Referral Officer’s Assessment Form - SPELD NSW

Supporting children and adults with specific learning difficulties

Referral Officer’s Assessment Form

Referral Officer

MM slash DD slash YYYY

Contact Details

Reasons for Assessment

Information About the Person Being Assessed

Previous Testing / Diagnosis

Previous Assessments


Has the person being assessed received intervention in these areas?
Has the client been advised by SPELD NSW that 6 months of intervention is required in the area of difficulty for diagnosis(Required)
Has the parent been advised that diagnosis is unlikely to attract individual school based funding?

Testing Preference

Assessment Type(Required)
Test Preference(Required)

Next Steps to start booking process

If client wants to proceed with assessment:(Required)
If the client wants to proceed with a booking with SPELD NSW please submit this form and then create a task in MemNet allocated to Heather (Admin) to book an assessment.
This field is for validation purposes and should be left unchanged.
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