2019 St. Thomas Aquinas College Summer LITERACY and SPECIAL ED Program Teacher REFERRAL and Teacher SURVEY
To be completed by teacher
Teacher(s) First and Last Name *
Your answer
Child's First Name *
Your answer
Child's Last Name *
Your answer
Current Grade *
Your answer
School *
Your answer
School Address *
Please provide the following: street address, city, state and zip code
Your answer
Please identify child's current reading level. If you use the Developmental Reading Assessment, indicate most current DRA level. *
Your answer
Please identify child's reading strengths and needs. *
Your answer
Please identify child's writing strengths and needs. *
Your answer
Please identify effective teaching methods you have used. *
Your answer
Please identify support services child receives and specific programs being used (e.g., Spector Phonics, Wilson, Reading Recovery)
Your answer
Please add anything else the teacher should know that will help her/him plan effective instruction. *
Your answer
Are you willing to be contacted to provide additional information if needed? *
Your answer
If yes, please provide email AND telephone number. *
Your answer
Your information and recommendation will assist us in planning an appropriate instructional program. Your assistance is appreciated. Thank you!
Your answer
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