Dyscalculia Document Generation

Templates and guidance for generating essential documents: IEPs, Section 504 Plans, Progress Monitoring Reports, Accommodation Letters, Screening Checklists, and Psychoeducational Summaries.

Math-Focused IEP Template

INDIVIDUALIZED EDUCATION PROGRAM (IEP)

Student Information

• Name: [Student Name]
• Date of Birth: [DOB] | Age: [Age] | Grade: [Grade]
• School: [School] | District: [District]
• IEP Meeting Date: [Date]
• IEP Effective Date: [Date] - [Date]
• Next Review Date: [Date]

IEP Team

• Parent/Guardian: [Name, Contact]
• Special Education Teacher: [Name, Credential]
• General Education Teacher (Math): [Name]
• School Psychologist/Evaluator: [Name]
• Administrator/IEP Coordinator: [Name]
• Related Service Providers (if applicable): [Names]

PRESENT LEVELS OF ACADEMIC PERFORMANCE (PLAAFP) — MATHEMATICS

Math Strengths

• Reasoning and problem-solving ability: [Description]
• Motivation and engagement: [Description]
• Specific skill strengths: [Examples]
• Learning preferences: [Tactile/visual/kinesthetic/auditory, etc.]

Math Deficits

• Number Sense: [Specific deficits in subitizing, magnitude comparison, quantity visualization, cardinality]
  • Current level: [Description with data]
  • Impact: [How deficit affects broader math learning]
• Computation Skills: [Specific deficits in single-digit facts, multi-digit operations, algorithms]
  • Current level: [Description with data]
  • Impact: [How deficit affects math fluency and problem solving]
• Math Fluency: [Automaticity with facts, speed vs. accuracy balance]
  • Current level: [Digits correct per minute, accuracy percentage]
  • Impact: [How slow fluency affects timed assessments and complex problem solving]
• Problem Solving: [Word problem comprehension, strategy selection, solution verification]
  • Current level: [Description with examples]
  • Impact: [How deficit affects applied mathematics and standardized testing]
• Math Reasoning: [Explanation of mathematical thinking, justification of strategies]
  • Current level: [Ability to explain processes verbally/in writing]
  • Impact: [How deficit affects deeper understanding and transfer to new contexts]

Math Anxiety

• Manifestations: [Describe how math anxiety appears: avoidance, frustration, shutdown, etc.]
• Triggers: [Specific situations that increase anxiety]
• Impact on Performance: [Does anxiety interfere with demonstration of actual ability?]

Formal Assessment Data

• KeyMath-3 Comprehensive: [Grade equivalent, standard score, subtest scores]
  • Number Concepts: [Standard Score, Percentile]
  • Operations: [Standard Score, Percentile]
  • Applications: [Standard Score, Percentile]
• TEMA-3: [Quotient, confidence interval, subtest scores]
  • Verbal Math: [Standard Score]
  • Quantitative Concepts: [Standard Score]
  • Informal Math: [Standard Score]
• WRAT-5 Math: [Grade equivalent, standard score]
• WISC-V (if applicable): [Verbal Comprehension, Perceptual Reasoning, Processing Speed, Working Memory]
• CBM Data: [Fluency probes, trend over time, rate of growth vs. expected]
• Classroom Assessment: [Teacher report, work samples, error patterns]

RTI/Intervention History

• Tier 1 (Core Instruction): [General math curriculum, time period, outcome]
• Tier 2 (Small Group): [Intervention provided, frequency, duration, progress]
• Tier 3 (Intensive): [Targeted intervention, frequency, duration, progress]
• Conclusion: [Despite intensive intervention, student demonstrates persistent deficit requiring special education services]

ANNUAL GOALS — MATHEMATICS (IEP Year)

Goal 1: Number Sense Foundation

Measurable Annual Goal: [Student] will demonstrate number sense competence by:

• Subitizing quantities 1-5 without counting with 90% accuracy across 10 trials
• Comparing two quantities (1-10) using "more than," "less than," "equal to" with 85% accuracy
• Decomposing numbers into parts (e.g., 8 = 5 + 3) with manipulatives with 80% accuracy

Progress Monitoring: Bi-weekly fluency probes, concept checklists; data reviewed at [frequency] meetings Baseline: [Current performance level] Expected Growth: [Specific improvement target by end of school year]

Goal 2: Computational Fluency

Measurable Annual Goal: [Student] will improve computational fluency by:

• Retrieving single-digit addition facts (sums 0-10) at a rate of 30 digits correct per minute with 85% accuracy
• Computing addition problems with regrouping (two-digit + two-digit) with manipulatives/representational models with 80% accuracy
• Applying addition strategies to word problems involving 1-2 steps with 75% accuracy

Progress Monitoring: Weekly fluency probes, work sample analysis, CBM probes; data reviewed at [frequency] meetings Baseline: [Current fluency rate, accuracy] Expected Growth: [Digits per minute increase, accuracy target]

Goal 3: Problem Solving and Math Reasoning

Measurable Annual Goal: [Student] will improve problem-solving competence by:

• Reading and comprehending addition/subtraction word problems with visual support (pictures/diagrams) with 80% accuracy
• Selecting appropriate strategies and explaining choices using mathematical vocabulary in 4 of 5 opportunities
• Verifying solutions for reasonableness and explaining how they know their answer is correct in 3 of 4 trials

Progress Monitoring: Problem sets with strategy explanations, think-aloud recordings, work sample analysis Baseline: [Current problem-solving accuracy, quality of reasoning] Expected Growth: [Improvement in comprehension, strategy sophistication, explanation clarity]

Goal 4: Math Anxiety Reduction

Measurable Annual Goal: [Student] will manage math anxiety by:

• Engaging in math instruction without avoidance behaviors (leaving classroom, refusing tasks) in 95% of sessions
• Using self-regulation strategies (deep breathing, positive self-talk, etc.) when frustrated in 4 of 5 trials
• Responding to errors as learning opportunities (requesting help, trying again) rather than shutting down in 4 of 5 trials

Progress Monitoring: Behavioral observation, teacher/student report, functional behavior assessment data Baseline: [Current anxiety manifestations, avoidance frequency] Expected Growth: [Reduced avoidance, increased self-efficacy, resilience with struggle]

SPECIAL EDUCATION SERVICES

Specialized Math Instruction

• Frequency: [X times per week]
• Duration: [X minutes per session]
• Setting: [Pull-out special education classroom / Push-in support in general math class / Hybrid model]
• Service Provider: [Title, Credentials]
• Instructional Focus: Concrete-Representational-Abstract (CRA) methodology; multisensory number sense instruction; evidence-based programs (TouchMath, Number Worlds, Stern, Strategic Math)

Related Services (if applicable)

• [Service Type]: [Frequency, Duration, Justification]

Supplementary Aids and Services

• Access to manipulatives (base-10 blocks, counters, Rekenrek, number lines, place value charts) for all math instruction
• Visual supports (color-coded place value, magnitude comparison cards, operation reference sheets)
• Digital supports (accessible math apps, calculator access, text-to-speech for word problems)
• Preferential seating near visual displays
• Frequent breaks to manage fatigue and anxiety

ACCOMMODATIONS — MATHEMATICS

Accommodations do NOT reduce conceptual demands but provide access to math curriculum.

Calculators and Computational Tools

• Use of scientific/basic calculator for computation-intensive tasks while still assessing number sense and reasoning
• Speech-to-text for showing work (reduces graphical/writing demands)
• Assistive technology for complex multi-step problems

Time Accommodations

• Extended time (1.5x-2x) on math assessments and timed tasks
• Untimed practice during instruction
• Breaks between problems to manage anxiety and fatigue

Presentation Accommodations

• Problems read aloud to student (by human or text-to-speech)
• Enlarged print (16pt+) with high contrast (black on white)
• Reduced number of problems per assignment (e.g., 5 representative problems instead of 20)
• Simplified language in word problems; extraneous information removed
• Number highlighted in word problems
• Clear problem formatting (one problem per line, adequate spacing)

Response Accommodations

• Verbal explanation of math process instead of written computation
• Pointing/selecting response from options (selected response instead of constructed)
• Typed response instead of handwritten
• Recording of explanations and strategies (audio file)
• Use of assistive technology (speech-to-text, dictation)

Manipulatives and Visual Supports (Always Available)

• Access to: base-10 blocks, counters, Rekenrek, number lines, ten-frames, place value charts, measurement tools
• Graph paper for column alignment and organization
• Formula sheets and operation reference guides
• Magnitude comparison charts and visual representations

Environmental Accommodations

• Separate, low-distraction testing location
• Preferential seating near front/visual displays
• Reduced background noise and interruptions
• Testing during times of day when student is most alert
• Frequent breaks built into assessments

Accommodation Monitoring

• Effectiveness reviewed at [frequency] IEP meetings
• Implementation verified through classroom observation and progress data
• Adjustments made as needed based on student performance

ACCOMMODATIONS — STANDARDIZED TESTING

• Extended time (1.5x-2x)
• Separate setting with minimal distractions
• Problems read aloud (human reader or text-to-speech)
• Use of calculator [specify which sections, if any]
• Large print materials (16pt+)
• Reduced-item format [if applicable to state testing]
• Assistive technology [specify]

LEAST RESTRICTIVE ENVIRONMENT (LRE)

[Student] will participate in:

• General education math class [X minutes per week] with push-in special education support
• Pull-out specialized instruction [X minutes per week] for intensive CRA-based remediation
• General education non-academic activities (specials, lunch, recess, assemblies) with same-age peers
• General education tests/assessments with accommodations as noted above

Justification: Student demonstrates significant deficits in math requiring specialized instruction not available in general education setting; regular participation in general math class with accommodation support provides appropriate challenge and peer interaction.

BEHAVIOR/SOCIAL-EMOTIONAL CONSIDERATIONS

• Math anxiety is primary concern; addressed through environmental supports, positive reinforcement, and growth mindset instruction
• Comorbidities (ADHD, dyslexia) [if applicable] considered in planning and accommodation selection
• Positive reinforcement for effort and strategy use; avoid pressure-based assessment
• Safe environment where struggle and errors are normalized

PARENT COMMUNICATION

Progress reports on math goals: [Frequency: monthly, quarterly, etc.] Method: [Email, in-person conferences, phone, learning management system, other] Opportunities for parent input on progress and accommodation effectiveness at each IEP review

IEP MEETING MINUTES & DECISIONS

• IEP developed based on comprehensive evaluation
• Parent consent obtained for services and accommodations
• All service dates specified and entered in student information system
• Progress monitoring schedule established
• Next annual review date: [Date]
• Signatures: Parent/Guardian, Special Education Teacher, General Education Teacher, Administrator, others as required by state

Section 504 Plan for Dyscalculia

504 PLAN — MATHEMATICS ACCOMMODATIONS

Student: [Name] | Age: [Age] | Grade: [Grade] School: [School] | Date: [Date] Disability: Math Learning Disability (Dyscalculia)

Accommodations

Implementation Verification

• Accommodations implemented as specified: Verified [monthly/quarterly]
• Effectiveness monitored through classroom observations, progress monitoring, student feedback
• Plan reviewed annually; adjustments made based on effectiveness and student needs

Progress Monitoring Report Template

PROGRESS MONITORING REPORT — MATHEMATICS

Student: [Name] | Report Period: [Dates] IEP/504 Goals: [List relevant goals] Progress Monitoring Measure: [Describe measure: fluency probe, concept checklist, CBM, work sample analysis, etc.]

Goal Progress Summary

Goal 1: [Goal title]

• Baseline (Start Date): [Performance level]
• Current Performance: [Performance level, date]
• Progress Rate: [Data trend: meeting expectations / approaching / not yet meeting]
• Target by End of Year: [Goal target]
• On Track? [Yes/No] | [% toward goal]

Graph or chart showing trend line and target line (if available)

Data Points Collected (Last 4-6 weeks):

Skill Area Analysis

Strengths Demonstrated

• [Specific skill improvements]
• [Student effort and engagement]
• [Progress on subgoals]

Areas for Continued Focus

• [Skill gaps remaining]
• [Barriers to progress]
• [Factors affecting performance]

Instructional Changes Made (if applicable)

• [Strategy adjustment]
• [Intervention intensification]
• [Accommodation modification]
• [Effective practice technique]

Recommendation

• Continue current instruction and monitoring
• Increase intervention frequency/intensity
• Modify instructional strategy
• Adjust accommodations
• Re-evaluate on [new timeline]

Parent/Student Communication

This report was shared with:

• Parent(s) on [Date] via [Method: email, meeting, conference, phone]
• Student discussed progress on [Date]
• Parent questions/input: [Comments]

Accommodation Letter Template

ACCOMMODATION LETTER FOR [STUDENT NAME]

[Date]

Dear [Student/Family]:

This letter describes the academic accommodations that [Student] is approved to use in mathematics instruction and assessments.

Approved Accommodations for Mathematics:

1. Calculator: Use of basic/scientific calculator for computation-heavy tasks and assessments [specify which sections/problems]
2. Extended Time: 1.5x to 2x additional time on timed math assessments and tests
3. Manipulatives: Continuous access to manipulatives (base-10 blocks, counters, Rekenrek, number lines, place value charts, ten-frames) for math instruction and independent practice
4. Graph Paper: Use of graph paper for all written math work to support column alignment and organization
5. Visual Supports: Reference sheets with place value charts, operation procedures, and magnitude comparison aids
6. Formula Sheet: Access to a formula reference sheet during problem-solving and assessments [specify which formulas]
7. Problems Read Aloud: Word problems and written instructions provided orally (by teacher or text-to-speech) during instruction and assessment
8. Separate Testing Location: A quiet, low-distraction setting for all formal math assessments
9. Breaks: Frequent short breaks during extended assessments or practice sessions to manage fatigue and anxiety

Accommodation Implementation

These accommodations are implemented in [all math classes / specific classes or settings]. Teachers have been informed and will apply these accommodations consistently.

Effective Dates

These accommodations are effective immediately and will remain in place throughout [school year / specified duration]. The accommodations will be reviewed and updated as needed at [specify review schedule].

Questions

If you have questions about these accommodations or would like to discuss your student's progress, please contact [contact information: teacher name, email, phone].

Sincerely,

[Signature] [Title] [School]

Dyscalculia Screening Checklist

DYSCALCULIA SCREENING CHECKLIST

Student: [Name] | Age: [Age] | Grade: [Grade] | Date: [Date] Completed by: [Name, Title]

This checklist is used to identify students at risk for dyscalculia and warranting further assessment.

Number Sense Indicators

Kindergarten - Grade 1

• Difficulty counting to 10 or beyond
• Unable to produce sets of objects when asked (e.g., "Show me 5 blocks")
• Cannot identify which is "more" or "less" between two small sets
• Finger use awkward or unfamiliar (poor finger gnosia)
• Trouble recognizing numerals on sight (confuses 2 and 5, 6 and 9)
• Difficulty forming numerals (reversed, poorly sized, inconsistent)

Grades 2-3

• Cannot subitize (instantly recognize) quantities 1-5
• Persistent counting-by-ones strategy; cannot skip count
• Slow, effortful single-digit addition/subtraction (still counting fingers)
• Cannot decompose numbers (8 = 5 + 3) without concrete support
• Transposing digits or writing numerals backwards
• Confusion with place value (confuses 12 and 21)

Grades 4-5

• Slow fluency with multi-digit addition/subtraction
• Cannot accurately perform regrouping/borrowing
• Weak understanding of multiplication/division concepts
• Cannot estimate or check reasonableness of answers
• Reading and interpreting word problems is labored
• Difficulty learning new computational strategies

Grades 6+

• Persistent weakness in fact fluency (still relies on counting or fingers)
• Cannot accurately execute multi-step algorithms
• Difficulty with fractions and decimal concepts
• Poor spatial visualization of geometric relationships
• Cannot estimate or perform mental math
• Algebraic reasoning significantly below grade level

Computation Indicators

All Grade Levels

• Frequent procedural errors despite understanding concepts
• Slow computational speed relative to peers
• Counting-based strategies beyond typical developmental age
• Difficulty learning and retaining facts through traditional instruction
• Strong conceptual understanding but weak procedural execution
• Inconsistent accuracy (correct some days, incorrect others, on same-type problems)

Associated Features

Math Anxiety (All Ages)

• Avoids math activities when possible
• Expresses frustration or shutdown when encountering difficult math problems
• Anxious facial expressions or body language during math lessons
• Refuses to participate in math instruction or practice
• Comments like "I'm bad at math" or "I can't do math"

Comorbidities (Consider These)

• Dyslexia or dysgraphia (reading/writing numbers and symbols may be difficult)
• ADHD (working memory or attention challenges during extended computation)
• Dyspraxia (difficulty with spatial relationships or coordination affecting computation)

Response to Intervention

• Despite 8+ weeks of Tier 2 small-group intervention, student shows minimal progress
• Despite 8+ weeks of Tier 3 intensive intervention, deficit persists
• Peer progress significantly outpaces student's progress on same curriculum

Teacher Observations

• Teacher reports concern about student's math learning
• Student performs significantly below grade-level standards
• Performance inconsistent across math domains (strong in geometry, weak in computation, for example)
• Significant discrepancy between math ability and other academic areas (strong reader, weak in math)

Screening Outcomes

Risk Level:

• Low Risk: 0-3 indicators; monitor but no immediate action needed
• Moderate Risk: 4-6 indicators; recommend small-group intervention and progress monitoring
• High Risk: 7+ indicators; recommend comprehensive evaluation for possible special education

Recommendation:

• Continue general classroom instruction with monitoring
• Implement targeted Tier 2 intervention for 8 weeks; monitor progress
• Refer for comprehensive evaluation including cognitive and math achievement assessments
• Coordinate with school psychologist for evaluation within 2 weeks

Follow-Up Action:

• Assessment scheduled for [Date]
• Intervention begins [Date]
• Progress monitoring start date: [Date]
• Re-screening date: [Date]

Psychoeducational Evaluation Summary for Dyscalculia

PSYCHOEDUCATIONAL EVALUATION SUMMARY

Student: [Name] | DOB: [Date] | Age: [Age] | Grade: [Grade] Evaluation Date: [Date] | School: [School] Evaluator: [Name, Credential] | Report Date: [Date]

Reason for Referral

[Brief description of concerns; referral source]

Background Information

• Developmental history: [Birth/milestones relevant to math development]
• Academic history: [Prior grade performance; prior interventions and outcomes]
• Medical history: [Relevant conditions; medications affecting cognition]
• Family history: [Math difficulties in family; learning disabilities]
• Current classroom performance: [Teacher observations and concerns]

Assessment Results

Cognitive Assessment

Instrument: [WISC-V, WPPSI-IV, or equivalent] Date Administered: [Date] Examiner: [Name]

Interpretation: [Describe overall cognitive ability; note any significant strengths/weaknesses; processing profile]

Math Achievement Assessment

Instrument: KeyMath-3 Comprehensive or TEMA-3 Date Administered: [Date]

Pattern Analysis: [Describe which areas are significantly lower; subtype pattern if evident: verbal, practognostic, lexical, graphical, operational, ideognostical]

Processing Deficits Assessment (if applicable)

Rapid Automatized Naming (RAN) [if assessing verbal or operational dyscalculia]:

• Numbers: [Score, rate, errors]
• Interpretation: [Slow naming suggests verbal dyscalculia; affects fact fluency]

Beery VMI or Visual-Spatial Assessment [if assessing practognostic dyscalculia]:

• [Score, interpretation]

Working Memory Measures:

• Digit Span: [Raw score, span forward/backward]
• Interpretation: [Working memory capacity relative to age]

Additional Measures

CBM Math Probes:

• Date: [Date]
• Fluency: [Digits correct per minute, accuracy percentage]
• Trend: [Increasing/stable/decreasing over last 8 weeks]

WRAT-5 Math Computation:

• Standard Score: [Score] | Percentile: [Percentile] | Grade Equivalent: [GE]

Summary of Findings

Math-Specific Profile

Number Sense:

• Subitizing: [Can recognize quantities 1-5 without counting? Yes/No/Inconsistent]
• Magnitude Comparison: [Understand "more/less"? Describe performance]
• Cardinality: [Understand last count = total amount? Describe]
• Quantity Decomposition: [Able to show part-whole relationships? Describe]

Computation:

• Single-digit facts: [Fluency rate, accuracy; describe strategies used]
• Multi-digit operations: [Accuracy and speed; describe errors]
• Strategy flexibility: [Can use multiple strategies? Yes/No]

Math Fluency:

• Automaticity: [Facts automatic? Or still counting/computing]
• Speed relative to grade level: [Significantly slow/moderately slow/adequate]
• Efficiency: [Describes problem-solving efficiency]

Problem Solving:

• Word problem comprehension: [Can understand problem structure? Describe]
• Strategy selection: [Appropriate and flexible? Describe]
• Solution verification: [Checks reasonableness? Describe]

Math Anxiety:

• Manifestations: [How anxiety appears in testing/classroom]
• Impact on performance: [Does anxiety exceed the math deficit alone?]

Cognitive Profile

• Cognitive ability: [Full Scale IQ classification]
• Discrepancy between IQ and math achievement: [Standard deviation gap; meets IDEA criteria for SLD if 1.5+ SD discrepancy]
• Processing strengths: [If any—verbal reasoning, perceptual reasoning, etc.]
• Processing weaknesses: [Impacting math learning—working memory, processing speed, visual-spatial, etc.]

Comorbidities

• Dyslexia/Reading disorder (affects number naming, symbol recognition)
• Dysgraphia (affects number formation, writing answers)
• ADHD (affects attention, working memory, task initiation)
• Other: [Specify]

RTI Data

• Tier 1 classroom instruction: [Period, outcome, teacher report]
• Tier 2 small group intervention: [Period, program, frequency, outcome]
• Tier 3 intensive intervention: [Period, program, frequency, outcome]
• Conclusion: [Student showed insufficient progress despite evidence-based intervention; disability suspected]

Disability Determination

Does student meet criteria for Special Education under "Other Health Impairment" or "Specific Learning Disability" related to Mathematics?

• YES: Student demonstrates:
  • Significant discrepancy between cognitive ability (IQ = [Score]) and math achievement (Composite Score = [Score]; gap = [SD] standard deviations)
  • Persistent deficit in math despite evidence-based Tier 2/3 intervention for [time period]
  • Math deficit(s) not better explained by: sensory impairment, intellectual disability, emotional disturbance, language proficiency, or environmental/economic disadvantage
  • Recommendation: Eligible for special education services under IDEA; IEP development recommended
• NO: [Explain if not eligible]

Recommendations for Instruction

Instructional Approach

• Primary methodology: Concrete-Representational-Abstract (CRA) progression
• Duration of concrete stage: [Extended; match to individual progress]
• Manipulatives essential: Base-10 blocks, counters, Rekenrek, number lines, place value charts
• Multisensory strategies: Incorporate tactile, kinesthetic, visual, auditory input
• Pacing: Flexible; progress based on mastery, not grade level

Program Recommendations

• TouchMath (for subitizing and counting bridge)
• Number Worlds (for comprehensive number sense)
• Stern Structural Arithmetic (for transparent place value)
• Singapore Math adaptations (with extended concrete stage)
• Strategic Math Series (for cognitive strategy instruction)

Service Recommendations

• Frequency: [X times per week]
• Duration: [X minutes per session]
• Service provider: Special education teacher trained in CRA and dyscalculia remediation
• Setting: [Pull-out specialist instruction / Push-in classroom support / Combination]

Specific Focus Areas (Based on Profile)

• Number Sense Foundation (if subitizing, magnitude, cardinality weak)
• Computational Fluency (if single-digit facts slow/inaccurate)
• Multi-digit Operations (if regrouping concepts weak)
• Problem Solving (if word problem comprehension/strategy weak)
• Math Anxiety Management (if anxiety is significant barrier)

Accommodation Recommendations

• Permanent access to manipulatives
• Calculator for computation-intensive tasks
• Extended time on assessments (1.5x-2x)
• Separate testing location (low-distraction environment)
• Graph paper for written work
• Visual supports and reference sheets
• Problems read aloud
• Verbal response options
• [Other specific accommodations]

Progress Monitoring

• Measures: Fluency probes, concept checklists, CBM, work sample analysis
• Frequency: Bi-weekly minimum for foundational gaps; at least monthly for developing skills
• Data use: Adjust instruction if insufficient progress (less than 1 correct additional response per week)
• Timeline: Expect measurable progress within 4-6 weeks; adjust if stalled

Related Services (if applicable)

• [Counseling for math anxiety if needed]
• [Occupational therapy if fine motor/spatial deficits co-occur]

Parent Collaboration

• Monthly progress reports on math goals
• Parent input on accommodations and strategies to use at home
• Guidance for home practice (if recommended): brief, low-stress, concrete-based activities

Examiner Signature

[Signature] [Name, Credential] [Date] [School]

Assessment Instruments Quick Reference

US (English-normed)

France (French-normed)

Spain (Spanish-normed)

French Document Templates (Locale: fr)

Sources current as of 2026-10. Template structures derived from Circulaire n° 2015-016 (PAP, four cycle versions; since 2025-26 entered in the Livret de parcours inclusif), the circulaire du 14 mars 2022 (NOR MENE2204112C) with annexes replaced by the circulaire du 17 juillet 2025 (NOR MENE2506522C, BO n° 31 du 21 août 2025, session 2026 onward) for aménagements d'examens de l'enseignement scolaire, the circulaire du 6 février 2023 (NOR ESRS2234137C) for examens et concours (source of the calculatrice simple non programmable provision for dyscalculic candidates), the circulaire du 1er septembre 2025 (NOR MENE2520651C) for the pôles d'appui à la scolarité, MDPH/CDAPH PPS procédure standard (Code de l'action sociale et des familles). RQTH dossier per Code du travail Art. L5213-2; France Travail (ex-Pôle emploi since 1er janvier 2024). The "Circulaire n° 2023-033" cited in releases before 1.4.0 matches no BO entry and has been replaced.

FR-1. PAP — Plan d'Accompagnement Personnalisé (Dyscalculie)

Standardized template per Circulaire 2015-016. Four cycle versions; this template emphasizes the Mathématiques / logique domain for dyscalculie.

PLAN D'ACCOMPAGNEMENT PERSONNALISÉ (PAP) — DYSCALCULIE
Circulaire n° 2015-016 du 22 janvier 2015

Cycle: ☐ Maternelle  ☐ Élémentaire  ☐ Collège  ☐ Lycée
École / Établissement: [Nom]
Année scolaire: [XXXX–XXXX]

─── IDENTIFICATION DE L'ÉLÈVE ───────────────────────────────
Nom, Prénom: [Nom Prénom]
Date de naissance: [JJ/MM/AAAA]
Classe: [Classe]

─── TROUBLE(S) IDENTIFIÉ(S) ─────────────────────────────────
☑ Dyscalculie
☐ Dyslexie comorbide          ☐ Dyspraxie comorbide
☐ TDAH comorbide              ☐ Autre: [Préciser]

Documents médicaux / bilans en appui:
├── Bilan orthophonique (incluant TEDI-MATH ou Zareki-R): [Date, Professionnel]
├── Bilan neuropsychologique (WISC-V): [Date si disponible]
├── Bilan psychomoteur (si comorbidité dyspraxique): [Date]
└── Autre évaluation: [Préciser]

─── PROFESSIONNELS EXTÉRIEURS IMPLIQUÉS ─────────────────────
Orthophoniste: [Nom, fréquence des séances]
Neuropsychologue: [Nom, si applicable]
Psychomotricien: [Nom, si applicable]

─── AMÉNAGEMENTS ET ADAPTATIONS ─────────────────────────────

Mathématiques / logique (domaine principal pour dyscalculie):
├── ☑ Calculatrice non programmable autorisée dans TOUTES les matières
├── ☑ Table de multiplication accessible en permanence
├── ☑ Ligne numérique et autres aide-mémoires mathématiques accessibles
├── ☑ Papier quadrillé pour alignement des colonnes
├── ☑ Présentation adaptée: UNE opération par ligne, espacement augmenté
├── ☑ Temps supplémentaire pour les activités de calcul
├── ☑ Réduction de la quantité d'exercices (mêmes concepts, moins d'items)
├── ☑ Acceptation de l'explication orale du raisonnement
├── ☑ Instruction explicite sur les irrégularités lexicales (soixante-dix, quatre-vingts)
├── ☑ Manipulatives accessibles (réglettes Cuisenaire, jetons, bloc base-10)
└── Autre: [Préciser]

Langage écrit (si comorbidité dyslexique):
├── Documents adaptés: police ≥ 14pt, interligne 1,5-2
├── Texte aligné à gauche, pas de justification complète
├── Non-pénalisation des erreurs d'orthographe
└── Autre: [Préciser]

Autres domaines cognitifs:
├── Instructions segmentées
├── Rappels visuels des étapes
├── Place préférentielle en classe
└── Autre: [Préciser]

Prothèses cognitives (cognitive prosthetics — supports permanents):
├── Calculatrice scientifique pour collège/lycée
├── Logiciels mathématiques: GeoGebra français, MathType français
├── Tableurs (LibreOffice Calc, Excel français) pour problèmes complexes
└── Polices spécifiques pour chiffres si rendu problématique

─── RÉVISION ANNUELLE ───────────────────────────────────────
Date de la prochaine révision: [JJ/MM/AAAA]
Observations / suivi: [Notes]

─── SIGNATURES ──────────────────────────────────────────────
Famille: _________________________ Date: ___________
Médecin de l'Éducation nationale: _ Date: ___________
Directeur/Proviseur: ______________ Date: ___________
Enseignant(s) référent(s): ________ Date: ___________

PAP compliance notes (dyscalculia-specific):

• Medical validation by the médecin de l'Éducation nationale is mandatory.
• The PAP must explicitly authorize the calculatrice simple non programmable, including in papers where calculators are otherwise banned; the exam-side provision is in the circulaire du 6 février 2023 and the request is made on the session-2026 forms of the circulaire du 17 juillet 2025. Classroom use documented in the PAP is what makes the procédure simplifiée available.
• The PAP is entered in the Livret de parcours inclusif (LPI) by the directeur or chef d'établissement.
• For French students, document number-word irregularity instruction explicitly as an accommodation — the 60-99 transcoding deficit is dyscalculia-relevant in French specifically.
• The cognitive prosthetics section (v1.2.0 framing) frames calculator + reference table as permanent supports, not temporary scaffolds.

FR-2. MDPH Support Dossier (Dyscalculie sévère, voie PPS)

When dyscalculia is severe enough to warrant AESH (human aide), ULIS placement, or state-funded math software (PPS pathway):

DOSSIER D'APPUI — DEMANDE DE PPS POUR DYSCALCULIE SÉVÈRE

Élève: [Nom Prénom]
Date de naissance: [JJ/MM/AAAA]
École / Établissement: [Nom]
Département: [Numéro et nom]

─── DOCUMENTS REQUIS ───────────────────────────────────────
☐ Cerfa n° 15692*01 — Formulaire de demande
☐ Cerfa n° 15695*01 — Certificat médical (< 6 mois)
☐ Bilan orthophonique incluant TEDI-MATH ou Zareki-R (≤ 1 an)
☐ Bilan neuropsychologique (WISC-V)
☐ Bilan psychomoteur si comorbidité dyspraxique
☐ Rapport scolaire avec observations enseignant + résultats CBM
☐ Copie du PAP actuel (le cas échéant) montrant insuffisance

─── MOTIFS DE LA DEMANDE (Dyscalculie sévère) ─────────────
Trouble identifié: Dyscalculie sévère (CIM-11: 6A03.2)
Sub-type principal (Kosc): ☐ Verbal ☐ Practognostic ☐ Lexical
                            ☐ Graphical ☐ Operational ☐ Ideognostical

Besoins spécifiques nécessitant la voie PPS:
☐ AESH (Accompagnant d'Élève en Situation de Handicap)
☐ Placement en ULIS-école / collège / lycée
☐ Matériel pédagogique adapté (calculatrice scientifique
   spécialisée, logiciels payants, dispositifs tactiles)
☐ AEEH (Allocation d'Éducation de l'Enfant Handicapé)
☐ Autre: [Préciser]

─── DESCRIPTION DES BESOINS (cadre cognitif) ──────────────
[Cadrer comme trouble cognitif neuro-développemental persistant —
diff de traitement numérique au niveau du sillon intrapariétal.
Décrire impacts fonctionnels: calcul, mémorisation de faits,
problèmes verbaux, calcul mental, transcodage 60-99.]

Mesures déjà en place et leurs limites: [Détailler PAP/PPRE
antérieurs et pourquoi insuffisants]

─── COORDONNÉES DE L'ÉQUIPE SCOLAIRE ──────────────────────
[Directeur, enseignant principal, médecin de l'Éducation
nationale, professeur de mathématiques]

FR-3. Demande d'Aménagements d'Examens (Dyscalculie)

DEMANDE D'AMÉNAGEMENTS D'EXAMENS POUR ÉLÈVE AVEC DYSCALCULIE
Circulaire du 14 mars 2022 (NOR MENE2204112C), annexes remplacées par la
circulaire du 17 juillet 2025 (NOR MENE2506522C, BO n° 31 du 21 août 2025),
applicable à compter de la session 2026. Calculatrice simple non programmable
pour les candidats dyscalculiques: circulaire du 6 février 2023 (NOR ESRS2234137C).
Formulaire à saisir dans Incluscol lorsque l'académie l'a déployé.

Procédure: ☐ Simplifiée (aménagements identiques au PAP/PPS en cours)
           ☐ Complète (avis du médecin désigné par la CDAPH requis)

Examen concerné: ☐ DNB / CFG  ☐ Baccalauréat général et technologique
                 ☐ Baccalauréat professionnel  ☐ BTS  ☐ CAP  ☐ CFA  ☐ Autre
Session: [Année]
Établissement: [Nom]
Académie: [Nom]

─── IDENTIFICATION DU CANDIDAT ─────────────────────────────
Nom, Prénom: [Nom Prénom]
Date de naissance: [JJ/MM/AAAA]
Classe: [Classe]
INE: [Numéro si connu]

─── AMÉNAGEMENTS DEMANDÉS ─────────────────────────────────
☑ Calculatrice non programmable autorisée pour TOUTES les épreuves
   (y compris épreuves où le calcul mental est normalement requis)
☑ Aide-mémoire mathématique (table de multiplication, formulaires)
   accessible pendant l'épreuve
☐ Tiers-temps (temps majoré d'un tiers)
   Justification: [Référence au PAP/PPS — usage habituel en classe]
☐ Sujets adaptés: ☑ Police agrandie pour chiffres
                    ☑ Une opération par ligne
                    ☑ Espacement augmenté entre items
☐ Énoncés adaptés quand la question présuppose calcul mental rapide
☐ Salle séparée
☐ Temps de pause (chronomètre arrêté)
☐ Secrétaire scripteur (si comorbidité dysgraphique)
☐ Épreuve orale de remplacement (cas exceptionnels)
☐ Dispense d'épreuve (cas exceptionnels — justification détaillée)

─── PIÈCES JUSTIFICATIVES JOINTES ─────────────────────────
☐ Certificat médical < 6 mois avec diagnostic CIM-11 6A03.2
☐ Bilan orthophonique avec TEDI-MATH ou Zareki-R
☐ Bilan neuropsychologique
☐ Copie du PAP ou PPS en vigueur
☐ Attestation de l'établissement confirmant l'usage habituel

─── ATTESTATION DE L'ÉTABLISSEMENT ────────────────────────
[Directeur/Proviseur attestant des aménagements utilisés en classe,
dates depuis, document de référence (PAP/PPS)]

─── DÉCISION ──────────────────────────────────────────────
(À compléter par l'autorité académique)
Décision du recteur: ☐ Accordé  ☐ Partiellement accordé  ☐ Refusé
Aménagements accordés: [Détail]
Date: [JJ/MM/AAAA]
Recours: Défenseur des Droits

Critical: Calculatrice authorization across ALL exam papers is the headline dyscalculia accommodation in France. If denied, this is grounds for appeal under Loi 2005-102.

FR-4. Demande de RQTH (Dyscalculie adulte / professionnel)

For adult workers with dyscalculia seeking RQTH-funded workplace accommodations:

DOSSIER D'APPUI — DEMANDE DE RQTH POUR DYSCALCULIE

Demandeur: [Nom Prénom]
Date de naissance: [JJ/MM/AAAA]
Adresse: [Adresse]
Département: [Numéro et nom]

─── SITUATION PROFESSIONNELLE ──────────────────────────────
[Statut: salarié CDI/CDD, indépendant, étudiant CFA, etc.]
Poste actuel / souhaité: [Description]

Difficultés rencontrées dues à la dyscalculie:
[Cadrer comme trouble cognitif persistant — diff de traitement
numérique. Décrire impacts: calcul professionnel, factures,
bilans, statistiques, lecture de tableaux, gestion du temps,
estimation, etc.]

─── DOCUMENTS REQUIS ──────────────────────────────────────
☐ Cerfa n° 15692*01 — Formulaire principal MDPH
☐ Cerfa n° 15695*01 — Certificat médical récent
☐ Bilan neuropsychologique adulte (WAIS-IV)
☐ Bilan orthophonique adulte (si disponible)
☐ Diagnostic CIM-11 6A03.2 ou DSM-5-TR (code CIM-10-CM F81.2)
☐ Attestation employeur sur impact fonctionnel (si applicable)

─── AMÉNAGEMENTS / ÉQUIPEMENTS SOLLICITÉS ─────────────────
Logiciels et prothèses cognitives (financement AGEFIPH/FIPHFP):
☐ Calculatrice scientifique adaptée
☐ Logiciel tableur (Excel, LibreOffice Calc) avec templates
☐ Logiciel de math symbolique (GeoGebra, MathType français)
☐ Logiciel de gestion du temps (Time Timer, scaffolds calendrier)
☐ Templates pour tâches numériques répétitives (factures, devis)

Aménagements de poste:
☐ Temps adapté pour tâches calculatoires complexes
☐ Documents numériques avant échéance (préparation possible)
☐ Bureau séparé pour tâches numériques intensives
☐ Réunions accompagnées de compte-rendus chiffrés écrits

Accompagnement humain:
☐ Job coach (financé AGEFIPH)
☐ Référent handicap entreprise (firmes ≥250 — Loi Avenir Pro 2018)

─── SIGNATURES ──────────────────────────────────────────────
Demandeur: _____________________ Date: ___________
Médecin certificateur: _________ Date: ___________

Spanish Document Templates (Locale: es)

Sources current as of 2026-10. Template structures aligned with LOMLOE (Ley Orgánica 3/2020) ACNEAE/DEA framework, ACNS procedures per regional implementing decrees (Andalucía Instrucciones 12/12/2014, Cataluña Decret 150/2017, Madrid Orden 19/01/2021, País Vasco Decreto 236/2015), Real Decreto 534/2024 (PAU national floor, art. 3.2 / 13.10 / 21.1) with the annual regional acuerdos. Workplace certification per Real Decreto Legislativo 1/2013 (≥33% certificado de discapacidad threshold); public-employment exam adaptations per Orden PJC/804/2025.

ES-1. ACNS — Adaptaciones Curriculares No Significativas (Discalculia)

The primary support document for discalculia students in Spain. Regional terminology varies (ACNS / ACI no significativa / PTI / Plan de Apoyo).

ADAPTACIONES CURRICULARES NO SIGNIFICATIVAS (ACNS) — DISCALCULIA
[Comunidad Autónoma: _______________]
[Denominación regional equivalente: _______________]

Centro educativo: [Nombre]
Curso escolar: [XXXX–XXXX]

─── IDENTIFICACIÓN DEL ALUMNO/A ────────────────────────────
Nombre y apellidos: [Nombre Apellidos]
Fecha de nacimiento: [DD/MM/AAAA]
Curso: [Curso]
Tutor/a: [Nombre]

─── CLASIFICACIÓN ──────────────────────────────────────────
Categoría ACNEAE: DEA — Dificultades Específicas de Aprendizaje
Dificultad específica:
☑ Discalculia
☐ Dislexia comórbida          ☐ Disgrafía comórbida
☐ TDAH comórbido              ☐ Combinación: [Especificar]

Informe Psicopedagógico de referencia:
Fecha: [DD/MM/AAAA]    Elaborado por: [Orientador/a / EOEP]

Nota: Este alumno/a NO tiene clasificación NEE. Las ACNS (no
significativas) son el instrumento de apoyo correcto para DEA.
No corresponde el Dictamen de Escolarización ni las ACS salvo
comorbilidad con NEE.

Encuadre clínico-neurocientífico (v1.2.0): la discalculia es un
trastorno neurodesarrollal cognitivo persistente — diferencia
cerebral en el procesamiento numérico (surco intraparietal). Las
adaptaciones no son apoyos temporales sino prótesis cognitivas
permanentes.

─── ÁREAS DE DIFICULTAD IDENTIFICADAS ──────────────────────
[Resumen del Informe Psicopedagógico: subitización, comparación
de magnitudes, recuperación de hechos numéricos, cálculo,
resolución de problemas, etc.]

Subtipo Kosc (si identificado):
☐ Verbal ☐ Practognóstico ☐ Léxico
☐ Gráfico ☐ Operacional ☐ Ideognóstico

─── ADAPTACIONES METODOLÓGICAS ─────────────────────────────
Organización del aula:
☐ Asiento preferente
☐ Instrucciones segmentadas
☐ Recordatorios visuales de los pasos
☐ Acceso a apuntes/esquemas con antelación

Presentación de materiales matemáticos:
☐ Texto en Arial o fuente similar ≥ 14pt; interlineado ≥ 1,5
☐ Una operación por línea, papel cuadriculado
☐ Números ampliados, espaciado entre cifras aumentado
☐ Sin penalización por errores aritméticos cuando el razonamiento es correcto

Metodología de enseñanza (CRA español):
☐ Manipulativos: regletas Cuisenaire, bloques base-10, ábacos
☐ Modelos de barras (método Singapur en español)
☐ Aprovechamiento del sistema base-10 transparente del español
  (regla -enta: veinte/treinta/.../noventa) — explicitar la regla
☐ Apoyo visual en explicaciones verbales
☐ Tecnología asistiva (prótesis cognitivas permanentes):
   ☐ Calculadora (siempre permitida)
   ☐ Tabla de multiplicar accesible
   ☐ Hoja de cálculo (LibreOffice Calc, Excel)
   ☐ Software adaptado: GeoGebra ES, Symbolab ES, Smartick

─── ADAPTACIONES EN LA EVALUACIÓN ──────────────────────────
☐ Tiempo adicional: [Especificar porcentaje: ___ %]
☐ Calculadora autorizada en TODAS las pruebas matemáticas
☐ Tabla de multiplicar disponible durante exámenes
☐ Lectura de los enunciados por el/la docente si comorbilidad lectora
☐ Respuesta oral del razonamiento permitida
☐ No penalización de errores de cálculo cuando el procedimiento es correcto
☐ Formato ampliado: Arial 14-16pt, interlineado 1,5
☐ Reducción de la cantidad de ítems (misma dificultad)
☐ Acceso a hoja de cálculo en evaluaciones que lo permitan
☐ Evaluación en sala separada si es necesario

─── RESPONSABLES Y COORDINACIÓN ───────────────────────────
Tutor/a: [Nombre]
Orientador/a: [Nombre]
PT implicado/a: [Nombre]
EOEP: [Nombre si aplicable]
Familia: [Acuerdo documentado]

─── ACUERDO FAMILIAR Y FIRMAS ─────────────────────────────
Familia: ___________________ Fecha: ___________
Tutor/a: ___________________ Fecha: ___________
Orientador/a: ______________ Fecha: ___________
V.º B.º Director/a: ________ Fecha: ___________

─── REVISIÓN ──────────────────────────────────────────────
Fecha de revisión prevista: [DD/MM/AAAA]

ES-2. Informe Psicopedagógico (Discalculia) — Compliance Checklist

INFORME PSICOPEDAGÓGICO — VERIFICACIÓN DE CUMPLIMIENTO
Dificultades Específicas de Aprendizaje: Discalculia

Alumno/a: [Nombre]     Fecha: [DD/MM/AAAA]
Elaborado por: [Orientador/a / EOEP]    Centro: [Nombre]

─── SECCIONES REQUERIDAS ───────────────────────────────────
☐ Datos de identificación
☐ Motivo de la evaluación
☐ Historial escolar relevante
☐ Instrumentos de evaluación matemática utilizados:
   ☐ Prueba cognitiva (WISC-V español o equivalente)
   ☐ Prueba normalizada de cálculo (PROCALCULO, TEDI-MATH ES,
     o Evamat) — percentil documentado
   ☐ Prueba de fluidez (cálculos por minuto)
   ☐ Análisis cualitativo de errores
   ☐ Criterios de exclusión verificados (sin discapacidad
     intelectual, déficit sensorial, instrucción inadecuada)
☐ Clasificación: ACNEAE – DEA – Discalculia
☐ NO clasificado como NEE
☐ Sub-tipo (Kosc) si identificable
☐ Descripción de las necesidades educativas
☐ Propuesta de ACNS recomendadas
☐ Coordinación: PT, EOEP
☐ Orientaciones para la familia
☐ Firmas: orientador/a + director/a
☐ Fecha de próxima revisión

─── ALERTAS DE CUMPLIMIENTO ───────────────────────────────
⚠ Si clasifica como NEE por sola discalculia: CLASIFICACIÓN INCORRECTA
⚠ Si recomienda ACS para sola discalculia: INADECUADO; debe ser ACNS
⚠ Si describe la discalculia como "dificultad temporal" o "falta de práctica":
  ENCUADRE INADECUADO — debe ser trastorno neurodesarrollal persistente
⚠ Si no usa prueba matemática normalizada en español: CRITERIO INCOMPLETO

ES-3. PAU Exam Accommodation Request (Discalculia; formerly EBAU/EvAU)

SOLICITUD DE ADAPTACIONES PARA LA PAU (Prueba de Acceso a la Universidad) — DISCALCULIA
Base: Real Decreto 534/2024, de 11 de junio, art. 3.2, 13.10 y 21.1, y Acuerdo
de la Comisión Organizadora de la Comunidad Autónoma para la convocatoria
Comunidad Autónoma: __________

Centro: [Nombre del IES]    Convocatoria: [Año]
Alumno/a: [Nombre]    Curso: 2.º Bachillerato

─── DIAGNÓSTICO Y DOCUMENTACIÓN ───────────────────────────
Diagnóstico: ☑ Discalculia
☐ Informe Psicopedagógico (Fecha: ___)
☐ Historial de ACNS durante Bachillerato adjunto
☐ Otros documentos clínicos: [Especificar]

─── ADAPTACIONES SOLICITADAS ──────────────────────────────
☑ Calculadora autorizada en todos los exámenes matemáticos
☐ Tabla de multiplicar / formulario accesible
☑ Tiempo adicional (30 min adicional habitual)
☑ Texto ampliado: Arial 16pt, interlineado 1,5
☐ Aula separada / tribunal específico
☑ Reducción de penalización por errores aritméticos cuando el razonamiento es correcto
☐ Hoja de cálculo permitida en problemas complejos
☐ Otras: [Especificar]

─── CONSISTENCIA CON EL HISTORIAL ACNS ────────────────────
Adaptaciones documentadas en ACNS durante Bachillerato:
[Listar las usadas en clase y exámenes internos. El RD 534/2024 art. 3.2 basa
las adaptaciones en el apoyo recibido en la etapa anterior y prohíbe que
minoren la calificación.]

─── FIRMAS ──────────────────────────────────────────────────
Familia/Alumno/a mayor de edad: _______ Fecha: ___________
Orientador/a del centro: _____________ Fecha: ___________
Director/a del centro: _______________ Fecha: ___________

ES-4. Workplace Accommodation Request (RDL 1/2013, Discalculia)

SOLICITUD DE ADAPTACIÓN DEL PUESTO DE TRABAJO — DISCALCULIA
Real Decreto Legislativo 1/2013 (Ley General de Discapacidad)

A la atención del departamento de RR.HH. de [Empresa]
De: [Nombre Apellidos]    Fecha: [DD/MM/AAAA]
Puesto: [Descripción]

─── ESTADO ACREDITATIVO ──────────────────────────────────
☐ Certificado de discapacidad ≥ 33% emitido por Centro Base
   Fecha: [DD/MM/AAAA]    CCAA: [Nombre]
☐ Diagnóstico clínico actualizado (DSM-5-TR, código CIE-10-CM F81.2 / ICD-11 6A03.2)
☐ Informe funcional sobre el impacto en el desempeño laboral

─── DESCRIPCIÓN FUNCIONAL ────────────────────────────────
La discalculia es un trastorno neurodesarrollal cognitivo
persistente — diferencia cerebral en el procesamiento numérico.
Impacta principalmente:
[Descripción específica al puesto: cálculos profesionales, lectura
de informes con datos numéricos, redacción de facturas/presupuestos,
análisis estadístico, gestión de horarios, etc.]

─── ADAPTACIONES SOLICITADAS ──────────────────────────────
Prótesis cognitivas (tecnología asistiva permanente):
☐ Calculadora científica avanzada
☐ Hoja de cálculo (Excel, LibreOffice Calc) con plantillas
☐ Software matemático (GeoGebra, Symbolab español)
☐ Software de gestión del tiempo (Time Timer, recordatorios visuales)
☐ Plantillas para tareas numéricas repetitivas

Adaptaciones del puesto:
☐ Tiempo adicional para tareas calculatorias complejas
☐ Recepción anticipada de documentación numérica
☐ Espacio tranquilo durante lecturas numéricas críticas
☐ Resúmenes escritos numéricos de reuniones verbales

─── REFERENCIA LEGAL ─────────────────────────────────────
- RDL 1/2013, Ley General de Discapacidad (art. 35-37)
- Estatuto de los Trabajadores, art. 17 (no discriminación)
- Ley Orgánica 3/2018 (LOPD-GDD) — confidencialidad

─── FIRMA ──────────────────────────────────────────────────
Firma del/la trabajador/a: ____________ Fecha: ___________