Post Primary School Form – Completed By Parent/Guardian

    Please fill in all fields marked with an *

    * Childs Name:

    * Childs Date of Birth:

    * Address:

    * Parent(s) or Guardian(s) Name:

    * Telephone Number(s):

    * Parent/Guardian Email Address:

    * School:

    * Year:

    * Course(LC,LCA, PLC etc.):

    * Address:

    * School Number:

    * School Email Address:

    * Name of Principal:

    Student Profile:

    * Family size:

    * Number of Boys:

    * Number of Girls:

    * Position in family:

    * Were there concerns about the student`s early development (e.g. walking, talking)?

    * Are there any medical condition/s that might be affecting academic progress? YesNo

    If there are, please give details:

    Has the student been assessed by any of the following?

    * Psychologist: YesNo

    Date Assessed:

    Outcome:

    * Physiotherapist: YesNo

    Date Assessed:

    Outcome:

    * Occupational Therapist: YesNo

    Date Assessed:

    Outcome:

    * Speech and Language Therapist: YesNo

    Date Assessed:

    Outcome:

    * Paediatrician: YesNo

    Date Assessed:

    Outcome:

    * Did the student have a hearing test? YesNo

    Outcome:

    * Did the student have a sight test? YesNo

    Outcome:

    * What are the student`s main strengths:

    * What are the student`s main interests and hobbies:

    * What are the main challenges facing the student:

    * What measures/resources could be put in place to help him/her overcome these challenges:

    Consent

    I/ We consent to a psychological evaluation of my/our son/daughter by Edward Joyce, Psychologist.

    * Name of Student:

    Name of both Parents or Legal Guardians: All persons who have legal custody of the child.

    * Father/Legal Guardian:

    * Mother/Legal Guardian:

    * Date:

    I consent to Edward Joyce Privacy Policy Terms, for more information click here.

    Please enter the letters below and then click on the send button.
    captcha