eetin g Date. Sign ed. Perm issio n fo r Screen in g d ate. Date Date. Screen ed. LLP. -â. K. TEA. -3. Read in g â. K. TEA. -3. M ath. â. AD. HD AD. DES. â. SB.
SBLC Log/Request of Screening Log: *Please date each column that applies, and (√ ) all screenings that were completed. *10 day deadline from the date of the request for assistance to the Initial SBLC Meeting date.
*Revised August 2017
Eligible for §504 Y or N
Implementation (if deemed necessary)
SBLC Meeting of Results and
ADHD ADDES √
KTEA-3 Math √
KTEA-3 Reading √
LLP-√
Signed Permission for Screening date Date Date Screened
Initial SBLC Meeting Date
Name
Date referred
*60 day deadline from the date of the request for assistance to the completion date of the assessment and implementation, if deemed necessary-SBLC Meeting of Results
Microemulsion Buffer: 6.6% (w/v) 1-butanol, 0.8% (w/v) n-heptane, 3.3% (w/v) sodium dodecyl sulfate, with 68 mM CAPS buffer (pH 10.3) made up to volume.
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