Learning Support Program Supplemental Application

Student Namerequired

First Name

Last Name

Applying for Graderequired

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 Comprehensionrequired

Relatively Easy

Moderate

Difficult

Handwritingrequired

Relatively Easy

Moderate

Difficult

Spellingrequired

Relatively Easy

Moderate

Difficult

Written Expression required

Relatively Easy

Moderate

Difficult

Grammar/Mechanicsrequired

Relatively Easy

Moderate

Difficult

Listening Comprehensionrequired

Relatively Easy

Moderate

Difficult

Basic Arithmeticrequired

Relatively Easy

Moderate

Difficult

Math Computationrequired

Relatively Easy

Moderate

Difficult

Organizationrequired

Relatively Easy

Moderate

Difficult

Test Takingrequired

Relatively Easy

Moderate

Difficult

Study Skillsrequired

Relatively Easy

Moderate

Difficult

Other

Please indicate levels of achievement in the following academic subject areas.

Reading/Language Artsrequired

Weak

Solid

Strong

Englishrequired

Weak

Solid

Strong

History/Social Studiesrequired

Weak

Solid

Strong

Sciencerequired

Weak

Solid

Strong

Mathematicsrequired

Weak

Solid

Strong

Foreign Languagerequired

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.