Federal special education law affords a child suspected of having a disability a comprehensive evaluation when referred for services under IDEA 2004. The purpose of this study was to examine school psychologists’ procedures, practices, and beliefs in implementing a multi-faceted evaluation for children suspected of having intellectual disability (ID). Record reviews and practitioner interviews were used to assess 135 student records in three West Virginia Local Education Agencies (LEAs) to determine the extent to which sufficiently comprehensive evaluations existed; the percentages of comorbid or secondary disabilities identified; and best practices for comprehensive evaluations of intellectual disability, according to practitioners. The results indicate that students who qualified with intellectual disability were observed with the highest percentage of sufficiently comprehensive evaluations (85.3%) when compared to other major disability categories. Moreover, students who qualified with intellectual disability were found eligible for a secondary exceptionality in 32.3% of the sample. Finally, school psychologists in the LEAs of interest commonly reported state policy, eligibility criteria, and teacher and parent concerns as the primary practices that guide comprehensive evaluations. Future research should strive to increase sample size and include additional LEAs, allowing for other trends in intellectual disability and major disability categories to be discovered. Additionally, further exploration in adaptive behavior ratings, different ranges of ID, and triennial evaluations will ideally lead to better understanding of ID prevalence rates.