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Skills Enhancement
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Initial Learner Information
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Initial Learner Information
Submit the form below to apply
Name of Learner
*
Name of School
*
Address of the School
*
Name of Inclusion Leader
*
Gender Of Learner
*
Male
Female
Age of learner
*
Year Group of Learner (Year or Grade)
*
Parent Name in Full (Main Contact Person)
*
Contact Number
*
Alternative Contact Number
*
Email Address
*
Residential Address
*
Emirate of Residence
*
Learner Needs
*
ASD
ADHD
Speech Delay
Dyslexia
Dysgraphia
Dyscalculia
Dyspraxia
Sensory and Physical
Social Emotional and Mental Healt
Visual
Hearing
Chronic and Acute Medical Condition
Others
If other please specify
Please tick options below if your child requires additional support.
Toileting
Emotional Regulation
Attention
Academic Support
Communication
Behavior Support
Physical Support
Others
If Others Please Specify
Any Formal Reports
*
Yes
No
Are you happy to share all reports?
*
Yes
No
Therapies ongoing
*
Yes
No
Name of the Center where Therapies are ongoing
Which Therapies are ongoing
Any other comments
Submit