Montréal / Laval Outaouais
Student's name
Grade
Contact parent's name
Contact parent's email address
Relationship to the child father mother other
Contact parent's phone number
Mother tongue french english spanish other
Language(s) spoken at home french english spanish other
Does your child have an Individual Education Plan (IEP) at school? yes no
Is the school currently implementing any adaptations and modifications for your child? yes no
If so, wich one(s)? Provided a quiet place to do exams Given more time to complete evaluations. Assigned a designated spot in the classroom. Allowed to be accompanied by a note taker . Allowed to use a laptop. Allowed to use text-to-speech software such as Word Q. Allowed to use a grammar and spell checker . Other
Has your child been diagnosed with any of the following? dyslexia dysorthographia speech disorder attention deficit disorder with hyperactivity (ADHD) attention deficit disorder without hyperactivity (ADD) pervasive developmental disorder central auditory processing disorder dyscalculia non-verbal learning disorder dyspraxia Other
Which of the following represent a challenge for your child? Check all that apply time management understanding instructions losing his or her material taking exams (anxiety) study methods note taking reading comprehension written production text correction using reference material reading fluency problem solving lack of effort lack of studying lack of motivation speed of execution memorization handwriting oral comprehension paying attention in class planning a text mathematical operations classroom behaviour spelling organizing his or her thoughts long-answer questions grammar stress management organization (planner, binder) respecting instructions teamwork lack of time to finish evaluations
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