Student Assessment Information Form

= Required Fields

Your Details

Who are you completing this form for?

Are you a parent / legal guardian of the child?

Child Details

First Name & Surname

Date of Birth

School

Year Level

Gender

Is your child of Aboriginal and / or Torres Strait Islander origin?

Speld QLD Financial Assistance

Are you applying for the Speld Qld Financial Assistance (SQFA) program?

Do you receive a means tested Commonwealth income support payment or concession card?

Must be a JPG, GIF, PNG, PDF, DOC or DOCX file no larger than 3MB with only - and _ characters in file names.

Drop multiple files at once or

Select Files

Additional Information

Please share you/your child’s pronouns?

Have you been referred to us by? (Click all that apply)

Note: No referral is needed to access Speld QLD's services

What assistance would you like? (Click all that apply)

Please note that additional assessment(s) may be recommended by the psychologist

Psychoeducational Assessment (cognitive ability/IQ and academic achievement to diagnose or rule out Dyslexia and other learning disorders)

Attention difficulties screener

Review Assessment (only available if full psychoeducational assessment completed at Speld within last 2 years)

Not sure

Do you have any additional notes about the assistance you require?

What are you hoping to get out of the assessment? (Click all that apply)

Does your child have any existing diagnoses that impact their learning? (Click all that apply)

Has your child previously completed a cognitive (IQ) and / or learning assessment?

If yes, who conducted this assessment?

If yes, when was the assessment completed?

How does your child feel about tests at school?

Has your child experienced anything significant recently that you think has impacted their current wellbeing?

e.g. serious illness, family changes, loss, bullying

Parent / Guardian Details

First Name

Surname

Mobile

Region

Street Address

Suburb

State

Postcode

Image Verification

Would you like to sign up for a Speld Membership?

Yes

At times, Speld undertakes its own research to improve services and collaborates with external research institutions such as universities. To do this, we ask for your consent to contact you about relevant research opportunities and/or use deidentified client data. You are free to say no, and this will not impact the services you receive at Speld in any way.

I give consent to being contacted about relevant research projects

I give consent for my/my child's deidentified data to be used for research and evaluation purposes

How did you hear about Speld Qld?

Before submitting, please ensure your phone and email address are correct so we're able to contact you.

Contact Us

Student Assessment Information Form

Your Details

Child Details

Speld QLD Financial Assistance

Additional Information

Parent / Guardian Details

Our Generous Sponsors View All

Our Partners View All

About Us

Learning Differences

How Can We Help?

Support Us

Quick Links