PARENTAL NOTIFICATION
STUDENT IDENTIFICATION FORM

 

To the Parents of ______________________________________.

__________________________________ is not progressing academically to his/her potential in the Chapter I reading program.

We are now considering qualifications to identify him/her as dyslexic or having a related disorder.

We would like to confer with you as to the qualifications and possible placement as soon as possible. Could you come on ___________________ at _____________________________ to the __________________________________ school office?

 

Sincerely,

_______________________________
Dyslexia Designee


Please check the appropriate answer and return this to your child's teacher

_____ I can come at the stated date and time.

_____ I cannot come at the stated date and time, (In this case the Dyslexia Designee will call you to schedule another date and time.)

 

_______________________________
Parent Signature

 

_______________________________
Phone Number