Post Primary School Form – Class teacher & the learning support/resource teacher(s)


    Please fill in all fields marked with an *

    * Childs Name:
    * Childs Date of Birth:
    * Address:
    * Parent(s) or Guardian(s) Name:
    * Telephone Number(s):
    * Parent/Guardian Email Address:
    * School:
    * Year:
    * Course(LC,LCA, PLC etc.):
    * Address:
    * School Number:
    * School Email Address:
    * Name of Principal:
    * What is the main reason for this referral?
    LearningBehaviourEmotionalOther

    * What are the main concerns about this student:

    Did the student receive learning support of resource teaching support in primary school? YesNo

    If he/she did, please give as much detail as possible (Subjects, number of years, number of classes weekly, duration of classes, size of classes):

    Is the student receiving, or has this student received, learning support/ resource teaching hours in post-primary school: YesNo

    Learning Support:

    Number of years:
    In what subject(s):
    How often weekly:
    Duration of classes:
    How many in the group:
    Resource teaching support:

    Number of years:
    In what subject(s):
    How often weekly:
    Duration of classes:
    Please include the results of Standardised (Reading and mathematics) tests done in the last 2 years.

    Date:
    Name of test:
    Results- give S.S. and percentile rank:
    Date:
    Name of test:
    Results- give S.S. and percentile rank:
    Date:
    Name of test:
    Results- give S.S. and percentile rank:
    Date:
    Name of test:
    Results- give S.S. and percentile rank:
    Please comment on the following

    * Attention:

    * Memory:

    * Concentration:

    * Oral skills:

    * Reading- Word attack skills-phonic skills etc.:

    * Reading- Comprehension:

    * Mathematics- Computational skills:

    * Mathematics-Problem solving:

    * Spelling:

    * Writing skills:

    * Fine motor skills:

    * Gross motor skills:

    * Social skills with teachers/other adults:

    * Social skills with his/her peers:

    * Behaviour in class:

    * Behaviour outside class:

    * Is the student receiving any Speech and Language or Occupational Therapy interventionsYesNo:

    If so, please give details:

    Please give details of any in-school interventions being used with the child, commenting on the efficacy of these interventions etc..:

    Any additional information or comments:

    Consent

    I/We understand that the results of this evaluation will be made known to me/us, to the School Principal, and, where the Principal deems it appropriate, to the relevant members of the school staff.

    * Name of Student:
    * Principle:
    * Learning Support teacher:
    * Resource Teacher:
    * Date:
    I consent to Edward Joyce Privacy Policy Terms, for more information click here.
    Please enter the letters below and then click on the send button.
    captcha