Personal Development History Form

This form is filled out and signed by a parent or guardian of a student suspected of having an Exceptional Learning Need.  There are some questions that may not need to be answered- for instance, if a Form 1 student is being referred to see if she has a Learning Disability such as Dyslexia it is not necessary to know when she was first toilet trained.  However, this may be a very relevant question for a younger student with a cognitive impairment who is struggling in Infant 1.

This form may be filled out by a school official or an agent of The NaRCIE during an interview with the parent or guardian, but the person being interviewed should always sign the form.

Classroom Observation Form

This form is filled out by a teacher or someone who works closely with the student suspected of having an Exceptional Learning Need in their educational setting.  It should be filled out as completely as possible.  This form provides valuable information to the Evaluating Officer for The NaRCIE about factors that could be effecting the student and how they interact with their educational environment.

This form may be filled out by a school official or an agent of The NaRCIE during an interview with the teacher, but the person being interviewed should always sign the form.

Medical Evaluation Form ***OPTIONAL***

This form is filled out and signed by a medical professional, preferably a doctor, familiar with a student suspected of having an Exceptional Learning Need.  It should be completely filled out during a physical examination by the Medical professional and signed shen complete.

This form is optional, but may provide important medical information to help develop programming and service recommendations for the student who may have an Exceptional Learning Need.