Psychoeducational Assessment Planning Worksheet

Referral question and strengths

Start with the decisions the assessment should inform, not an assumed diagnosis or outcome.

• Main referral question in plain language
• Who raised the question, when and in which settings?
• Student's strengths, interests and successful learning conditions
• Student's priorities, concerns and preferred way to participate
• Learning, attention, communication or well-being questions to explore
• Decisions the assessment is expected to inform

Supports tried and outcomes

• Support, accommodation, teaching strategy or intervention tried
• Start and end dates, frequency, duration and setting
• Who provided the support and how consistently?
• Starting point and information used to track change
• Observed outcome across subjects, tasks or settings
• Student and family view of what helped, did not help or caused difficulty
• Support to continue while assessment planning proceeds

School referral log: board assessment and IPRC

Keep the pathways distinct: an IPRC decides educational identification and placement; it is not a psychoeducational assessment or diagnosis. A school-board psychological assessment is a separate professional assessment pathway. A professional assessment is not mandatory to access special-education programs or services a student needs.

• In-school team meeting: date, attendees, concerns and agreed next steps
• Board psychological-assessment request or referral: date and recipient
• Board response, referral criteria, waiting-list status and estimated timing
• Board special-education plan checked for assessment process and wait times
• Consent information received before any professional assessment begins
• Separate IPRC request or referral, if pursued — Record it as an identification-and-placement process, not as a diagnosis or request for a psychoeducational assessment
• Copies of requests, responses, meeting notes and contact names

Assessor comparison

Verify psychology practitioners in the CPBAO Public Register and compare the people responsible for each part of the service.

• Practitioner or clinic name and contact information
• CPBAO registration status and certificate type — Confirm whether practice is autonomous or supervised
• Authorized area or areas of psychology practice relevant to the referral
• Authorized client population appropriate for the student
• Relevant assessment experience, languages and accessibility accommodations
• Who interviews, administers tests, scores and interprets results?
• Supervisor's name, CPBAO status and role, if supervision applies
• Person holding clinical responsibility and signing the final report

Documents, fees, insurance, timeline and consent

• Documents requested and why each is relevant
• Report cards, work samples, attendance and intervention records
• Current IEP, IPRC statement and earlier professional reports, if applicable
• Itemized fees for intake, testing, scoring, feedback, report and extra copies
• Insurance coverage, referral or pre-authorization requirements
• Cancellation, rescheduling and additional-session fees
• Wait time, assessment dates, feedback date and final-report timeline
• Purpose, procedures, limits, risks and alternatives explained before consent
• Student assent, participation choices, breaks and accommodations
• Who will receive the report and how consent can be changed or withdrawn

Convert report recommendations into IEP actions

Translate each accepted recommendation into a specific school action, then repeat this section or attach another page for additional recommendations.

• Report recommendation and the strength or need it addresses
• Specific IEP action — Accommodation, teaching strategy, service, learning expectation or transition action
• Action owner
• Target date
• Progress measure and starting point
• Review date
• Student and parent input on the proposed action
• Where the action and progress update will be recorded