DANIEL FRANKLIN, PhD
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Franklin Educational Services
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Home
About
Blog
Contact
Appearances
Press
Franklin Educational Services
DANIEL FRANKLIN, PhD
View Unteachable
Franklin Learning and Behavior Survey
Name
*
First Name
Last Name
Date
MM
DD
YYYY
Child/Student Name
First Name
Last Name
Relation to Child/Student
Date of Last Physical Exam
MM
DD
YYYY
Was it Normal?
Yes
No
Date of Last Eye Exam
MM
DD
YYYY
Was it Normal?
Yes
No
Date of Last Hearing Exam
MM
DD
YYYY
Was it Normal?
Yes
No
Language and Math
Speaking Skills
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Listening Skills
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Reading - Decoding Skills
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Reading - Comprehension
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Reading Rate
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Spelling Skills
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Writing Skills
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Math Skills
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Other Comments
*
Thank you!