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SIGNATURE OF APPLICANT                                                                        TEACHER INCHARGE (DATED)

Learning Disability Checklist

(Click here for a more comprehensive checklist from the Learning Disabilities Association)

Do you suspect that you may have a Learning Disability?

Check below if any of these characteristics of students with learning disabilities describes you: 
(You may want to print this out and fill it in...)

_____    Long term  difficulty in reading, writing, spelling, grammatical usage, and/or using
                numerical concepts in contrast with average or superior skills in other areas.

____     Excessive difficulty in learning a foreign language. Earned very poor grades in 
              this area.

_____   Is easily distracted by background noise or visual stimulation; has difficulty 
              concentrating.

_____   Confuses similar letters, numeral or words such as bad and dad, then or them,
              b and d.

_____   Difficulty recalling common words; uses hands a lot and call things: "what-cha-
              ma-call-it" or "thing-a-ma-jig".

_____   Takes two or three times longer to read than other people. Has to go back two 
              or three times to understand what was read.

_____   Verbal skills far exceed reading, spelling, and writing skills.

_____   Poor handwriting: inconsistent slants, shapes and sizes of letters. Mixes lower
             and upper case letters and cursive and manuscript letters.

_____   Severe inability to spell or to recall irregularly spelled words.

_____   Difficulty with mathematical concepts including calculation, time and space.

_____   Difficulty taking notes and listening to lectures at the same time.

_____   Slowed processing of information: needs "think time" to respond to questions, 
              to retrieve information or to solve problems.

_____   Poor organizational skills, including organizing thoughts on a page.

_____   Severe difficulty reading multiple choice questions; easily confused by 
              double negatives.

If you checked 4-5 or more characteristics, you may wish to make an appointment PLEASE CALL AT 03219441951