Behavioral Functional Assessment Checklist for Teachers ...



Student _____________________________

|Reading Performance: |Assessment Procedure and Results: |

|Areas of Concern: ( All that apply |________________________________________________________________________________ |

|Alpha knowledge |________________________________________________________________________________ |

|Phonemic Awareness |________________________________________________________________________________ |

|Word analysis/decoding |________________________________________________________________________________ |

|Comprehension skills |________________________________________________________________________________ |

|Vocabulary |________________________________________________________________________________ |

|Fluency or rate of reading | |

|Other: ____________________ | |

|Math Performance: |Assessment Procedure and Results: |

|Areas of Concern: ( All that apply |________________________________________________________________________________ |

|Math Facts/Concepts |________________________________________________________________________________ |

|Operations (+-x÷) |________________________________________________________________________________ |

|Fractions |________________________________________________________________________________ |

|Money, time, measurement |________________________________________________________________________________ |

|Story problems | |

|Other: ____________________ | |

|Written Language Performance: |Assessment Procedure and Results: |

|Areas of Concern: ( All that apply |________________________________________________________________________________ |

|Organization/sequencing |________________________________________________________________________________ |

|Sentence structure |________________________________________________________________________________ |

|Paragraphing |________________________________________________________________________________ |

|Vocabulary |________________________________________________________________________________ |

|Punctuation |________________________________________________________________________________ |

|Spelling |________________________________________________________________________________ |

|Capitalization |________________________________________________________________________________ |

|Penmanship | |

|Syntax/Semantics - formats | |

|Other: ____________________ | |

|Communication Areas of Concern: ( All that apply |Observations of Learning Behaviors: |

|Articulation |Areas of Concern: ( All that apply |

|Fluency |Has trouble keeping track of assignments/work |

|Voice |Is learning, but at a much slower rate than peers |

|Oral Expression |Poor study habits |

|Listening Comprehension |Frequently requires instructions to be repeated |

| |Produces adequately in a one-to-one situation, but not in a group |

|Communication Concerns: (including educational impact) |Functions best when time and activities are highly structured |

|______________________________________________________ |Has a short attention span |

|______________________________________________________ |Is afraid to make a mistake |

|______________________________________________________ |Is disorganized and/or messy |

|Comments: (Use back of form if needed) |Slow to finish work |

|______________________________________________________ |Seems not to be interested in any classroom activities |

|______________________________________________________ |Is easily distracted by peripheral noise or movement |

|______________________________________________________ |Does things which distract other students |

|______________________________________________________ |Is overactive in most situations |

|______________________________________________________ |Homework not turned in |

| |Limited English proficiency |

| |Frequently absent |

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LEVEL 3 - Academic

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