Learning Disability Symptoms Check List
Do you recognize any of these symptoms in
your child? Problems in one or more of these areas could mean a learning
We want to help address the cause of the
problem. Check the areas that apply and submit the form so we can
be of further assistance to you.
Age: Birth Date:
Symptoms of Student & Your Comments
Check any symptom that
applies. If you have any comments, type it in the entry box below
the symptom. Submit the form for a response from our staff at
Essential Learning Institute.
Confuses or reverses letters or words.
Has poor handwriting skills
Has poor reading comprehension
Avoids reading and writing
Does little or no voluntary reading at home
Has poor enunciation of sounds
Suffers failure in spelling and other reading-related work
Is unable to perceive sounds, letters, and words correctly
Fails to complete tasks
Becomes emotionally upset about school work
Forgets assignments and tests
Homework is a frustrating, negative experience for both students and
Seems distracted easily
Is often impulsive or over-active
Fails to understand or remember instructions and assignments
Has low self-esteem
Name of Parent(s)
E -.mail Address
State Zip Code
I want to order an evaluation/testing kit for my child.
I would like to schedule an evaluation at your facility in Allentown,
I am interested in obtaining the therapy for my child after the
evaluation is completed and the individualized LD strategy is
In addition to the 9 month computer based therapy, I am interested in
Home Schooling curriculum.
I would like to discuss my child's situation and the benefits of the ELI
program with your certified personnel.
I would like an Information Packet mailed to me.