IAT Referral Form

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    READING:

    Areas of STRENGTH/CONCERN relative to child’s constellation of abilities: (Note: All areas do not need to be marked just areas relevant to student)
    Phonemic Awareness: The ability to hear and manipulate sounds in words.  
    Alphabetic Principle: The ability to associate sounds with letters and use these sounds to form words.
    Vocabulary: The ability to understand (receptive) and use (expressive) words to acquire and convey meaning.
    Comprehension: The complex cognitive process involving the intentional interaction between reader and text to convey meaning.
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    WRITING:

    Areas of STRENGTH/CONCERN relative to child’s constellation of abilities: (Note: All areas do not need to be marked just areas relevant to student)
    Fluency
    Word order
    Spelling
    Volume/Production
    Quality of content
    Handwriting
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    Math

    Areas of STRENGTH/CONCERN relative to child’s constellation of abilities: (Note: All areas do not need to be marked just areas relevant to student)
    Calculation
    Fact Fluency
    Mathematical Problem-Solving
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    Social/Emotional

    Areas of STRENGTH/CONCERN relative to child’s constellation of abilities: (Note: All areas do not need to be marked just areas relevant to student)
    Makes and keeps friends
    Demonstrates effective advocacy skills
    Offers support to others
    Involved in extracurricular activities
    Tantrums
    Work Refusal
    Bullying Behavior
    Fatigued/Lethargic
    Argumentative
    Poor Frustrations Tolerance
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    Attendance

    Areas of STRENGTH/CONCERN relative to child’s constellation of abilities: (Note: All areas do not need to be marked just areas relevant to student)
    Arrives on time
    Arrives late
    Good Attendance
    Poor Attendance
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    Academic Readiness

    Areas of STRENGTH/CONCERN relative to child’s constellation of abilities: (Note: All areas do not need to be marked just areas relevant to student)
    Organization
    Participation
    Following multistep directions
    Concentration
    Retention of information
    Homework Completion
    Ready to work
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