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Applicationform
Personal information
name
first name
date of birth
dd-mm-jjjj
adress, postal code + city
telephone number
email
school
adress, postal code+city
telephone number
group, class or grade
teacher/tutor
Family information
family composition
reason of application
assessment of capacities/intelligence
reading
arithmetic/mathematics
writing
behavioural problems
others
question to be answered
History
are there any particulars as regards pregnancy and/or birth?
what was your child's motor development like? (sitting, crouching, standing, walking)
what was its language development like? when did he/she start talking?
what was the physical development like?
has your child suffered from serious illnesses?
does your child sleep well?
is your child lively and boisterous?
can or could your child play well?
what does your child like to play with?
which hobbies does your child have?
do reading, language and/or aritmic problems occur in the family?
what is the relationship with brothers and/or sisters like?
Educational (school) history
did your child visit nursery school?
was anything special noticed when at nursery school?
was your child aripe for school when going to group 3 (class 1)?
have there been any problem when going to secondary school?
has he/she ever repeated a class?
when did the problems first become apparent?
has there been additional tuition at home or at school?
in which group/class? how often and by whom?
what are the strong features in learning and in character?
how is his/her attitude to school work?
how is the relationship with the teachers and the other pupils?
does your child show conspicious behaviour at home or at school?
Findings from previous examinations
has your child been examined or tested before? If yes by whom and what was the reason? what was the date of the examination?
more additional information
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