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Learning Disabilities (Reading & Writing) Screening Form
Home
Learning Disabilities (Reading & Writing) Screening Form
Name
*
Email Address
*
Contact Number
*
Child’s Age
Select
4–5 years
5–6 years
6–7 years
7 years and above
Child’s Gender
Select
Male
Female
Prefer not to say
Other
Main Learning Concern
Select
Difficulty in reading
Difficulty in writing
Difficulty in spelling
Difficulty in both
Class / Grade Level
Select
Preschool / KG
Grade 1
Grade 2
Grade 3 or above
Letter Recognition
Select
Unable to recognize letters
Recognizes few letters
Recognizes most letters
Age-appropriate
Reading Ability
Select
Unable to read words
Reads with difficulty
Reads slowly with errors
Age-appropriate
Writing Ability
Select
Difficulty holding pencil
Difficulty forming letters
Difficulty writing words/sentences
Age-appropriate
Spelling Skills
Select
Unable to spell simple words
Frequent errors
Spells simple words
Age-appropriate
Attention During Academic Tasks
Select
Very poor attention
Easily distracted
Attends with reminders
Good attention
Homework Completion
Select
Refuses / avoids
Completes with difficulty
Completes with support
Independent
Previous Academic Support
Select
None
Tuition only
Special education
Multiple interventions
Parent’s Primary Goal
Select
Improve reading
Improve writing & spelling
Improve overall academics
Assessment & guidance
Submit
Contact Details
+92-3124982158
info@vicakids.com
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