1. J
Directions for Completing the CERT
(Abridgedfrom CERT Script FL DOE)
The CERT outlines a srudent's need for educationally relevant therapy as determined by the school-based
therapist in collaboration with the IEP team. Best pracrice would be to use the CERT with evaluations and
re-evaluations at a minimum. Academic goal.s and objectives should be written for each srudent integrating
OT/PT goals under independent functioning. These goals are reviewedby the IEP team annually. Annual
review of goals will determine the necessiry for changes in service rype, duration, intensiry, etc. Such reviews
will guide the necessiry for continuing, altering, or discontinuing the related sewice. The CERT may be a
valuabie tool in leading this &scussion or assisting in consensus of the team.
The CERT form involves a rwo-step process. The first part of the process-complerion of the Srudent
Profile-occursbeforethe IEP meeting, at the conclusion of the initial evaluarion, and during any re-evaluation.
The second part of the process-completion of the Therapy Frofile and lower portion of the Summary Sheet-
occurs at the IEP meeting. Remember, the IEP team members, together, determine whether the expertise and
intewention of an occupational or physical therapist is needed. If the student has been evaluated by an
occuparional therapist cnd a physical therapist, then each therapist should complete a separateCERT form,
filling in all sections based on their specific &scipline and expertise.
The CERT is completed using multiple sources of information, inclu&ng the results of srudent evaluarions
suchas theEvaluationofFunctionalskillsintheEducanonalEnvironmentAssessmentdevelopedbytheDeparrmentof
Education or other assessments, observations of the student in various educational settings, interviews with
teachers and parents, and other relevant student records.
The CERT consists of a Summary Sheet, Scudent trrofile Sheets, and a Therapy Profile Sheet. The Summary
Sheet contains one section that is completed before the IEP meeting, with the remainder completed at the IEP
meeting. The Student Profile section of the CERT summarizes the student's performance in five areas of school-
related functions: personal care, mobiliry, gross motor, fine and visual motor, and sensory processing. These five
areas are more fully described on pages rwo and three of the CERT.
The Summary Sheet also contains information from the student's prioriry educational needs, information from
the Therapy Profile, and recommendations for therapy. Let's take a closer look at each of the five areas
addressed in the Student Profile section.
Personal Carerefers to the management of personal needs and equipment within the educacional environment.
Examples of personal care include:
o Obtaining food from the cafeteria or lunch box
o Use of utensils for feeding
o Dressing andundressing
. Toileting, and
o Washinghands

2. Mobilityrefers to safe and adequate movement with or without equipmenr or devices.
Exampies of this include:
o Boar&ng, riding, or exiting a school bus
a Ascending or descending stairs
a Maneuvering throughout the school campus or other places in the community in a safe and efficient
manner. This movement may involve:
-Even and uneven surfaces with or without assistance devices
-Carrying school materials such as a backpack or lunch rray
'Opening and closing doors-Transferring to and from the 0oor
-Use of chairs or toilet seats, and -Accessing age-appropriate playground equipment
Gross Motor Skillsarc developmental motor skills, positioning equipment, an#or static and dynamic balance
needed to participate in the educational environment.
Examples of gross motor skills include:
. Changing or maintaining appropriate positioning
a Static and dlmamic sitting balance
o Static and dynamic standing balance
o Participacion in physical educaEion activities, and
a Bilateral integracion and coordination
Fine motor Skillsinclude visual perception, visual motor, and fine motor skills needed to manipulate and
manage materials within the educational environment.
Examples of fine or visual motor skills include:
o Grasping and the use of tools such as writing instruments, utensils, and scissors
o Manipulation of objects
o Management of fasteners such as buttons, snaps, and zippers
o Coordinated bilateral hand use, and
o Visual-motor integration or eye-hand coordination
Sensory Processingrefers to body awareness and sense of movement, sensory perception, exploration, and
interaction with others during play and work activities within the student's educarional environment. Sensory
processing deficits may be observed in siluations where the srudent is asked to:
o Explore various stimuli by touching or smelling
o Waikinline
a Playwith other s[Lldents
The Student Profile is completed by school-based therapists prior ro the IEP meering using informacion
obtained from student tecords, evaluarions, observations, parent-teacher input, and other data along with
the therapist's professional knowledge. For each of the five areas of the Student Profile, rhe CERT documenr
contains a description of four levels of srudent abiliry along a continuum.
The therapist must read each descriptor carefully before choosing the level which best describes the presenr
level of perforrnance and support. The therapist then interprets these descriptors within rhe conrexr of the
srudent's educational environment. The description does not have to match the srudent completelyinorder ro be
selected. Rather, the score should reflect the best description of the overall functional abiliry of rhe srudenr in
that category. A doubie asterisk (**) indicates that the srudent's needs are being addressed through the
classroom curriculum or other existing services-including assistance by school staff-and no additional
services are necessary.
Scores from each of the five areas are recorded in the Srudent Profile section of the Summary Sheet and chen
added to show rhe total score. In the Source of Inlormation and Additional Commenrs column, specific tools

3. used for evaluation should be identified and written down. The therapist completing the Srudent Profile should
sign and date this section, leaving no sections blank.
Only the Student Profile section of the Summary Sheet may be completed prior to the IEP meering. During the
IEP meeting, the occupacional and/or physical therapist will complece the Therapy Profile seccion of the
Summary Sheet basedupon the input of the IEP team. It is important for the entire IEP team to provide input
for the completion of the CERT. The occupational and/or physical therapist should complete the form during
the IEP team process. Remind the team that their input is important. Discussing what other resources and
needs are available may affect the needed frequency of the service.
At the IEP meering, the team discusses the student's prioriry educarional needs,goals and objectives. Based
upon the s$denCs goals and objectives, as determined by che team, they can then determine if the srudent's
goals and objectives require the support of an occupational or physical rherapist. At this time, the therapist
records the student's prioriry edueational goals and objectives that require the support of an occupational
andlor physical therapist on the CERT Summary Sheet.
The next secEion of the CERT form, the Therapy Profile, describes factors in five areas that commonly influence
the effectiveness of therapy services.
Having reviewed the srudent's record, the therapist should go to the meeting knowing the number of years of
educationally relevant sewice the srudent has received. Then the therapist should thoroughly read each
column and choose the coiumn that best describes the following information:
o The number of years the student has received educationally rela,anttherupy
o The student's potential response to educationally relevant therapy (To determine potencial response,
consider the srudent's current performance level and determine if therapy services are needed to support
the IEP goals and objectives.)
o The srudent's abiliry to access their learning environment, including the need for community-based
inslntction with or without modificarions or accommodations required, and any recommended assistive
technology
In determining the therapy services, the IEP team should consider the amounr of support needed to
meet the student's educational goals, recognizing that no one service delivery model is better than the
other. Rather, therapy services are a conrinuum. The IEP team must keep in mind that therapy works
toward a funccional outcome that meets the srudent's goals.
Support services to be provided to school staff and/or parents, inciuding the amounr of training needed by
teachers or parents to follow through on the student's educational program andwhether or nor trained
school personnel can assist with adaptive equipment and techniques throughout rhe school day
The scores from each of the five areas in the Therapy Profile are then recorded on the Summary Sheet in the
Therapy Proftle section. The scores are added together and the total recorded in rhe appropriate box.
In the Sources of Information and Additional Comments section, the therapist should include parent or
teacher input and other information shared at the IEP meeting. The therapist complering the Therapy Profile
should sign and date this section, ensuring that no sections are left blank.
The IEP team-including the occupational and/or physical therapist-can now proceed with aRecommendation
forTherapy Services. The grid at the bottom of the CERT form is designed to assist in determining if therapy
services are indicated and, if they are, the frequency at which therapy should occur.
)

4. Using the score derived from the Srudent Profiie SecEion, place an X over the range that contains the
srudent's score on the top row of the grid. Using the score derived from the Therapy Profile secrion,
place an X over the range that contains the srudent's score on the first coiumn of the grid. Draw a line
down from the srudent profile score and across from the therapy profile score. The point where the
lines intersect indicates a recommended frequency of therapy. The therapist who atrends the IEP
meetingmust sign this section
For purposes of this video, we are providing the following examples as guidelines for the therapist to use in
interpreting the scoring grid:
. Services are not indicated when the student is self-reliant and funcrional in the educational environmenr
or the student's needs are addressed by the classroom curriculum or other exisring services, which may
include any assistance provided by school staff.
r Periodic Services include environmental or equipment modifications and rraining and,/or consultation
with parents and/or school staff. Examples of therapy frequency at this level include once a month, Ewice a
gra&ngperiod, or once a semes[er.
. Regular Services include specific therapeutic strategies, environmental or equipment modifications, and
rraining or collaboration with parents and school staff. Examples of therapy frequency include fwice a
month, once a week, or less than 45 minutes per week.
r Intensive Services include intensive therapeuric srrategies, muhiple environmental or equipment
modifications, implemented throughout the day with classroom particrpation, and rraining of parenrs
and/or school staff. Examples of therapy frequency include one or Ewo rimes a week or less than 60 minutes
per week. Notes, such as a difference in the professional judgment of the therapist and the IEP team's
recommendation, should be noted on the comment secrion of the form.
According to the Individuals with Disabilities Educacion Act, the role of a related service, such as
occupacional or physical therapy, is to enable the student co benefit from special educarion in order ro receive
a free appropriate public education. Occupational and physical therapists, along with other IEP team
members, determine the need for educarionally relevant therapy.

5. .JLK
Considerations for Educationally Relevant Therapy
OccupnnoNAL AND Pnvsrcnt Txempv Sunnuany Sneer
School District:
RelatedService(s): flOccupationalTherapy flenysicalTherapy
Florida Department of Education
Bureau of Exceptional Education and Student Services
Student:
ESE Program(s):
Sources of lnformation and Additional Comments
Total Points: Completed by: Date:
To be completed at IEP meeting
According to 34 CFR 300.24, related services such as occr:pational and physical therapy are provided to assist the student
with a disability to benefit from special education. The student's priority educational needs and goals and objectives identified
on the IEP that require the support of an occupational therapist or physical therapist are:
g
E
e
[
a.
E
o
F
Points Sources of lnformation and Additional Comments
Number of Years Student Has Received
Educationally Relevant Therapy
Potential Response to Educationally Relevant Therapy
Student's Learning Environment
Therapy Services to Be Provided to Student
Support Services to Be Provided to School Staff/Parents
Total Points: Gompleted by: Date:
Student Protile
o
o
a.
a-
g
o
F
The IEP team recommendation is:
-
ffi Occupational therapy is not indicated
_ ffi Physical therapy is not indicated.
Recommendation for Therapy Services
Place an X on the horizontal axis to reflect the score on the
Student Profile. Place an X on the vertical axis to reflect the
score on the Therapy Profile. The point where the axes inter-
sect indicates a recommended frequency of therapy.
Therapist's Signature Print Therapisfs Name
_ Occupational therapy is indicated.
_ Physicaltherapy is indicated.
The recommended frequency of therapy is:
-
Wperiodic.
-
ffi regutar.
-
I intensive
Comments:
(CERT-Revised 8/04)
ESE 8575

6. 0L r6
Student Profile
Personal car+ management of personal needs and equipment within the educauonal environment
Sh.adent demonstrate
adeqtnte dressing/undressirg,
hygien€, self-feediry skills, or
oral motor skills witr/rvithorX
present equipment or devlces.
Sfudent demonstratee
adequate personal care skiils
using equipmenUdarices.
Student requires supervision/
proTpts fc dressing/urdreasing,
h)€iene, sdf-feeding, or oral
motaskills.
Student require supervision/
prompts to use personal care
equipmenUdwices.
Student reguires physical
assistanceor specific
Srategles for eessirg/
urdressing, hygiene, sdf -
feedng, or oral motor skills.
Student requires multiple
equipment /devices and needs
physcal assistane.
Student requires Intensfue
trainirg by heragst to
facilitate ernergirg'dr€sslr41
undressing, hlglene,
sdf-feeding, or oral motor
skills.
Sludent require mr/tple
equipmenUdevices anil
needs jntensive hainlng by
therapist in use of derrices.
Mobility- safe and adequate
{no.v.9lnTt (e-g-' transfers, transitions between positions or locations, the ability tonavigate architecturar ba'iers) within the iuricationat environment vvetqsrro ur rv(
Student demonslrates
adequate mobilig with pr*ent
equipment or denices.
Student dernonstrates
a@uate mobility withort
equipment or dwie.
Student dernonstraGs
adequate hansferand
transition skills.
*
Student uses equipment or
devices for mobilit/ wift superui-
sior/prompts.
Studant requlres supenrlsion/
prompts for safe and dequate
mobility.
Student requires superrrlsion/
prompts to complete transitons/
transfers.
Student reguires grysical
assistance or specific skats
gies to use equipment fc
mobility.
Student requires physical
assistiance or specific
strategies for safe and
adeqrate mobility.
Strrdent requires physlcal
assistanceor specific
strategies to complete
transitionsltransfers.
Student requires intenslve
tralnirg by ttreapist ln
specific strategies for netrr
equipment.
Student requlre intersho
training by therapist to
demonstrate anergringi
mobiliVskills.
SMent requires lntenslw
hainirq by herapisn b
denronstrate ernergnS
transition/transfer sldlli.
Gt".."? M.oto1;.dw.dopmental motorskills, pcitioning equipment, and/or staticldynamic balance needed toparticipate within the educational environmdnt
' 'e -1--r'--'ii' 5'r
Sfudent sr as$Jme, maintaln,
or cfiarqe positlons needed for
parffdpation.
Stt.ldent dernonstrates
adeguate gross motor skills
nded forpartidpafion
SMent dernmstrates
adequate use of equipmenU
positioning dadces for gross
motorskills.
$tudenl require supenridon/
prornpts to assume maintain, or
change pc$tbns.
Strdent requires supervislonl
pronpb to perform gross motor
skills.
Sfudant requires supenrislory'
prompts to use equipmenU
pasitbning deryi,ces for gross
motorskilfs.
Student requiree phlrsical
assistance ard/or speciflc
slrategies to assume, mainhh,
or change positions.
Student requires physlcal
assistarrce or speciftc sbate
gies to perform gross motor
skills.
Studvrt requirw physical
assistance andor specific
strategies to use equipmenU
@timing device forgrws
motqskills.
Sftdent has anergirg skills
and requires lntensiw
haldng byherag$ b
assumef maintaio, or
charqe positions.
Student requireC lntanlhre
fainirq tdperturmsoss
motorskills. , r,
Sturdent requires multiple
tdals of positiontqg eqirtp
ment to accass the
educatimal envirorunenl

7. bkk Therapy Profile
Number of Years student Has Received Educationally Relevant Therapy
More than 8 years of therapy 5 to I years oftherapy 3 to 5 years of thaapy Les than 3 years of therapy
Potential Response to Educationally Relevant Therapy
Student is ereected to
function in the educational
swironment withort therapy
seryie.
Student is elgec*ed to maintain
cunent levd of performance
with pen:odic therapy serrrie in
the educational environment.
Student is eryeded to make
progress torads educational
goals with therapy senrices.
Student is el<pected to make
significant progress tolrlards
educati,onal goals with therapy
services.
Student is able to access the
leaming erwironment with/
wifrtout use of conpensatory
skills or modifications.
Periodic revieur or modification
of the student's leaming
environment, induding
oornmunity-based instrdion
sites, is neccsary.
Regular rwievv or modification
of the student's learning
environmqrt, induding
oommunr'ty-based insdrudion
sits, is necessary.
bdensive revievv or modifie
tion of the studsrt's leaming
environment, indudirg
cornmunig-based instnrc-tion
sites, is necessary.
Therapy Services to Be provided to Student
Strdent does not rquire
interventon by the theiapist
orne sugg€sted modifications
are in plae.
Studsrt does not require
intenrention by the therapist
to access and benelit from
special education.
StJdent requires paiodic
support from the therapist to
benefit from special education.
Sttdsrt requires regular
support from the therapist to
benefit ftrom spedal edr.rcation.
Student requires extensive
support ftom the therapist to
benelit frorn specjal education
as strrdent's educational needs
are ftequantly cfranging.
support services to Be Provided to school staffand/or parents
Statr/parents do not require
ttrerapist involvement to
€stablish a program and
sdeci adaptive equipment,
technique, or routines.
Staff/parenb require periodic
therapist invdvesnent and/or
training to etablish a program
and sdect adaptive equipmant,
techniques, or routines.
Staff/parents require regular
therapist inrolvernent and/or
haining to estauish a progftm
ard sded adaptive equignent,
techniques, or routires.
Staff/parenb require intensfue
therapist involvenrent and/or
training to estrablistr a program
and select adaplive equipment,
techniques, or routines.

8. Student Profile
Fine MotorMsual Motor-visual perception, visual motor, and fine motor skills needed to manipulate and managematerials within the educational environment
Stulent denronstrates
adequate visual perceptual
ard/or Msual motor skills.
Sttdent can manipulate
objectsftools/ada$ive dwices.
**
Student requires supenrision/
prompb to perfonn Msual
perceptual and/or visual motor
skills.
Student requires supervision/
prompts to manipulate
obrech/tools/adaptive dwices.
Student requires physical
assistance and/or specifi c
strategie to perform visual
percepfual and/or visual motor
skills.
Student requires physicd
assistance ard/or specif ic
stratqies to manipulate
objecdsltoolVadaptive dwices.
Student requires intensive
training by thaapist to perform
visual perceptual andor
visual motorskills.
Student requires intensive
kaining by therapist to
dernonstrate enrerging
manipulation of
obiedMools/adaptive dedces.
*!|s:.w Processing- body awareness and sgnse of movement, sensory perception, exploration, and interactionwith others during play and work adivities within the eoucationai Lnvironment
Student toleratee movement,
toucfr, todures, sights, sounds,
and srndls occuning in the
educati,snal erwironment.
Sfudent seeks appropriate
sensory input.
Sludent adequately uses
suggested technigues for sdf-
regulation.
Stdent is able to make
cfioices, organize, motor plan,
and initiate tasks.
Student reguires super-vision/
prompts to tolerate toudr,
textures, sights, sounds, and
smells or to seek appropriate
sensory input.
Student requires supervision/
prompts to utilize suggested
techniques for adequate sdf-
regulation.
Student requires supenrision/
prompts to make cfioices,
organize, motor plan, and
initiate tasks.
Student require phpical
assistance and/or specifi c
strategies to derate
mor/ernfft, toucfi , texture,
siglrts, somds, and smdls or
to seek appropriate sensory
input.
Student requires phystcal
assistrarrce ard or speciftc
strategies to utilize sqggested
tecfiniques for adeqtnte sdf-
regulatior.
Student requips physical
assistance and/or specif ic
slrategies to make choices,
organize, motor plan, and
initiate tasks-
Student requires intgrsive
intenrentions by therapist to
tolqate movernent, touch,
teXures, sights, sourds, and
smdls cto seek appropriate
sensory input.
Student requires intensive
training by therapist to use
suggeted tecfiniques for sdf-
regulation.
Student requires intensive
training by theraftst to make
choiges, organia, motor plan,
and initiate tasks.
* student's needs are addressed through dassroom qniculum or other existing senrices, rvhi,cfr may indude total assistance bysdmlstafi-