a federal law passed by the United States Congress with the purpose of prohibiting discrimination against disabled persons who may participate in, or receive benefits from, programs receiving federal financial assistance. In the public schools specifically, §504 applies to ensure that eligible disabled students are provided with educational benefits and opportunities equal to those provided to non-disabled students. Under §504, a student is considered “disabled” if he or she suffers from a physical or mental impairment that substantially limits one or more major life activities. Section 504 also protects students with a record of an impairment, or who are regarded as having an impairment from discrimination on the basis of disability. Students can be considered disabled, and can receive services under §504, including regular or special education and related aids and services, even if they do not qualify for, or receive, special education services under the IDEA. The purpose of this Notice is to inform parents and students of the rights granted them under §504. The federal regulations that implement §504 are found at Title 34, Part 104 of the Code of Federal Regulations (CFR) and entitle eligible student and their parents, to the following rights: 1. You have a right to be informed about your rights under §504. [34 CFR 104.32] The School District must provide you with written notice of your rights under §504 (this document represents written notice of rights as required under §504). If you need further explanation or clarification of any of the rights described in this Notice, contact appropriate staff persons at the District’s §504 Office and they will assist you in understanding your rights. 2. Under §504, your child has the right to an appropriate education designed to meet his or her educational needs as adequately as the needs of non-disabled students are met. [34 CFR 104.33]. You have the right to refuse consent for services at any time. 3. Your child has the right to free educational services, with the exception of certain costs normally also paid by the parents of non-disabled students. Insurance companies and other similar third parties are not relieved of any existing obligation to provide or pay for services to a student that becomes eligible for services under §504. [34 CFR 104.33]. 4. To the maximum extent appropriate, your child has the right to be educated with children who are not disabled. Your child will be placed and educated in regular classes, unless the District demonstrates that his or her educational needs cannot be adequately 30 Source – Dyslexia Handbook Revised 2014

met in the regular classroom, even with the use of supplementary aids and services. [34 CFR 104.34]. 5. Your child has the right to services, facilities, and activities comparable to those provided to non-disabled students. [34 CFR 104.34]. 6. The School District must undertake an evaluation of your child prior to determining his or her appropriate educational placement or program of services under §504, and also before every subsequent significant change in placement. [34 CFR 104.35]. You have the right to refuse consent for initial evaluation. 7. If formal assessment instruments are used as part of an evaluation, procedures used to administer assessments and other instruments must comply with the requirements of §504 regarding test validity, proper method of administration, and appropriate test selection. [34 CFR104.35]. The District will appropriately consider information from a variety of sources in making its determinations, including, for example: aptitude and achievement tests, teacher recommendations, reports of physical condition, social and cultural background, adaptive behavior, health records, report cards, progress notes, parent observations, statewide assessment scores, and mitigating measures, among others. [34 CFR 104.35]. 8. Placement decisions regarding your child must be made by a group of persons (a §504 committee) knowledgeable about your child, the meaning of the evaluation data, possible placement options, and the requirement that to the maximum extent appropriate, disabled children should be educated with non-disabled children. [34 CFR 104.35]. 9. If your child is eligible under §504, he or she has a right to periodic reevaluations. A reevaluation must take place at least every three years. [34 CFR 104.35]. 10. You have the right to be notified by the District prior to any action regarding the identification, evaluation, or placement of your child. [34 CFR 104.36] 11. You have the right to examine relevant documents and records regarding your child (generally documents relating to identification, evaluation, and placement of your child under §504). [34 CFR 104.36]. 12. You have the right to an impartial due process hearing if you wish to contest any action of the District with regard to your child’s identification, evaluation, or placement under §504. [34 CFR 104.36]. You have the right to participate personally at the hearing, and to be represented by an attorney, if you wish to hire one. 13. If you wish to contest an action taken by the §504 Committee by means of an impartial due process hearing, you must submit a Notice of Appeal or a Request for Hearing to the District's §504 Coordinator at the address below. In Texas, you must 31 Source – Dyslexia Handbook Revised 2014

submit the required notice or request in writing within one year of the action or omission giving rise to your complaint. Failure to make a timely request will result in the loss of your opportunity to pursue a due process hearing on that action or omission. A date will be set for the hearing and an impartial hearing officer will be appointed. You will then be notified in writing of the hearing date, time, and place. District 504 Coordinator: Amber Rains – Nocona Elementary – Phone 825-3151 14. If you disagree with the decision of the hearing officer, you have a right to seek a review of the decision by making a written request to the District’s Section 504 Coordinator, and/or you may seek relief in state or federal court as allowed by law. 15. You also have a right to present a grievance or complaint through the District’s local grievance process. The District will investigate the situation, take into account the nature of the complaint and all necessary factors, and respond appropriately to you within a reasonable time. Parents may contact the District’s Section 504 Coordinator for more information about the District’s grievance process. 16. You also have a right to file a complaint with the Office for Civil Rights (OCR) of the Department of Education. The address of the OCR Regional Office that covers this school district is: Director, Office for Civil Rights, Region VI 1999 Bryan Street, Suite 1620, Dallas, Texas 75201-6810, Tel. 214-661-9600

32 Source – Dyslexia Handbook Revised 2014

Aviso a Padres de Estudiantes Incapacitados de sus Derechos Legales bajo la Seccion 504 del Decreto de Rehabilitación de 1973 (Form 6) El Decreto de Rehabilitación de 1973, conocido generalmente como la “Seccion 504,” es una ley federal legislada por el Congreso de los Estados Unidos. El propósito de esta ley es de prohibir discriminación contra estudiantes incapacitados y asegurar que tengan oportunidades y beneficios educativos tan adequados como los de estudiantes sin incapacidades. Bajo la Seccion 504, un estudiante es considerado “incapacitado” si padece de un impedimento o condición física o mental que limita substanciálmente por lo menos una de sus actividades vitales. La ley tambien protege a estudiantes que han tenido un impedimento o condición física o mental substancial en el pasado, o que son considerados incapacitados aunque realmente no lo sean. Estudiantes pueden ser considerados incapacitados bajo la Seccion 504 y pueden recibir asistencia educativa bajo esa ley, incluyendo servicios educativos regulares o especiales y otra asistencia relacionada aunque no reciban educación especial segun la ley federal IDEA. El propósito de este Aviso es de explicarle los derechos legales garantizados bajo la Seccion 504 a estudiantes incapacitados y a sus padres. Los reglamentos federales que dan efecto a la Seccion 504 (los cuales se encuentran en el Título 34, Parte 104 del Código Federal de Reglamentos, o CFR) otorgan a los padres de familia y a estudiantes incapacitados los siguientes derechos: 1. Usted tiene derecho a ser informado de sus derechos bajo la Seccion 504. [34 CFR 104.32]. El distrito escolar debe darle información escrita sobre sus derechos (este Aviso precísamente sirve para informarle de sus derechos). Si necesita que le expliquen o clarifiquen cualquier de los siguientes derechos, los dirigentes apropiados del distrito escolar le ayudarán a resolver sus preguntas. 2. Bajo la Seccion 504, su hijo/a tiene derecho a una educación apropriada diseñada para satisfacer sus necesidades educativas individuales tan adecuádamente como las de estudiantes sin incapacidades. [34 CFR 104.33]. Usted tiene el derecho de rechazar, a cualquier punto, su permiso a recibir servicios. 3. Su hijo/a tiene derecho a servicios educativos gratuitos, con la excepción de gastos que normalmente se les cobran tambien a estudiantes sin incapacidades (o a sus padres). Compañías de seguros, y otras terceras personas similares, no son libres de sus obligaciones normales para proporcionar o pagar por servicios para un estudiante considerado incapacitado bajo la Seccion 504. [34 CFR 104.33]. El recibir asistencia 33 Source – Dyslexia Handbook Revised 2014

educativa bajo la Seccion 504 no disminuye su derecho a recibir otra asistencia pública o privada de cualquier tipo. 4. Su hijo/a tiene derecho a ser colocado en el ambiente educativo que permita máximo contacto y relaciones con estudiantes sin incapacidades. [34 CFR 104.34]. A menos que sus necesidades educativas no puedan ser satisfechas ahí, su hijo/a será colocado en clases regulares. 5. Su hijo/a tiene derecho a equipo, clases, edificios, servicios y actividades comparables a las que son proporcionadas a estudiantes sin incapacidades. [34 CFR 104.34]. 6. Su hijo/a tiene derecho a una evaluación antes de determinar una colocación educativa o programa de asistencia bajo la Seccion 504, y tambien antes de cualquier cambio importante en colocación subsequente. [34 CFR 104.35]. Usted tiene el derecho de rechazar permiso para la evaluación inicial. 7. Procedimientos utilizados para administrar pruebas y otras evaluaciones educativas deben cumplir con los requisitos de la Seccion 504 en cuanto a la validez de las pruebas, su forma de administración, y las areas necesarias de evaluación. [34 CFR 104.35]. El distrito considerará apropiadamente información de diversas fuentes y orígenes, incluyendo, por ejemplo: pruebas de aptitudes y aprovechamiento, recomendaciones de maestros, reportes de condición física, antecedentes sociales y culturales, análysis de comportamiento adaptado, reportes médicos, calificaciones, reportes de progreso, observaciones de los padres, anécdotas de maestros, calificaciones de pruebas estatales, y medidas aliviantes, entre otras. [34 CFR 104.35]. 8. Las decisiones de colocación educativa deben realizarse por un grupo de personas (llamado el comité 504) que conocen la situación de su hijo/a, el significado de los resultados de las evaluaciones, las opciones de colocación, y la obligación legal de asegurar el ambiente educativo que permita el máximo contacto con estudiantes no incapacitados. [34 CFR 104.35]. 9. Si es considerado incapacitado bajo la Seccion 504, su hijo/a tendrá derecho a nuevas evaluaciones, llamadas re-evaluaciones, periódicamente. Generalmente re-evaluaciones educativas se haran para cada niño incapacitado por lo menos cada tres años. [34 CFR 104.35.] 10. Usted tiene derecho a que el distrito escolar le avise antes de tomar cualquier acción en relación a la identificación, evaluación o colocación educativa de su hijo/a. [34 CFR 104.36]. 11. Usted tiene derecho a examinar archivos y documentos relacionados a la educación de su hijo/a (normalmente archivos y documentos con relación a la identificación, evaluación o colocación educativa de su hijo/a). [34 CFR 104.36]. 34 Source – Dyslexia Handbook Revised 2014

12. Usted tiene derecho a una audiencia imparcial si no esta de acuerdo con las acciones del distrito en relación a la identificación, evaluación, o colocación educativa de su hijo/a. Usted tiene la oportunidad de participar personalmente en tal audiencia y de ser representada por un abogado, si desea contratarlo. [34 CFR 104.36]. 13. Si desea protestar o disputar las acciones del Comité 504 del distrito a traves de una audiencia imparcial, debe presentar un Aviso de Apelación escrito ante el Coordinador 504 del distrito, en la siguiente dirección. Se fijará una fecha para una audiencia ante un oficial imparcial, y serán notificados por escrito de la fecha, hora, y lugar de la audiencia. En el Estado de Texas, la petición para una audiencia imparcial se debe presentar a menos de un año despues de el acto u omisión que da a cabo la petición. Peticiones tardías resultaran en la perdida de oportunidad para una audiencia imparcial sobre tal acto u omisión. District 504 Coordinator: Amber Rains – Nocona Elementaire – 940- 825-3151 14. Si usted está en desacuerdo con la decisión final del oficial imparcial de audiencia, tiene derecho a pedir por escrito un reviso de tal decisión al Coordinador de §504 del Districto Escolar, o a traves de petición formal a una corte estatal o federal tal permitida por ley. [34 CFR 104.36]. 15. Tambien tiene el derecho de presentar una queja local al Coordinador de §504 del Districto Escolar (o su dirigente), quien investigará la situacion, considerará los temas de la queja y todo factor necesario, y le responderá apropiadamente dentro de un plazo de tiempo razonable. Si tiene preguntas sobre el proceso para presentar quejas locales, se puede comunicar con el Coordinador de §504 para obtener respuesta. 16. Usted también tiene el derecho a presentar una queja ante la Oficina de Derechos Civiles de el Departamento de Educación de los Estados Unidos. La dirección de la Oficina Regional a la cual pertenece a este distrito es: Director, Office for Civil Rights, Region VI 1999 Bryan Street, Suite 1620, Dallas, Texas 75201-6810, Tel. 214-661-9600

Appendix D Teacher Input for Section 504 Evaluation (Form 7) Student Name:

Student ID #: 35

Source – Dyslexia Handbook Revised 2014

Grade:

Teacher’s Name:

Subject Matter:

Date:

Instructional Rating Rate the concerns you have about this student. For each skill, mark: 1= Poor 2=Below Average 3=Average 4=Above Average 5=Superior N=Not observed 1 2 3 4 5 N 1 2 3 4 5 Reading Skills Tests Math Skills Follows oral directions Written Follows written Expression directions Spelling Organizational skills Classroom work Interaction with staff Homework

N

Behavioral Rating Rate this student’s behavior in relation to other students of the same AGE. For each behavior, mark: 1= Poor 2=Below Average 3=Average 4=Above Average 5=Superior N=Not observed 1 2 3 4 5 N Generally cooperates or complies with teacher requests. Adapts to new situations without getting upset. Accepts responsibility for own actions. Makes and keeps friends at school. Works cooperatively with others. Has an even, usually happy, disposition. Appropriate attention and concentration Compliance with teacher directives Brings necessary materials to class Fidgets, squirms or seems restless Completes tasks on time Stays on task, is easily redirected Remains seated Takes turns, waits for turn What have you done differently in your classroom to meet this student’s educational/behavioral needs?

36 Source – Dyslexia Handbook Revised 2014

What were the results of these efforts?

Teacher Signature__________________________________ Date __________________

37 Source – Dyslexia Handbook Revised 2014

Parent Input for Section 504 Evaluation (FORM 8) The information requested will greatly assist the §504 Committee in evaluation of your child. If you have additional information that you want the Committee to consider (and that is not requested here) please feel free to attach additional pages. Disregard any question that makes you uncomfortable. If you would prefer to provide this information by phone, please contact ___________________________at________________________ Student Name: Date of Birth: Address: Phone: School: Grade: General Information Mother’s Name: Occupation: Level of Education: Father’s Name Level of Education: With whom does the child live? Relationship to child: Other Children in the Home (attach additional page if necessary) Name Age Relationship Other Adults in the student’s Home Relationship to student

Do any family members have learning problems? If yes, please explain Compared to other children in the family, this child’s development was: (check one) Slower About the same Faster At what age, in months, was the student able to do the following: Sat without support Crawled Walked without support Used spoon fairly well First word Reasonably well-toilet trained The Student’s Friends & Activities Does the student prefer to play/socialize with Girls Boys Does the student have friends his/her own age? Does the student have friends who are younger than the student? Does the student have friends who are older than the student? The Student at Home Please check each item available for the student’s use at home: Computer Books Tape recorder Video games Television Educational toys

No preference Yes No Yes No Yes No

CD player Radio

What kinds of activities does your family do together? (Read, play games, camp, etc.) 38 Source – Dyslexia Handbook Revised 2014

Have there been any important changes within the family during the last three years (For example, job changes, moves, births, deaths, serious illnesses, separations, divorce) With whom in the family is the student particularly close? Has the student ever been separated from the family due to family problem, health reasons, etc? If yes, please explain. How did the student react to the separation? Describe the student’s behavior at home with peers, siblings, neighbors, and parents. (For example, is the student generally well-behaved? Social? Affectionate? Withdrawn? What methods of discipline are used with this student at home? (For example, spanking, extra chores, early bedtimes, taking away of privileges; is he/she given rewards for good behavior?) How does the student react to discipline? Who usually disciplines the student at home? The primary language in the home is: How long has the student lived in the United States? What time does the student go to bed at night? Does the student eat breakfast? What does the student do when not in school? (Please list the student’s common indoor and outdoor activities.) Does your student have a part-time job after school or on weekends? If yes, please provide the average number of hours worked per week. The Student at School Has your student talked to you about difficulties or problems at school? Please explain: Do you think your student is having difficulties in school? Yes If you think your student is having difficulties, please explain your concerns. What do you think is causing the student’s difficulties at school? 39 Source – Dyslexia Handbook Revised 2014

No

When did you first notice the difficulties? If you have discussed these concerns with the school, please indicate when and with whom you shared your concerns: If your student qualifies for Section 504, what services or accommodations do you think are necessary so that the student can participate and benefit from school?

Childhood & Medical History Has your student ever had the Never Began at age? Ended at age? Still has problem following? Frequent fevers Frequent earaches Frequent vomiting Thumb sucking Nightmares Sleepwalking Head banging Rocking of body Teeth grinding Bedwetting Fingernail biting Temper tantrums Run away from home Breathing Issues Lost consciousness Convulsions Current Medical Treatment & Medication Doctor’s reports, letters and diagnoses can be very helpful to the 504 Committee. Please attach the student’s medical records so that the Committee can have a more complete picture of your child. If you would prefer, you may give the District written consent to seek those records from your doctors directly. Please notify (504 Coordinator) at to get the necessary form. Please identify any medical problem for which your student is currently receiving medical care: Does your student appear to have any other physical health problems for which the student is not currently receiving medical care? 40 Source – Dyslexia Handbook Revised 2014

Please list all medications currently taken by your student (over the counter and prescription). Please describe any side effects the student experiences from these medications. Please identify any medication(s) taken by your student for over 1 year: Please describe any hospital stays by your student, including the date, reason for the stay, the duration, and the result of treatment. Does your child have a medical condition or illness with symptoms that are sometimes more serious than other times? If yes, please answer the following questions: What is the name of the condition or illness? When and how often is the condition or illness a problem for your child? How does the condition or illness affect your child when the symptoms are most serious? (Are there things that he cannot do or things that are more difficult because of the condition or illness?) Did your child used to have a serious medical condition or illness that has gone away? If yes, please answer the following questions: What is the name of the condition or illness that your child used to have? When did your child suffer from the condition or illness? How did the condition or illness affect your child when the symptoms were most serious? (Were there things that he could not do or things that were more difficult because of the condition or illness?) Is the condition or illness likely to return? Is there any other information about your student or family that you would like the Section 504 Committee to consider when evaluating your student for Section 504 eligibility? If so, please provide it here.

_ 41 Source – Dyslexia Handbook Revised 2014

Signature of Parent

Date

_ Signature and Position of person assisting (if any) Date

42 Source – Dyslexia Handbook Revised 2014

Información de Padres para Uso en la Evaluación Sección 504 (Form 8) La siguiente información que se les pide a los padres asistirá al Comité §504 Committee en la evaluación del estudiante. Si tiene mas información que desea ser considerada por el Comité que no esta incluida en este documento, favor de añadir páginas o documentos. Si no desea responder a ciertas pregunta, siga a la siguiente. Si prefiere dar su información por teléfono, haga el favor de llamar al siguiente número telefónico:_________________ Nombre del Estudiante: Dirección: Escuela:

Fecha de Nacimiento: Teléfono: Nivel/Grado:

Información General Nombre de la Madre: Ocupación: Nombre del Padre Ocupación: Con quien vive el estudiante?

Nivel de Educación: Nivel de Educación: Relación al estudiante:

Otros Niños en el Hogar (Añada páginas si es necesario) Nombre Edad

Otros Adultos en el Hogar

Relación

Relación al Estudiante

Otros familares han tenido problemas de enseñanza? Si SI, explique. Comparado con otros niños en la familia, el desarrollamiento de el estudiante ha sido: Lento Similar Rápido A que edad, en meses, podia el estudiante hacer los siguientes: Sentarse sin apoyo Gatear Caminar sin apoyo Usar cuchara Primeras Ir al baño solo palabras Amigos y Actividades del Estudiante 43 Source – Dyslexia Handbook Revised 2014

Prefiere jugar con: Tiene amigos de su propia edad? Tiene amigos mas pequeños? Tiene amigos mas grandes?

Niñas

Niños

Sin preferencia Si No Si No Si No

En el Hogar Indique los recursos que el estudiante tiene a su alcanze en su hogar: Computadora Libros Grabadora Tocador de CDs Juegos de video Television Jugetes educativos Radio Cuales actividades hace la familia juntos? (Leer, jugar, salir al campo, etc.) Han habido cambios importantes para la familia en los últimos tres años? (Por ejemplo, mudanzas, cambios de trabajo, nacimientos, muertes, enfermedades serias, etc.) Con quien de la familia se lleva mejor el estudiante? Ha estado separado el estudiante de la familia; por ejemplo, por razones de salud, etc? Si SI, explique Cómo reaccionó el estudiante a esa separación? Describa el comportamiento del estudiante en el hogar con otros niños, hermanos, vecinos, y padres. (Por ejemplo, se porta bien? Social? Cariñoso? Solitario? Cuales métodos de disciplina se usan en el hogar con los niños? (Por ejemplo, nalgadas, trabajos hogareños, ir al cuarto, quitar jugetes, premios por portarse bien?) Cómo reacciona el estudiante a la disciplina? Normalmente, quien administra la disciplina en el hogar? El lenguaje predominante el el hogar es: Cuanto tiempo ha vivido el estudiante en los Estados Unidos? A que hora va a la cama el estudiante? Come desayuno? Que le gusta hacer al estudiante cuando no esta el la escuela? (Indique actividades comunes dentro y fuera de la casa.)

44 Source – Dyslexia Handbook Revised 2014

Tiene el estudiante algun trabajo cuando no esta en la escuela? Si SI, indique cuantas horas.

El Estudiante en la Escuela Habla el estudiante sobre difficultades o problemas escolares? Si SI, explique. Piensa que el estudiante tiene dificultades en la escuela? Si SI, explique cuales.

Si

No

Que piensa que está causando éstas dificultades? Cuando se fijó por primera vez de éstas dificultades? Si ha hablado con la escuela sobre estos problemas, indique cuando y con quien ha hablado: Si el estudiante califica para recibir asistencia bajo la Sección 504, que servicios piensa necesarios para que reciba una educación apropiada?

Niñez e Historia Médica Ha tenido el estudiante los siguientes? Nunca Comienzo Fiebres frecuentes Dolores del oido frecuentes Vómitos frecuentes Chuparse el dedo Pesadillas Sonanbulismo (caminar dormido) Pegarse el la cabeza o cuerpo Mecerse solo Apretar los dientes Mojar la cama Comerse las uñas Berrinches Fugarse de la casa Problemas respiratorios Desmayo Convulsiones 45 Source – Dyslexia Handbook Revised 2014

Fin

Sigue el problema

Tratamiento y Medicamento Reportes, cartas, y diagnoses de medicos pueden ayudar al Comité Sección 504. Favor de añadir estos documentos para que el Comité tenga información completa. Si le es mas conveniente, puede firmar un permiso para que los medicos proporciones los documentos directamente a la escuela, dondre se mantendran confidenciálmente. Comuníquese con __________________(Coordinador 504) al ___________________ para firmar permiso. Indique las condiciones o los problemas para cuales el estudiante recibe tratamiento médico: Tiene el estudante otros problemas de salud para cuales no recibe tratamiento? Indique todos los medicamentos que toma el estudiante (recetados o comerciales). Indique si existen efectos secundarios de estos medicamentos. Indique medicamentos que el estudiante ha tomado por mas de un año: Indique si el estudiante ha sido hospitalizado; la fecha, razones, tiempo, y resultados. Tiene el estudiante alguna condición con síntomas que a veces son mas serios que otras veces? Si SI, conteste las siguientes preguntas: Cual es la condición? Cuando y que tan frequente es es un problema para el estudiante? Como le afecta al estudiante esta condicion cuando los síntomas son mas severos? (De que manera le limita la condicion en esas ocasiones?)

Tenía el estudiante alguna condicion que preséntemente esta en remisión? Si SI, conteste las siguientes preguntas: Cual fue la condición? Cuando tenía el estudiante esa condición? 46 Source – Dyslexia Handbook Revised 2014

Como le afectaba al estudiante esta condicion cuando los síntomas eran mas severos? (De que manera le limitaba la condicion cuando estaba presente y con síntomas mas graves?) Cual es la posibilidad que la condición recurra?

Hay mas información que quiere proporcionar al Comité Sección 504 Committee para que considere cuando evalue al estudiante para eligibilidad bajo la Sección 504? Si hay tal información, inclúyala aqui o añada páginas, si es necesario. _ Firma del Padre

Fecha _

Firma y Puesto de persona asistiendo al Padre (si existe)

Fecha

47 Source – Dyslexia Handbook Revised 2014

APPENDIX E Texas Dyslexia Law and Section 504 Initial Evaluation & Periodic Re-Evaluation (Form 16) Student: Grade: Campus: Referred by: Date of Referral: Type of Evaluation: Initial

Student ID #: Date of Birth: Previous Campus: Position/Relation to Student: Today’s Date: Periodic (3YR) Re-Evaluation Other:

Required Texas Dyslexia Law and §504 Committee Membership: By regulation, the Section 504 Committee is a group of knowledgeable people. List each member attending and check the area of knowledge each provides. Use this chart to document proper attendance. Each type of knowledge must be present for the Committee to be properly constituted under Texas law for dyslexia purposes, and Federal law for Section 504 purposes. Note that Committee members can have more than one type of knowledge. For each member, check all boxes of knowledge that apply. (Attach an additional sheet if necessary). Name of Committee Member

Position/Title

This member has knowledge of….. The Child The Meaning of the Evaluation Data & the dyslexia assessment The Placement Options The reading process Dyslexia and related disorders Dyslexia instruction District or charter school, state & federal guidelines for assessment The Child The Meaning of the Evaluation Data & the dyslexia assessment The Placement Options The reading process Dyslexia and related disorders Dyslexia instruction District or charter school, state & federal guidelines for assessment The Child The Meaning of the Evaluation Data & the dyslexia assessment The Placement Options 48

Source – Dyslexia Handbook Revised 2014

The reading process Dyslexia and related disorders Dyslexia instruction District or charter school, state & federal guidelines for assessment The Child The Meaning of the Evaluation Data & the dyslexia assessment The Placement Options The reading process Dyslexia and related disorders Dyslexia instruction District or charter school, state & federal guidelines for assessment The Child The Meaning of the Evaluation Data & the dyslexia assessment The Placement Options The reading process Dyslexia and related disorders Dyslexia instruction District or charter school, state & federal guidelines for assessment Procedural Checklist: For an Initial §504 & Dyslexia Evaluation, complete Questions 1-5. If this is a §504 Re-Evaluation AND an initial evaluation for dyslexia eligibility, parental consent is required, so complete Questions 1-5. If this is a Re-Evaluation, there is no requirement for parental consent (mark Question 1 “N/A”, and complete the other four questions). Please verify by checkmark that each requirement is completed before proceeding. 1. Verify that the parent consented to §504 initial evaluation, Form 5 (Does not apply to reevaluations) 2. Verify that the §504 Committee is a group, including a person with knowledge in each of the required areas. 3. Verify the Student’s dominant language: Dominant language of the home: 4. Verify that the parent received Notice of Parent Rights under §504 5. Verify how the parent was informed of the date, time, and place for this evaluation (check 1) In writing By Phone In Person Other: NOTE on current special education eligibility or pending special education evaluation: If the student being assessed is either currently eligible under special education (regardless of eligibility category) or is currently undergoing special education evaluation, a dyslexia evaluation 49 Source – Dyslexia Handbook Revised 2014

under Section 504 is inappropriate, and dyslexia assessment should be pursued under the authority of the student’s ARD Committee and pursuant to the IDEA procedural safeguards. Texas Dyslexia Evaluation Data. Pursuant to the 2014 Dyslexia Handbook, (Burgundy Book) instructions, the Section 504 Committee will begin the evaluation by determining the student’s eligibility under the Texas Dyslexia Law. The evaluation data reviewed by the §504 Committee to make the dyslexia eligibility decision included data from the following areas (mark with a check to document that each area of required data was reviewed.) Observations of the teacher, district or charter school staff, and/or parent Data gathered from the classroom (including student work and results of classroom measures) and information found in the student’s cumulative folder (including the developmental and academic history of the student). The results of administered assessments (including both formal and informal measures) appropriate for the student’s level of reading development, including: reading real words in isolation; decoding nonsense words; phonological awareness; letter knowledge (name and associated sound); rapid naming; orthographic processing; fluency/rate and accuracy; reading comprehension; and written spelling. Previously administered dyslexia assessments must also be reviewed. (Tex. Educ. Code §38.003(b-1)). Data-based documentation of student progress during instruction and intervention LPAC documentation (where applicable) All other accumulated data regarding the development of the student’s learning and educational needs. Texas Dyslexia Law Eligibility. In making the determination of dyslexia eligibility, the Committee reviewed the evaluation data identified above (including the formal dyslexia assessment), and considered the factors required by the Burgundy Book as fully described therein. Based on that data, mark each area of consideration with “Agree” or “Disagree.” Dyslexia Eligibility Factors Agree Disagree The student has received conventional (appropriate) reading instruction; The student has experienced an unexpected lack of appropriate progress in the areas of reading and written spelling; The student has adequate intelligence (an average ability to learn in the absence of print or in other academic areas); The student exhibits characteristics associated with dyslexia (see the primary characteristics and review the student’s underlying cognitive processes associated with dyslexia as explained in the Burgundy Book); AND The student’s lack of progress was not due to sociocultural factors such as language differences, irregular attendance or lack of experiential background. Results of Texas Dyslexia Evaluation. If the Committee marked “Agree” in response to each of the preceding five statements, the student is identified as having dyslexia and is eligible for services under the Texas Dyslexia Law. If the 50 Source – Dyslexia Handbook Revised 2014

Committee answered any of the previous five statements with “Disagree,” the student is not eligible under the dyslexia law based on Burgundy Book criteria, and can only receive dyslexia services through action of a Section 504 Committee or ARD Committee when such services are required to provide the student with a free appropriate public education (FAPE). Note that a student can be identified as having dyslexia by a Section 504 Committee or ARD Committee even if Texas Dyslexia Law requirements are not met. This is not, however, a common result. Based on the evaluation data reviewed, and the answers to the required statements, the Committee has determined that (check one): The student is ELIGIBLE under the Texas The student is NOT ELIGIBLE under the Dyslexia Law. Texas Dyslexia Law. Section 504 Eligibility While eligibility under the Texas Dyslexia Law commonly creates eligibility under Section 504, eligibility under Section 504 is determined based on federal eligibility requirements and the analysis below. That analysis must address the impact of the student’s dyslexia on the major life activity of “reading” (in addition to the broader major life activity of “learning”). Should the school suspect that the student has any other impairment(s) in addition to dyslexia, the Section 504 Evaluation should address that/those impairments as well. Evaluation Data Considered from a Variety of Sources The Committee reviewed and carefully considered data gathered from a variety of sources, including the Referral Document. [Please check each type of data reviewed by the Committee, or attach copies of the data.] Parent input Student work portfolio Teacher/Administrator Input & Special education records (specify) Recommendations Aptitude and Achievement Tests Social or cultural background Other Tests Disciplinary records/referrals Early Intervention data Mitigating measures Grade reports Adaptive behavior School Health Information Dyslexia assessment/Dyslexia progress data Medical evaluations/diagnoses/physical Other condition NOTE: If information from a conversation or other data in unwritten form was considered, please document that oral data relied upon by attaching written notes summarizing the conversation or data.) Section 504 Eligibility Determination As directed by Congress in the ADAAA, the Section 504 Committee understands that the definition of disability “shall be construed in favor of broad coverage of individuals under this Act, to the maximum extent permitted by the terms of this Act.” 51 Source – Dyslexia Handbook Revised 2014

1. Does the student have a physical or mental impairment? If so, please identify the impairment(s) in the box below. Notes (1) This is an Eligibility Question educational determination only, and not a medical diagnosis for purposes #1 of treatment. (2) Impairments that are episodic, in remission or mitigated should also be listed. (3) OCR guidance indicates that in “virtually every No case,” diabetes, epilepsy, bipolar disorder and autism will result in Yes eligibility under Section 504. Extensive documentation or analysis should not be required for these impairments. If you answered “yes” to Question 1, identify the impairment(s) here.

2. Does the physical or mental impairment affect one or more major life activities (including major bodily functions)? If so, identify the major life activity or major bodily function by checking the appropriate box or boxes. Note: For an impairment that is episodic, in remission, or mitigated, identify the activity or function affected when the disability was present or active.

Eligibility Question #2 Yes

Caring for oneself Performing manual tasks Seeing Hearing

Major Life Activities include, but are not limited to: Eating Lifting Learning Sleeping Bending Reading Walking Standing

Speaking Breathing

Functions of immune system Normal cell growth

Bowel function

Reproductive function

Neurological function

Bladder function

Concentrating Thinking Endocrine function Respiratory function Circulatory function

3. Does the physical or mental impairment substantially limit a major life activity? Notes: (1) “Substantially limits” does not mean “significantly restricted.” (2) This question asks whether the person evaluated is substantially limited in performing a major life activity as compared to the “average student” of the same grade or age or as compared to “most students” of the same grade or age. (3) The ADAAA requires that when making this determination, the Committee should not consider the ameliorative (helpful or positive) effects of mitigating measures (except for ordinary eyeglasses or contact lenses). (4) The fact that the impairment is episodic (the impact of the impairment is sometimes substantially limiting, but not always), or in remission, does not preclude eligibility if the 52 Source – Dyslexia Handbook Revised 2014

No

Communicating Working Brain function Digestive function Other: Other: Other:

Eligibility Question #3 Yes

No

impairment would substantially limit a major life activity when active. If Eligibility Question 3 is answered “no,” explain why the student is not substantially limited and describe how the committee addressed the positive impact of mitigating measures (what measures are used by/for the student, and what was their impact?): Section 504 Plan & Placement (completed only if each of the three preceding questions were answered “Yes.”). Plan & Placement Does the student need Section 504 services in order for his/her Question educational needs to be met as adequately as those of non-disabled Yes No peers? Notes: (1) If the student’s needs are so extreme as to require special education and related services, a referral to special education should be considered. (2) If the student’s impairment is in remission, and creates no need for services or accommodations, the student is not in need of a §504 Services Plan. (3) If the student’s needs are currently addressed by mitigating measures with no need for additional services or accommodations, and the mitigating measures are provided or implemented by the student or parents, with no action required by the school, the student is not in need of a §504 Services Plan. If the Plan and Placement question is answered “no,” explain why the student does not need a Section 504 Services Plan:

53 Source – Dyslexia Handbook Revised 2014

Analyzing the results of the Committee’s answers 1. If all four questions are answered “YES”, the student is eligible for both the nondiscrimination and FAPE (Section 504 Services Plan) protections of Section 504. The Section 504 Committee will create a Section 504 Services plan for this student. 2. If only the first three questions are answered “YES”, the student is eligible for the nondiscrimination protections of Section 504, together with manifestation determination, procedural safeguards, and periodic Re-Evaluation (at least ever three years) or more often as needed. The Section 504 Committee will not create a Section 504 Services Plan at this time as the student’s needs are currently being met as adequately as his nondisabled peers. Should such a need develop, the §504 Committee shall re-convene and develop an appropriate Section 504 Services Plan at that time. 3. If any of the first three answers is “NO”, the student is not eligible for Section 504 nondiscrimination protection and is not eligible for a Section 504 Services Plan. Special instructions for implementing the decision: 1. For students eligible under both the Texas dyslexia law and Section 504: The Committee should develop appropriate services using Form 13. 2. For students determined eligible for Section 504, but not under the Texas dyslexia law: The Committee should consider appropriate services utilizing Form 13. 3. For students eligible under the Texas dyslexia law but not eligible for Section 504: The Committee should consider appropriate accommodations including dyslexia services. These accommodations and services should be documented on the appropriate local form. Do not use Form 13 for a student who is not §504-eligible. Section 504 Committee’s Decision The Section 504 Committee’s analysis of the eligibility criteria as applied to the evaluation data indicates that at this time (check the appropriate box or boxes): Not §504 Eligible. The student is not eligible under Section 504. §504 Eligible + Plan + Dyslexia Services. The student is identified as dyslexic, is eligible under Section 504, and will receive a Section 504 Services Plan that governs the provision of a free appropriate public education to the student. The Plan will include dyslexia services. The student will receive manifestation determination, procedural safeguards, periodic re-evaluation (at least ever three years) or more often as needed, as well as the nondiscrimination protections of Section 504. §504 Eligible + Plan + No Dyslexia Services. The student is eligible under Section 504, and will receive a Section 504 Services Plan that governs the provision of a free appropriate public education to the student. The student will receive manifestation determination, procedural safeguards, periodic re-evaluation (at least ever three years) or more often as needed, as well as the nondiscrimination protections of Section 504. §504 Eligible + No Plan (In Remission). The student is eligible under Section 504, but will not require a Section 504 Services Plan because the physical or mental impairment is in remission, and there is no current need for services. The student will receive manifestation determination, procedural safeguards, periodic re-evaluation or more often as needed, as well as 54 Source – Dyslexia Handbook Revised 2014

the nondiscrimination protections of Section 504. Should need for a Plan develop, the Section 504 Committee shall reconvene and develop an appropriate Section 504 Services Plan. §504 Eligible + No Plan (Mitigating Measures). The student is eligible under §504, but will not require a §504 Services Plan because the student’s needs are met as adequately as his nondisabled peers due to the positive effect of mitigating measures currently in use. The student will receive manifestation determination, procedural safeguards, periodic re-evaluation or more often as needed, as well as the nondiscrimination protections of §504. Should need for a Plan develop, the §504 Committee shall reconvene and develop an appropriate §504 Services Plan. This result applies when the mitigating measures are neither provided by nor implemented by the School. §504 Eligible + No Implemented Plan (Refusal/Revocation of Consent for Services). The Student is eligible under §504, but will not be served under a §504 Services Plan at this time because the Student’s Parent has either refused consent for initial Section 504 Services or has revoked consent for continued Section 504 Services. The Parent’s action is documented in Form 12. The Committee will complete the Section 504 Services Plan (Form 13), but the Plan will not be implemented due to the Parent’s refusal to consent or revocation of consent. The Student will receive manifestation determination, procedural safeguards, periodic re-evaluation or more often as needed, as well as the nondiscrimination protections of §504. Should the Parent desire Section 504 Services for the Student, the Parent will notify the §504 Coordinator to convene a Section 504 Meeting. Continued §504 Eligibility. The student remains eligible under Section 504, and will receive an updated Section 504 Services Plan that governs the provision of a free appropriate public education to the student. The student will receive manifestation determination, procedural safeguards, periodic re-evaluation (at least ever three years) or more often as needed, as well as the nondiscrimination protections of §504. (For use with Re-Evaluations). Dismissal from §504. The student is no longer eligible for Section 504 and is exited from the program. The student will now receive regular education without Section 504 services. The student will receive the nondiscrimination protections of Section 504 as a student with a record of an impairment, together with procedural safeguards, but will not receive manifestation determination, or periodic re-evaluation (at least ever three years). IDEA Eligible & §504 Dismissal. The student has been determined special education eligible by an ARD Committee/IEP Team. Consequently, the student is no longer served through a Section 504 Committee and is exited from the program. The student will receive a free appropriate education through the ARD Committee/IEP Team, together with the nondiscrimination protections and procedural safeguards of Section 504. Other (please describe) Additional notes or explanations by the Committee:

55 Source – Dyslexia Handbook Revised 2014

56 Source – Dyslexia Handbook Revised 2014

Appendix F Dyslexia Instructional Program Exit Criteria Student: _______________________ DOB:_______ Grade____ Campus: _________ Dismissal of dyslexia instructional program MUST be based on a comprehensive and thorough consideration of a preponderance of student data that meets most or all the criteria outlined below. Either the Campus 504 Committee or the ARD Committee can make the decision to exit a student from the District’s dyslexia instructional program if a preponderance of evidence is available to support each decision. ☐Yes ☐No 1. Student has met standards on the STAAR/EOC Reading test for at least one year AND is reading at grade level as measured by a Reading Inventory Measure from the District’s dyslexia instructional program and classroom administered fluency checks. AND ☐Yes ☐No 2. The student has completed/mastered all the objectives in the District’s dyslexia instructional program; AND ☐Yes ☐No 3. Student’s reading teacher indicates student’s grades and performance in the regular reading program demonstrate that there is no longer an educational need for the placement in the dyslexia instructional program; AND ☐Yes ☐No 4. Student’s dyslexia teacher and regular reading program teacher are in agreement that student no longer has an educational need for the dyslexia instructional program. NOTE: You must answer YES to questions 1-4 in order to exit student from dyslexia instructional program. ☐Yes ☐No ☐ N/A 5. Student demonstrates minimal to no measureable progress in the District’s dyslexia program and/or an inability to grasp the concepts taught in the program after consistent implementation AND is demonstrating regression. ☐Yes ☐No ☐ N/A 6. Factors such as behavior and/or absenteeism prevent the student from benefitting from the District’s dyslexia instructional program. NOTE: If answer to question 5 or 6 is yes, this must be supported by documentation of parent conference as well as progress reports on the impact of the program’s interventions on student learning. This lack of progress/benefit must be documented in either the student’s 504 committee minutes or ARD minutes. Student must be referred for further evaluation. A student exited from the dyslexia instructional program will continue to be monitored by the dyslexia teacher on a six weeks basis and may continue to require a service plan to 57 Source – Dyslexia Handbook Revised 2014

be implemented in the general education classroom. All students receive an annual review by either the Campus 504 Committee or ARD Committee. 504/ARD Committee Decision: ☐Yes ☐No 1. The student has met the above exit criteria. ☐Yes ☐No 2. The data used for making this decision is on file with this form in the student’s 504 or Special Education folder. ☐Yes ☐No 3. A parent conference was held prior to this committee decision so as to collect parental input. ☐Yes ☐No 4. At this time, the student does NOT meet exit criteria,, however, the parent has requested that the student be exited from the dyslexia instructional program. Parent has withdrawn consent. Based on the above noted data, ___________________________________ has exited the (student name) District’s dyslexia instructional program, effective ______________ (date) Committee Signatures: Name/Signature

Position/Title

58 Source – Dyslexia Handbook Revised 2014

Knowledge of… ☐ child ☐evaluation data ☐placement options ☐ child ☐evaluation data ☐placement options ☐ child ☐evaluation data ☐placement options ☐ child ☐evaluation data ☐placement options ☐ child ☐evaluation data ☐placement options