Dyslexia referral form 2026

1. Click ‘Get Form’ to open the dyslexia referral form in the editor.
2. Begin by entering the student's name, ID number, and date at the top of the form. Ensure accuracy as this information is crucial for identification.
3. Fill in the student’s date of birth, gender, grade, school, and teacher's name. This section helps contextualize the student's educational background.
4. In Section A, have the current or most recent classroom teacher complete the evaluation. They should assess the reader level and indicate which assessment was used along with its date and level.
5. Rate the student on various characteristics of dyslexia by circling 'Always', 'Sometimes', or 'Never' for each item listed. This provides a comprehensive view of the student's reading abilities.
6. In Section B, note any at-risk factors that may affect academic performance. If there are none, leave it blank.
7. Indicate if there is a family history of reading difficulties by checking 'Yes' or 'No' and providing an explanation if applicable.
8. Finally, submit 3-4 dated examples of the student’s written work to support their eligibility for dyslexia assessment.

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