Moderate Learning Difficulties Initial Assessment
Specialist Adviser Details: Date of Assessment:
Where did the assessment take place?
- About the Learner
Name: Date of Birth: Age:
Preferred method of contact: Contact Details:
Emergency Contact: Relationship to learner:
- Medical Details
Do you have any known medical or health issues?
Do you take any medication?
Any other health/medical related information:
- Learners Goals/aspirations
Does the learner feel that these are achievable?
How can these goals be measured?
- Previous or current support
Have you learner received any sort of support in the past/at school/at any time? (Such as counselling, in class support, out of class support, mentoring):
If yes, how do you feel about the support received? Did it help, was it enjoyable?
Current support name and contact details (if applicable):
Has the learner ever received a statement of special educational needs (SEN)? If so, when?
- Functional Skills
Reading: Favourite lesson:
Writing: Least favourite lesson:
Verbal communication skills:
- Social relationships and learning experiences
How do you feel about group situations such as classrooms?
Do you find it relatively easy to make new friends?
Do you get easily frustrated?
If so, how do you manage this?
- Study and learning skills
Do you get distracted easily?
Do you take notes during or after classes?
Do you ask questions if you are unsure?
Do you find it easy to concentrate?
Do you find it easy to organise yourself (making sure you have the correct books, materials etc, timekeeping, knowing where you have to be, keeping to timetables)
- Your spare time
What do you do to relax/switch off?
Do you have any hobbies or interests?
- Additional information
Is there anything else you feel that the learning organisation/your counselor should be aware of in order to support your studies?