Student’s personal characteristics, health or home background: Describe any behaviour concerns: Describe the child’s academic development/performance: Student's fine and gross motor skills compared to age expectations: Student's speech and language skills compared to age expectations: Student’s special interests or talents: Describe his/her social interaction with other students and with adults: Parent/school relationship: (Are parents involved, concerned, aware of difficulties?) Any Medical conditions/Medications: Additional Comments: ***Note: Please submit any SMART goals developed for child along with this form*** Principal (or designate) Signature: ___________________________________ Date: ____________________ Parental Consent Form Special Education Services: Educational Psychology
Student’s personal characteristics, health or home background: Describe any behaviour concerns: Describe the child’s academic development/performance: Student's fine and gross motor skills compared to age expectations: Student's speech and language skills compared to age expectations: Student’s special interests or talents: Describe his/her social interaction with other students and with adults: Parent/school relationship: (Are parents involved, concerned, aware of difficulties?) Any Medical conditions/Medications: Additional Comments: ***Note: Please submit any SMART goals developed for child along with this form*** Principal (or designate) Signature: ___________________________________ Date: ____________________ Parental Consent Form Special Education Services: Educational Psychology