Dyslexia Testing Student Profile Student: DOB: ID: Grade: Date of Test: Examiner: 1A. The pattern of weaknesses in a student with dyslexia will reflect one or more difficulties with low performance for the student’s age and education level in the following academic skills: Primary Characteristics Assessment Composite SEM Below Average Above Scores Average Average Word Reading Word Decoding Spelling Fluency Rate Accuracy 1B. Is there a deficit in one or more of the Secondary Consequences of dyslexia? Secondary Assessment Composite SEM Below Average Above Characteristics Scores Average Average Reading Comp. Written Composition 2. Is there a deficit in Phonological Processing/Phonemic Awareness? (Underlying causes of Dyslexia) Phonological Assessment Composite SEM Below Average Above Processing/ Scores Average Average Phonemic Awareness Phonological Awareness Phonological Memory Naming Letter Knowledge 3. Is there evidence of unexpectedness? Yes No Data shows that student has received effective classroom instruction? _____ Data shows that student has academic difficulties in reading and written spelling? _____ Data shows that student exhibits one or more of the primary characteristics? _____ Data shows that student has a deficit in phonological/phonemic awareness? _____ Data shows that the student has adequate intelligence (ability to learn in absence of print? _____ Data shows that the student’s lack of progress is NOT due to: The student’s primary language is not English? Irregular attendance? _____ Lack of experiential background? Brain injury, disease, surgery or other health factor that would interfere with learning? ____
Dyslexia Testing Student Profile Student: DOB: ID: Grade: Date of Test: Examiner: 1A. The pattern of weaknesses in a student with dyslexia will reflect one or more difficulties with low performance for the student’s age and education level in the following academic skills: Primary Characteristics Assessment Composite Scores SEM Below Average Average Above Average Word Reading Word Decoding Spelling Fluency Rate Accuracy 1B. Is there a deficit in one or more of the Secondary Consequences of dyslexia? Secondary Characteristics Assessment Composite Scores SEM Below Average Average Above Average Reading Comp. Written Composition 2. Is there a deficit in Phonological Processing/Phonemic Awareness? (Underlying causes of Dyslexia) Phonological Processing/ Phonemic Awareness Assessment Composite Scores SEM Below Average Average Above Average Phonological Awareness Phonological Memory Naming Letter Knowledge 3. Is there evidence of unexpectedness? Yes No Data shows that student has received effective classroom instruction? _____ Data shows that student has academic difficulties in reading and written spelling? _____ Data shows that student exhibits one or more of the primary characteristics? _____ Data shows that student has a deficit in phonological/phonemic awareness? _____ Data shows that the student has adequate intelligence (ability to learn in absence of print? _____ Data shows that the student’s lack of progress is NOT due to: The student’s primary language is not English? Irregular attendance? _____ Lack of experiential background? Brain injury, disease, surgery or other health factor that would interfere with learning? ____
Dyslexia-Student-Profile-English.docx