* 1. Name of Student

* 2. School

* 3. Name of Teacher Completing Checklist

* 4. Email Address of Teacher Completing this Checklist

* 5. Student's Current Grade

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

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

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

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

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

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

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

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

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

* 15. Does the student have difficulty with spelling?

* 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)?

* 17. Is handwriting often illegible or messy?

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

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

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

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

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