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School Questionnaire
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School Questionnaire
Information is being gathered to clarify this child's learning, emotional and /or behavioural needs. Information from the current school will be very useful and help to provide a wider context in which to place these needs. Your support is therefore appreciated.

All information given will be treated confidentially

The Helen Arkell Dyslexia Charity is a registered charity in England and Wales (1064646) . Whilst great care is taken in all matters, the Charity cannot accept liability or responsibility for any advice given by the professionals to whom the Charity refers the child/adult (assessee).
We are totally committed to protecting your information and using it responsibly. Please read our Privacy Policy carefully to understand how we collect, use and store your information. https://www.helenarkell.org.uk/about-us/privacy-policy.php
Child's full name:
Child's date of birth: (please use this format "1st September 2006" *
School:
Year Group:
Name of person completing this form:
Role in School:
School contact phone:
School contact email:
School Performance
Please provide details about this child's National Curriculum attainments (if applicable).
SATs/end of key stage 1 results for English:
SATs/end of key stage 2 results for English:
SATs/end of key stage 3 results for English:
SATs/end of key stage 1 results for Maths:
SATs/end of key stage 2 results for Maths:
SATs/end of key stage 3 results for Maths:
SATs/end of key stage 1 results for Science:
SATs/end of key stage 2 results for Science:
SATs/end of key stage 3 results for Science:
Current subject performance in relation to peer group:
Above average
Average
Below average
Speaking and listening
Reading accuracy
Reading comprehension
Writing
Spelling
Maths
Science
Languages (MFL)
Humanities
PE
Art
DT
ICT
Other
Clear selection
Please give details of any recent assessments with test names, dates and results, e.g. reading, spelling, cognitive etc:
Does the child have any difficulty with: *
Yes
No
Gross motor co-ordination
Remembering instructions
Copying from the board
Planning and organising written work
Fine motor co-ordination
Self-organisation
Getting started with written work
Continually losing things
Does there appear to be a discrepancy between the child's verbal ability and written work: *
Does the child have a preferred learning style (please select any that apply):
Attitude to work (please select any that apply):
Peer relationships (please select any that apply):
Is this child being monitored for Special Educational Needs: *
Is there an Individual Education Plan (IEP)/Personalised Learning Plan (PLP):
Clear selection
Please detail any current support/provision this child is receiving:
Who gives this support (role in school):
What type of support:
How long and frequent are the support sessions (e.g. 1 hour per week)
Has this child been discussed/assessed/monitored by any external agencies e.g. Educational Psychologist, Behaviour support, Learning support etc:
Clear selection
If Yes, please give details:
Please outline your concerns, if any, regarding this child and your objectives for the assessment:
If you feel this child may qualify for an access arrangement in exams, please indicate which types you consider may be appropriate:
If the pupil is in year 9 or above, a JCQ Form 8 has to be completed for any required access arrangements. It is important to establish who will complete Form 8 in advance of an assesment. As you know it is the responsibility of the school to fill in Part 1 & 3. It is a JCQ requirement that Part 1 is completed before an assessment takes place. Please select one answer below: *
If the child has an Education Health Care Plan or a Statement of Educational Needs, please email a copy of the most recent Annual Review and any other relevant documents to: questionnaire@helenarkell.org.uk
Would you like to sign up to receive Helen Arkell monthly newsletters and emails? (You can unsubscribe at any time, we will not bombard you with emails and we will not share your details with third parties)
Clear selection
Thank you for taking the time to complete this questionnaire. Your submission is your acknowledgement that you have read, understood and accept our Privacy Policy and that you agree to the Charity maintaining a confidential file. Please press submit below (ensuring you have filled in all the "required" responses).
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