LISA Academy Public Charter Schools
ACT Aspire / MSAA
Family Service Outcomes Survey
The Seven Challenges Program
Myths about Dyslexia
Signs of Dyslexia and Strengths
OG in 3D Program
Dyslexia: An Article by Sally Shaywitz
Referral - ESL
Online Resource Guide
Parent Referral for Dyslexia Screening
*This referral is for a Level One screening for the characteristics of dyslexia. This screening does not diagnose Dyslexia.
Indicates required field
Relationship to Student
Name of Student
Place a check beside each behavior observed at home or in the classroom.
Difficulty learning and remembering the names of he letters in the alphabet.
Difficulty sequencing the alphabet orally or in writing.
Difficulty associating letters with sounds, such as the letter t with the /t/ sound.
Difficulty recognizing and generating rhyming patterns.
Diffculty pulling words apart into individual sounds. (ex. mat /m/ /a/ /t/).
Difficulty with blending sounds to form words.
Very slow in acquiring reading skills.
Makes guesses on unfamiliar words in reading.
Problems keeping place on page when reading.
Deficient word attack skills.
Failure to understand what he / she reads.
Difficulty using the correct short vowels in spelling words.
Has trouble spelling words correctly in a sentence.
Makes spelling errors that involve changing the order of letters within a word.
Difficulty with finding the right word to say and / or seems to hesitate when trying to answer a question.
Spelling, reading, writing skills are below what you would expect in view of perceived intellectual ability.
Any family history of reading difficulties.
Reasons for Referral
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