FORKS RIVER ELEMENTARY SCHOOL
                                                NEEDS ASSESSMENT OF NEW ADMISSIONS
                                                DATE ____________________________________
 

Student’s Name____________________________________________  Grade____________________________

Teacher ______________________________________Student’s Date of Birth ___________________________

Concerns as reported by parent:
 

            Non-English Language Spoken _________

                                    (language spoken ______________)

                       Reading ___________

                       Mathematics _______

                       Special Services received_______________________

                       Behavior ___________

                       Speech _____________

                       Other _______ Explain: _____________________________________________________________
                       __________________________________________________________________________________


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                                                                        TEACHER COMPLETES FROM HERE:
 
Possible problems detected by teacher:

                       1.  Reading _____________________                    

                       2.  Mathematics __________________                    

                       3.  Behavior _____________________

                       4.  Speech _______________________
 

                             Explain:______________________________________________________________________________
                             _____________________________________________________________________________________  

                        5.  Other _________________________
                             Explain: ______________________________________________________________________________
                             _____________________________________________________________________________________
                       

Needs for student:_____________________________________________________________________________________
 

Supplies from home:____________________________________________________________________________________

________________________________________________________________________________________________________________________________________________

Textbooks/Workbooks/Supplies from school:

Teacher’s signature: _________________________

Additional comments: