Multiple Disabilities Evaluation Checklist
Pull together data from many disciplines when more than one impairment affects learning. A free, fillable checklist for school psychologists and evaluation teams.
What’s inside
- The federal eligibility requirements, each with space to note where the evidence is documented
- 14 commonly used measures to check off, with date tested, examiner and results
- Records, interviews, observations and screenings
- Planning considerations
- Evaluation timeline and a team summary box
Get it free
Enter your email and confirm it. You’ll go straight to the download, plus all our other free checklists and tools.
What IDEA requires for Multiple Disabilities
The checklist walks your team through each part of the federal definition so nothing is missed at the eligibility meeting:
- Two or more concomitant impairments (for example, intellectual disability with blindness or with an orthopedic impairment)
- The combination causes such severe educational needs that they cannot be met in a program solely for one impairment
- Not deaf-blindness (a separate category)
- Adversely affects educational performance
- Student needs specially designed instruction
Summary of federal IDEA regulations (34 CFR §300.8(c)(7)). Your state may add criteria or use different terms. Follow state and district procedures.
Measures included in the checklist
No single test determines eligibility. The checklist lists measures school psychologists commonly use so you can document what was given, when and by whom:
- Cognitive and adaptive: Nonverbal or motor-reduced cognitive measure (Leiter-3, UNIT2), Vineland-3 (parent / teacher), ABAS-3 (parent / teacher), Functional skills / curriculum-based assessment
- Communication: Speech-language evaluation, Augmentative and alternative communication (AAC) evaluation
- Sensory, motor and health: Vision evaluation / functional vision assessment, Audiological evaluation, Occupational therapy evaluation, Physical therapy evaluation, Assistive technology evaluation, Medical records and health plan
- Behavior and observation: BASC-3 or other rating scale (if appropriate), Observation across settings and routines
Blank rows let you add any other measures your team uses.
Planning considerations
- Each impairment documented
- How the combination affects access to instruction
- Communication system used across settings
- Positioning, mobility and personal care needs
- Health and medication needs
- Family priorities and goals
Frequently asked questions
Is the checklist fillable?
Yes. You can type into it on a computer or print it. Check boxes are printed, and every date, examiner and notes field can be filled in digitally.
Does this replace my state or district forms?
No. It is a working checklist to organize data. Your state may add criteria or use different terms, so always follow state and district procedures and use their required forms.
Can I share it with my evaluation team?
Yes. Share it with colleagues on your team. If others want their own copy, send them to this page.