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Academic Performance
  1. The following statements describe auditory processing and language based concerns that some children may have. Please indicate the behaviors which are considered to be a concern to you.
  2. Full Name (*)
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  3. E-mail (*)
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  4. Phone
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  5. Studies many hours for a test but does not get a good grade.
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  6. Has trouble getting started on homework assignments.
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  7. Backpack/locker is disorganized.
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  8. Leaves assignments and studying for tests until the last moment.
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  9. Needs assistance from an adult to stay on task.
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  10. Often forgets homework assignments or school supplies at school.
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  11. Has poor time-management skills.
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  12. Written work seems disorganized and “sloppy.”
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  13. Becomes easily overwhelmed by large assignments.
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  14. Has “test anxiety “ which results poor test performance and the feeling of “going blank” during test or test-like situations.
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