Yes   No   An audiological report documents that hearing loss is so severe
                that the student is impaired in processing linguistic information,
                with or without amplification, to the extent that prevents the
                auditory channel from being the primary mode of learning speech
                and language.

Yes  No  The student's educational performance is adversely affected as
               documented by specific examples:
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The results and analysis of a current assessment of language development, as
measured by standardized tests or professionally recognized scales appropriate
to age level and administered individually are required prior to identification.

Student Name: _________________ CST Date: __________