Evidence Record Sheet OCR Level 5/Level 7* Diploma in Teaching/Assessing Learners with Dyslexia/Specific Learning Difficulties QCF Qualification: Candidate Name: Unit: Evidence Evidence title Assessment method Assessment Criteria reference or location I confirm that the evidence provided is a result of my own work. Signature of candidate: .......................................................................................................................................... Date: ............................................ I confirm that the candidate has demonstrated competence by satisfying all of the performance criteria and range for this element: Signature of assessor: .......................................................................................................................................... Date: ............................................ IV name (if sampled) + date: ........................................................................ Countersignature (if required) + date: .............................................................. OCR L5 and 7 Diploma in Teaching/Assessing Learners with Dyslexia/Specific Learning Difficulties QCF Qualifications (10128 and 10129) * delete as appropriate © OCR 2012