Exhibit 3 – Emotional Disturbance – IEP Format without Explanations of the NASET Coding System and Guide Codes

School District/Agency: Newtown School District

Name and Address:  Newtown Province, IL

Section 1- Background Information

Student Name:          David Morris

Date of Birth: 2/5/05Age:    11

Street: 14 River Rd.

City:    Newtown         Zip: 16753

Date of Referral for Committee Review: March 17, 2016
Telephone: 768–0943            County of Residence: Newtown

Male_X_ Female __ Student ID#: 8786Y Current Grade: 5
Dominant Language of Student: English    Interpreter Needed: Yes___ No _X__

Medical Alerts: none

Mother’s Name/Guardian’s Name: Mary

Street Address: same

City:    same    Zip: same

Telephone: same        County of Residence:

Dominant Language of Parent/Guardian: English Interpreter Needed: Yes__ No_X_

Father’s Name/Guardian’s Name: Paul

Street Address: same

City:    same    Zip: same

Telephone: same        County of Residence: same

Dominant Language of Parent/Guardian: English Interpreter Needed: Yes__ No__X_

Section II-Type of Meeting:

A-Initial Evaluation

1.   Date of Initial Evaluation Meeting: March 8, 2016

2.   Area of Suspected Disability – (NASET Coding System and Guide Level I Diagnosis)-Emotional Disturbance

3.   Origin of Evaluation used in determining classification:

• In-school ___X____ Non-school Personnel Evaluation __X___

4.   Components of Present Evaluation:

• Individual Standardized Testing _____X____
• Informal Assessment Measures ____X___ (i.e. Portfolio Assessment)
• Observation ___X___
• Social History ___X___
• Teacher Reports ___X___
• Interviews with Child ___X___
• Review of Medical Records ___X____

5.   Specific Areas Covered in Evaluation:

1. Intelligence Testing ___X____
2. Academic Testing ___X___
3. Medical Evaluation ____X____
4. Speech Language Evaluation _______
5. Occupational Evaluation _______
6. Other (Be Specific) _________
7. Audiometric Evaluation _______
8. Psychiatric Evaluation ____X___
9. Psychological Evaluation ____X___
10. Portfolio Assessment ___X____
11. Curriculum Based Assessment _______
12. Authentic Assessment ___X_____
13. Task Analysis ____X____
14. Outcome Based Assessment ________
15. Learning Styles Assessment ____X____

6.   Committee Recommendations:

Classification (NASET Coding System and Guide Coding):

Level I-Emotional Disturbance                                                                      ED

Level II-Anxiety Reactive Disorder   Code                                                    ED 6.00

Level III- School Avoidance Anxiety

Reactive Disorder                                                                                           ED 6.02

Level IV                                                                                                         Not Applicable

Level V                                                                                                           Moderate

Level I-Emotional Disturbance                                                                      ED

Level II-Anxiety Reactive Disorder                                                               ED 6.00

Level III- Panic Reaction Type                                                                      ED 6.01

Level IV                                                                                                         Not Applicable           

Level V-                                                                                                          Moderate

Level I-Emotional Disturbance                                                                      ED

Level II-Inappropriate Behavior or Feelings                                                  ED 3.00

Level III-Disruptive Behavior Type                                                               ED 3.02

Level IV-                                                                                                        Not Applicable           

Level V                                                                                                           Moderate

Level I-Emotional Disturbance                                                                      ED

Level II-Relationship Problems Disorder                                                       ED 2.00

Level III                                                                                                         Not Applicable

Level IV                                                                                                         Not Applicable

Level V                                                                                                           Moderate

Level I-Emotional Disturbance                                                                      ED

Level II-Somatic Complaints Disorder                                                          ED 5.00

Level III                                                                                                         Not applicable

Level IV                                                                                                         Not Applicable           

Level V                                                                                                           Moderate

Note that in the above case the school district also chose to use the five levels of the coding system. The flexibility of this system allows for the district to use as many levels as they see appropriate.

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