The dePaul School - Louisville

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*Parent:		E-mail:
*Home Phone:		Alt. Phone:
*Address:
*City:		State: Zip:
*Student:		Age: D.O.B:
*School:		*Grade:
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The following information is optional, but will help us more quickly determine if de Paul is a good match for your child.
Diagnoses:
Dyslexia APD Dyscalculia ADHD
NVLD Dysgraphia Sensory Integration Disorder
Other
Symptoms/Difficulties with:
Language/Reading Reading Fluency Word Attack Comprehension Spelling Math Math Computation Math Facts Word Problems Social Independence Confidence Sportsmanship Friendships Nonverbal cues Changes in routine		Organization Time/Sequencing Decision making Completing tasks Attention Focusing/Distractibility Following directions Impulsivity Motor Skills Handwriting Coordination Memory Studying/Test taking Recall of facts
Desired results/Improvements:
Reading Math Writing composition Handwriting Social Skills Attention		Study Skills Organization Self Advocacy Independence Confidence
Other
Miscellaneous:

The de Paul School / 1925 Duker Avenue / Louisville, KY 40205 / Telephone (502) 459-6131 / e-mail