• Mon - Thurs 8.30 - 4.30 Fri  8.30 - 3.30
  • Kensington 302-304 Kensington,
  •  0151 259 1556

Dyslexia Screening

Rocket Training

    1. Do you find difficulty in telling left from right?YesNo

    2. Is map reading or finding your way to a strange place confusing?YesNo

    3. Do you dislike reading aloud?YesNo

    4. Do you take longer than you should to read a page of a book?YesNo

    5. Do you find it difficult to remember the sense of what you have read?YesNo

    6. Do you dislike reading long books?YesNo

    7. Is your spelling poor?YesNo

    8. Is your writing difficult to read?YesNo

    9. Do you get confused if you have to speak in public?YesNo

    10. Do you find it difficult to take messages on the phone and pass them on correctly?YesNo

    11. When you have to say a long word, do you sometimes find it difficult to get all the
    sounds in the right order?YesNo

    12. Do you find it difficult to do sums in your head without using your fingers or paper?YesNo

    13. When using the telephone, do you tend to get the numbers mixed up when you dial?YesNo

    14. Do you find it difficult to say the months of the year forwards in a fluent matter?YesNo

    15. Do you find it difficult to say the months of the year backwards?YesNo

    16. Do you mix up dates and times and miss appointments?YesNo

    17. When writing cheques do you frequently find yourself making mistakes?YesNo

    18. Do you find forms difficult and confusing?YesNo

    19. Do you mix up bus numbers like 95 and 59?YesNo

    20. Do you find it hard to learn your multiplication tables at school?YesNo

    To help us provide whatever support you need to complete your learning program, some background information would be useful. We would be grateful if you would answer the questions below. Please note that the information we want is needed so we can offer you the best possible support and not to decide whether we take you on.

    1. How would you describe your record of attendance at school?
    Up to 70%70/80%Higher than that

    2. Did you have any gaps in your time at school? If so, how long and for what reason?

    3. Were you ever suspended/excluded from school?

    Did you enjoy your time at school?

    5. Do you live:With your parent(s) Independently in your own accommodation:



    6. Do you find communicating with other people:

    EasyDifficultIt depends who they are

    7. Which do you find the easiest way to learn?

    In a groupOne to one with a tutorReading books and notesBeing shown and then doing it yourself

    8. Are there any external agencies you are currently involved with?

    9. Why do you wish to join and what do you aim to get out of this course?

    10. Do you have any medical problems? Are you currently on any medication?

    11. Are you registered with Connexions?

    12. Do you smoke?

    Privacy Notice

    How We Use Your Personal Information

    This privacy notice is issued by the Education and Skills Funding Agency (ESFA), on behalf of the
    Secretary of State for the Department of Education (DfE). It is to inform learners how their personal
    information will be used by the DfE, the ESFA (an executive agency of the DfE) and any successor
    bodies to these organisations. For the purposes of relevant data protection legislation, the DfE is the
    data controller for personal data processed by the ESFA.

    Your personal information is used by the DfE to exercise its functions and to meet its statutory
    responsibilities, including under the Apprenticeships, Skills, Children and Learning Act 2009 and to
    create and maintain a unique learner number (ULN) and a personal learning record (PLR). Your
    information will be securely destroyed after it is no longer required for these purposes.

    Your information may be shared with third parties for education, training, employment and well-being
    related purposes, including for research. This will only take place where the law allows it and the
    sharing is in compliance with data protection legislation.

    The English European Social Fund (ESF) Managing Authority (or agents acting on its behalf) may
    contact you in order for them to carry out research and evaluation to inform the effectiveness of

    You can agree to be contacted for other purposes by ticking any of the following boxes:

    About courses or learning opportunities.For surveys and research.By post.By phone.By e-mail.

    Further information about use of and access to your personal data, details of organisations with whom
    we regularly share data, information about how long we retain your data, and how to change your
    consent to being contacted, please visit:www.gov.uk/government/publications/esfa-privacy-notice

    If you do not agree to share your personal information we cannot process your Application or offer
    you a training place.

    I have read the privacy notice

    I agree for my information to be shared with the organisations mentioned above

    I disagree for my information to be shared with the organisations mentioned above

    If I do not agree I have also read the full implications of not sharing my data.

    I have brought in my form of identification of proof of who I am.

    I have seen the identification brought in by the learner

    Recruitment Signature
    Learner Signature