Parent Request for Dyslexia Screening
Prior to testing for Dyslexia, I will conduct a screener.  This is a short process which tests for phonological and phonemic awareness skills.  Based on this screener, we will determine whether official Dyslexia testing should be pursued.  Before any dyslexia testing can be conducted, I must have signed parent permission.  By completing this form, you are beginning the process for dyslexia testing.  Please complete this form indicating the request for the process to begin.  Upon receipt of this form, a permission slip requiring parent/guardian signature will be sent home.  Only AFTER I receive signed permission will I begin the testing process.  If you have any questions or concerns regarding this process please contact me at lbell@somervilleisd.org.
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Email *
Parent Name *
Phone Number *
Student Name *
Student Birthday *
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Student Grade Level *
Student Homeroom Teacher *
Please indicate your concerns and observations regarding your student that have you pursuing Dyslexia testing: *
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