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Learning Support Program Supplemental Application
This form requires Javascript to be enabled for submission and authorization.
*
Required
Student Name
*
required
First Name
Last Name
Applying for Grade
*
required
9
10
11
12
Boarding or Day?
*
required
Boarding
Day
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
Educational
Psychological
Both
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
Relatively Easy
Moderate
Difficult
Reading Comprehension
*
required
Relatively Easy
Moderate
Difficult
Handwriting
*
required
Relatively Easy
Moderate
Difficult
Spelling
*
required
Relatively Easy
Moderate
Difficult
Written Expression
*
required
Relatively Easy
Moderate
Difficult
Grammar/Mechanics
*
required
Relatively Easy
Moderate
Difficult
Listening Comprehension
*
required
Relatively Easy
Moderate
Difficult
Basic Arithmetic
*
required
Relatively Easy
Moderate
Difficult
Math Computation
*
required
Relatively Easy
Moderate
Difficult
Organization
*
required
Relatively Easy
Moderate
Difficult
Test Taking
*
required
Relatively Easy
Moderate
Difficult
Study Skills
*
required
Relatively Easy
Moderate
Difficult
Other
Please indicate levels of achievement in the following academic subject areas.
Reading/Language Arts
*
required
Weak
Solid
Strong
English
*
required
Weak
Solid
Strong
History/Social Studies
*
required
Weak
Solid
Strong
Science
*
required
Weak
Solid
Strong
Mathematics
*
required
Weak
Solid
Strong
Foreign Language
*
required
Weak
Solid
Strong
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.
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