Dual Language Assessment (DLA) Service
Request Forms

Every request for a Dual Language Assessment must include a Multi-Purpose Referral form (page 1 and page 2) or other documentation of the concerns and reasons for referral. Requests for DLA's  must show evidence that the prereferral steps delineated in the CLiDES Handbook flowchart and in FCPS Regulation 2217.2 have been followed, and that a group of educators, parents, caregivers, and/or others involved with the student agrees the Local Screening Committee should review the case for possible further testing.

In addition to the Multipurpose Referral form, DLA requests must also include a completed CLD Student Data Checklist, and, if the student is currently receiving ESOL, an ESOL Assessment Summary.

CLD Student Data Checklist
Preschool Student Data Checklist
ESOL Assessment Summary
Home Language Survey (located in the student's cumulative folder)

Phone: (703) 876-5294
Fax: (703) 208-8019

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