Name of Student

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* 1. Name of Student

School

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* 2. School

Name of Teacher Completing Checklist

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* 3. Name of Teacher Completing Checklist

Email Address of Teacher Completing this Checklist

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* 4. Email Address of Teacher Completing this Checklist

Student's Current Grade

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* 5. Student's Current Grade

Does the student seem to have the intellectual ability or academic potential to develop reading, writing, and spelling skills?

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* 6. Does the student seem to have the intellectual ability or academic potential to develop reading, writing, and spelling skills?

Are the student’s reading, spelling, or writing skills below what you would expect in view of perceived intellectual ability or academic potential?

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* 7. Are the student’s reading, spelling, or writing skills below what you would expect in view of perceived intellectual ability or academic potential?

Does the student have difficulty identifying basic sight words?

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* 8. Does the student have difficulty identifying basic sight words?

Does the student have difficulty sounding out words using phonics skills?

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* 9. Does the student have difficulty sounding out words using phonics skills?

Does the student comprehend text read aloud by others?

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* 10. Does the student comprehend text read aloud by others?

Is the student’s oral reading slow and laborious?

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* 11. Is the student’s oral reading slow and laborious?

Does the student have difficulty writing the letters of the alphabet in sequence without a model?

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* 12. Does the student have difficulty writing the letters of the alphabet in sequence without a model?

Does the student have difficulty naming the vowels.

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* 13. Does the student have difficulty naming the vowels.

Does the student have difficulty using the correct short vowels in spelling words?

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* 14. Does the student have difficulty using the correct short vowels in spelling words?

Does the student have difficulty with spelling?

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* 15. Does the student have difficulty with spelling?

Does the student frequently make spelling errors that involve changing the order of the letters within the word (i.e. left/felt or spelt/slept)?

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* 16. Does the student frequently make spelling errors that involve changing the order of the letters within the word (i.e. left/felt or spelt/slept)?

Is handwriting often illegible or messy?

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* 17. Is handwriting often illegible or messy?

Is pencil grip awkward, tight, or fist-like?

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* 18. Is pencil grip awkward, tight, or fist-like?

Does the student have problems with organization or memory?

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* 19. Does the student have problems with organization or memory?

Does the student have problems with spatial orientation (i.e., before/after, left/right)?

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* 20. Does the student have problems with spatial orientation (i.e., before/after, left/right)?

Does the student have difficulty “finding the right word” or seem to hesitate when trying to answer direct questions?

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* 21. Does the student have difficulty “finding the right word” or seem to hesitate when trying to answer direct questions?

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