Initial Eligibility Ages 3-21

To be used when initial eligibility process begins after child’s third birthday. For children transitioning from Infant and Toddlers (Part C) to Preschool (Part B), see Initial Eligibility Prior to Age 3 with IEP. 

1. Complete the all information in the  form.  

2. Input information into the following areas.

• Area(s) Impacted
• Is a determinant factor for the child's lack of academic progress the result of:
• Does the student require specially designed instruction in order to make adequate progress in school?
• Document the bases for the decision(s). Images, charts, and tables can be added to the text boxes.

In the Disability section, select the Primary Disability from the drop-down list.  If Specific Learning Disability is selected, choose the appropriate option(s).  If Other is selected, please specify.

3.  Complete the Dates section. The following date fields should be filled in:

• Date of parent consent for initial evaluation
• Date of initial evaluation
• Date of initial IEP development
• Date of parent consent for initial of services
• Date of initial IEP is in effect

The following date fields should not be filled in:

• Date of Parent Consent-Continue Early Intervention Services through an IFSP at age 3
• Date local school system was notified of parent decision to request services through an IEP
• Date extended IFSP services ended

At the bottom of the Dates section, choose “No” to “Is this student transitioning from Infants and Toddlers (Part C) to Preschool (Part B) and receiving services through an IEP?”

Below is an example of  the 'magic dates":

• "Select an age group" should be "INITIAL ELIGIBILITY FOR STUDENT AGES 3-21"
• Date of parent consent for initial evaluation - should already be in there from Copy from Active Elig 6 Status Report
• Date of initial evaluation - should already be in there from Copy from Active Elig 6 Status Report
• Date of Parent Consent-Continue Early Intervention Services through an IFSP at age 3 - should already be in there from Copy from Active Elig 6 Status Report
• Date local school system was notified of parent decision to request services through an IEP OR
• Date extended IFSP services ended BUT NOT BOTH
• Date of initial IEP development
• Date of parent consent for initiation of services
• Date initial IEP is in effect
• Is this student transitioning from Infants and Toddlers (Part C) to Preschool (Part B) and receiving services through an IEP? = Yes

4. Reason for delay is required only if (“Date of initial evaluation” is more than 60 days after “Date of parent consent for initial evaluation”.  Select the appropriate radio button.  If Other is selected, please specify reason for delay in text box. 

Note:  The Date of Initial Evaluation will populate on the Close Record screen as Most Recent Evaluation Date.