ENVIRONMENTAL, CULTURAL AND/OR ECONOMIC CONCERNS



|Dothan City Schools – Department of Exceptional Student Services |

|CLASSROOM TEACHER INPUT |

|Student | |Grade | |Date | |

|School | |Teacher | |Subject | |

Please complete the following teacher input information and return this form within five (5) days to assist the IEP team in evaluating your student.

Teacher Observations – Based on your knowledge and observation, please rate this student’s performance in the following areas:

|OBSERVATIONS | UNSATISFACTORY < - - - - - - - - - - - - - - - - -> EXCELLENT |

|Classroom Work |[pic] |[pic] |[pic] |[pic] |[pic] |

|Homework |[pic] |[pic] |[pic] |[pic] |[pic] |

|Tests |[pic] |[pic] |[pic] |[pic] |[pic] |

|Reading Performance |[pic] |[pic] |[pic] |[pic] |[pic] |

|Math Performance |[pic] |[pic] |[pic] |[pic] |[pic] |

|Written Performance |[pic] |[pic] |[pic] |[pic] |[pic] |

|Following Directions |[pic] |[pic] |[pic] |[pic] |[pic] |

|Attendance/Timeliness to Class |[pic] |[pic] |[pic] |[pic] |[pic] |

|Attention Span |[pic] |[pic] |[pic] |[pic] |[pic] |

|Organizational Skills |[pic] |[pic] |[pic] |[pic] |[pic] |

ACTIONS TAKEN (Check only those that apply) RESULTS

|[pic] |Sent reports home | |

|[pic] |Talked with counselor | |

|[pic] |Rearranged Seating | |

|[pic] |Preferential/Isolated Seating | |

|[pic] |Ignored Behavior | |

|[pic] |Referred to Administrator | |

|[pic] |Contracts | |

|[pic] |Assignment Notebook | |

|[pic] |Alternative Assignment | |

|[pic] |Reduced work w/o eliminating core content | |

|[pic] |Additional Time for assignments | |

|[pic] |Small group instruction | |

|[pic] |Cooperative learning | |

|[pic] |Parent Conferences | |

|[pic] |Other: | |

[pic]

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