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1. Does your child have difficulty sounding out words phonetically, particularly new words. "Giraffe" as "J/Er/A/F" ?* YesNoI don't know

2. Does your child either reverse letters when writing, well after most children of similar age have stopped doing so, or leave out letters in a word ("swimng")?* YesNoI don't know

3. Does your child incorrectly copy notes from the board, by missing information, misspelling, or reversing information?* YesNoI don't know

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4. When comparing your child to others of similar age or grade, do you feel your child is academically at the same level with their peers? * YesNoI don't know

5. When comparing your child to others of similar age or grade, do you feel your child is at the same level with their peers when measuring reading aloud and overall reading ability? * YesNoI don't know

6. Does your child struggle with comprehension of age-appropriate reading material? * YesNoI don't know

7. Does your child struggle with solving mathematical word problems? * YesNoI don't know

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8. Does your child struggle with multiple choice tests, due to misunderstanding or misreading details in the question, rather than lack of knowledge about the answer? * YesNoI don't know

9. When reading, does your child have trouble keeping place, missing individual words or whole lines? * YesNoI don't know

10. Does your child make reading mistakes in letters, numbers, or grammar, such as confusing "a " and "o " (pat, pot); "7" and"1"; or not pausing for punctuation such as periods and commas? * YesNoI don't know

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11. Did your child have trouble learning left and right or processing spatial directions ("Find the toy underneath the bed")? * YesNoI don't know

12. Does your child have difficulty understanding multi-step processes or directions (written or oral) or learning sequenced information (example, tying shoes)? * YesNoI don't know

13. Does your child exhibit unusual verbal mistakes in accurately recalling names of letters or identifying objects or mispronouncing words or common phrases? * YesNoI don't know

14. Does your child have difficulty with fine or gross motor skills (handwriting, holding a pencil, catching and throwing a ball, team sports)? * YesNoI don't know

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