Yes   No   The student has a significantly subaverage general intellectual
             functioning, and
Yes   No   The student has significant deficits in adaptive behavior and
             educational performance, especially in the area of application of
             basic academic skills in daily life activities.
Yes   No   The presence of subaverage general intellectual functioning must
             occur between conception and the 18th birthday.
 

DEFINITIONS:

"General intellectual functioning" means performance on a standardized
intelligence test that measures general cognitive ability rather than one limited
facet of ability.

"Significantly subaverage general intellectual functioning" is defined as two
or more standard deviations below the population mean on a standardized
intelligence test. Error in test measurement requires clinical judgment for
students who score near two standard deviations below the mean.
ÒDeficits in adaptive behaviorÓ is defined as significant limitations in the
student's effectiveness in meeting the standards of personal independence,
interpersonal communication, and social responsibility expected for the
student's age/grade peers and cultural group as measured by standardized
instruments or professionally recognized scales.

Student Name: _________________ CST Date: __________