Get Other Health Impairment Eligibility Determination Form

Completing the Other Health Impairment Eligibility Determination Form online can facilitate the assessment of a student’s eligibility for special education services. This guide provides clear instructions on how to effectively fill out each section of the form.

Follow the steps to complete the eligibility determination form

1. Press the ‘Get Form’ button to access the Other Health Impairment Eligibility Determination Form and open it in your digital editor.
2. Enter the student’s full name, SSID, date of birth, and date of eligibility determination in the designated fields. This information is crucial for accurately identifying the student.
3. Fill in the school name in the appropriate section to indicate where the student is enrolled.
4. For question 1a, indicate 'yes' or 'no' regarding the existence of a health impairment. Specify the health impairment if applicable, such as attention deficit disorder or diabetes.
5. In question 1b, assess and mark if the student has limitations in strength, vitality, or alertness due to the health problem.
6. Proceed to questions 2, 3, and 4, answering 'yes' or 'no' based on evaluation information regarding adverse effects on educational performance, lack of instruction in reading and math, and limited English proficiency.
7. On the next page, provide supporting documentation demonstrating how the ARC substantiated the disability and confirmed its impact on educational performance.
8. Conclude by selecting the appropriate eligibility determination regarding whether the student meets or does not meet eligibility criteria for specially designed instruction and related services.
9. After completing the form, you can save your changes, download the document, print it for physical records, or share it as necessary.

Complete the Other Health Impairment Eligibility Determination Form online today to ensure timely support for the student's educational needs.