Teacher Checklist



Teacher ChecklistRecommendation for Dyslexia AssessmentStudent: ___________________________DOB______________ Grade_______Teacher’s Name:____________________ Subject:______________ School:_____________________Does student wear glasses? __________ If yes, for near far visionPlease answer ‘Y’ for “yes” and ‘N’ for “no” to the following questions.The student:____ has adequate intelligence, ability to learn____ has inconsistent performance on academic tasks____ is unable to read satisfactorily in spite of adequate intelligence and opportunity____ exhibits frequent letter reversals, rotations, and transpositions in reading, writing, &spelling____ demonstrates reading comprehension significantly below grade level____ demonstrates better reading comprehension when reading aloud than silently____ reads unfamiliar words better in context than in isolation____ has good/excellent listening comprehension____ has difficulty with written expression, but does well with oral evaluations____ has difficulty reciting (not singing) the alphabet correctly in sequence____ has difficulty writing the alphabet correctly in sequence____ has difficulty associating sounds with letters____ demonstrates weak sound blending ability when reading____ has difficulty with spelling____ demonstrates poor overall coordination____ has difficulty with handwriting____ has difficulty with copying____ has difficulty with drawing____ mispronounces some speech sounds____ is or has been in speech therapy____ has difficulty expressing him/herself.____ has difficulty remembering/following directions____ is easily distracted____ has a short attention span____ exhibits signs of frustration____ forgets or loses papers____ lacks organizational skills____ has difficulty with math computations____ is successful with computation but has difficulty with math word problems.____ has poor sense of direction and/or time ____ has difficulty with before/after, left/right, etc.____ demonstrates low self esteem ................
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