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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