Learning Support Program Supplemental Application


Student Namerequired
First Name
Last Name
Applying for Graderequired
Boarding or Day?required
When was your child first formally evaluated?required
When was the most recent evaluation completed for your child?required
For this most recent evaluation, what tests were given?required
What do you understand to be the current diagnosis?required
When were learning-related problems first suspected?required
Please indicate whether any of the following academic skills were/are especially difficult or relatively easy for your child to learn.
Decoding (phonics)required
Reading Comprehensionrequired
Written Expression required
Listening Comprehensionrequired
Basic Arithmeticrequired
Math Computationrequired
Test Takingrequired
Study Skillsrequired
Please indicate levels of achievement in the following academic subject areas.
Reading/Language Artsrequired
History/Social Studiesrequired
Foreign Languagerequired
Which modifications to, or accommodations within the educational environment (i.e. extended time on tests, use of facilitative or assistive technologies such as audio books) have been implemented?required
What modifications to, or accommodations within the educational environment have proved especially useful and are still in place for your child?required
Please list all current and previous educational interventions (i.e. tutoring) and/or specialized educational programs (i.e. pull-out support, in-class support teacher or aide) or therapies (i.e. organizational coach, academic counseling) that have been implemented for your child.required
Please describe which of the above educational interventions seemed most or least effective? required
In general, what do you regard as your child’s strengths (social, academic, physical, personality, etc)?required
What do you regard as your child’s areas of greatest need?required
How does your child learn best? For example: Would you describe your child as a visual learner, auditory learner, hands-on learner, etc.? Or are there environmental conditions such as classroom considerations, or teacher attributes that significantly influence your child’s learning?required
Please provide any other information you think would help us to understand and work effectively with your child.