Teacher Input for comprehensive Re-Evaluation



Teacher Interview / Organizational Checklist

Please return to ________________________________

The following information is being gathered for purposes of skill based evaluation and IEP planning. Your input is very important in this process. Thank you.

Student___________________________________Teacher: ____________________________

Class/Setting: _________________________________Date: ___________________________

Academic Functioning

1. What is the child’s academic functioning?

Strengths?

Weaknesses?

2. Does the child attend to what is in class?

3a. Is daily work completed?

b. How does the student perform on tests:

e. Average percentage of assignments completed: __________

Average Percentage of accuracy on assignments: __________

Average percentage attained on tests: __________

f. On what kinds of assignments does he finish his work?

g. Does the child participate in classroom discussions?

h. How does the student’s performance compare with peers?

Below ___________________________________________Above

1 2 3 4 5

i. Approximate grade at this time:

4. What modifications are you presently making in the classroom to meet the student’s needs? Check modifications you are using for this individual student.

_____modify daily assignments _____highlighted tests

_____extra time for assigned completion _____materials on lower reading level

_____lectures taped _____special seating arrangements

_____teacher/peer classmate provided _____notes during tests

_____open-book tests _____tests read to student

_____modified tests _____reviews individually with teacher

_____peer tutoring provided _____reviews individually with teacher before school

_____extra time for tests _____individualized grade system

_____oral quizzes/tests rather than written

_____other(s) you may feel are necessary (please explain)

Behavioral Functioning

5a. What specific behaviors does the child exhibit which concern you?

b. What do you do when this happens? What does the child do?

c. How often do these behaviors occur (every day, twice a week, once a month….)

d. How intense are these behaviors (danger to others, creating arguments with peers, interruption to teaching…)?

e. How long has the behavior been going on (how many weeks/months)?

f. In your opinion, why is the student performing the behavior?

____Get adult attention ____Get desired item/activity

____Avoid activity ____Escape setting

____Get peer attention ____Imitation

____Retaliation ____Communication

____Avoid person ____Avoid demand/request

____Sensory input

Other (please explain):

6. What is the behavioral makeup of your class?

Social Functioning

7a. Describe this student’s use of social skills and interaction with other peers in your class:

7b. Does the child initiate problems or does s/he respond to others?

c. Are the child’s interactions with peers and/or adults primarily positive or negative?

d. Characterize the child’s friends…..Many? One or two?

8. Other comments:

Organizational and Independent Work Skills Checklist

:______________________________________________________

| | |Area of Concern/Needs | |

|Rate student on following skills: |Independent |Assistance |/Comments |

|Organization and Work Skills | | | |

|Follows daily class schedule | | | |

|Uses and follows assignment book/planner | | | |

|Organizes and studies course materials | | | |

|Listens and works without distraction | | | |

|Begins and completes work within time allotted | | | |

|Understands assignment expectations | | | |

|Turns in work on time | | | |

|Completes tests | | | |

|Obtains and completes makeup assignments when absent | | | |

|Transitions from one classroom activity/setting to | | | |

|another within the time allowed | | | |

| -with needed materials and supplies | | | |

|Uses independent time appropriately | | | |

|Participates actively in class discussions/group | | | |

|activities/projects | | | |

|Advocates for self to clarify classroom requirements or | | | |

|meet personal needs | | | |

|Motor – related to strength/endurance/pain management | | | |

|Moves through natural school environment in a safe and | | | |

|timely manner (including emergency evacuation) | | | |

|Participates in physical education class | | | |

|Utilizes all natural school environments (i.e. lunchroom,| | | |

|playground, bathroom stage) | | | |

|Meets personal needs (eating, dressing, toileting) within| | | |

|the daily schedule | | | |

|Produces written work that is legible and completed | | | |

|within time lines, without fatigue | | | |

|Manages school materials and belongings in a timely | | | |

|manner | | | |

|Organizes school materials, folders, locker | | | |

|Operates standard computer/mouse | | | |

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