Duchesne High School | DHS Educational Needs Form

At Duchesne we share your interest in helping your child experience success in their educational endeavors. In order for us to work cooperatively to establish a learning environment to best meet your child's needs, we ask that you take a few moments to complete this form. Please indicate below if your child has been evaluated for learning difficulties by a physician, psychologist, the Special School District, the Department of Special Education, the Archdiocese, or any private agency.

Please answer the following:No, my child has never been evaluated. Although my child has never been evaluated, I have concerns regarding some learning needs.Yes, my child has been evaluated.

My child was diagnosed with:Non-handicapped - no label givenAttention Deficit/Hyperactivity Disorder (Inattentive)Attention Deficit/Hyperactivity Disorder (Hyperactive-impulsive)Attention Deficit/Hyperactivity Disorder (Combined Type)Learning DisabilityLanguage ImpairedEducational HandicappedHearing ImpairedAutism Spectrum Disorder (Aspergers, PDD, Autism or other)Visually ImpairedBehavior DisorderPsychological/Emotional Disorder (i.e. Depression, Bipolar, Anxiety)

Please check all that apply.My child receives SNAP services from the Public School District

My child takes medication due to his/her special needs.
If so, please list the name of the medication(s), dosage, when the medicine is taken, and where the medicine is taken:

Special Needs Services (Check all that apply)My child has received classroom and /or testing accomodation in the past.I anticipate my child will require classroom and/or testing accomodations at Duchesne.I do not anticipate my child will require classroom and/or testing accomodations at Duchesne.My child plans to work with a private tutor.

The best time for the Learning Consultant or Guidance Counselor to reach me during the day to discuss my child's needs is:
My phone number is:

Please attach a copy of the most recent evaluation report, IEP or service plan, or mail it to the school. If the evaluation was for a medical condition, AD/HD, please attach or send information from the diagnosing professional. (1 file @ 100 MB)

2024 DHS Educational Needs Form