Student ____________________
Subject __________________ Teacher ____________________
Please provide detailed answers to the following questions as best you can for each student. This
information is necessary and extremely important in developing an accurate IEP and 504 Plan for our
students.
Academic Performance: Answers to these questions can be categorized as strengths or
weaknesses depending how you answer. Please indicate if you classify your answer as a
strength or weakness for the student.
1.
Is the student able to follow instructions independently?
2.
Is the student able to comprehend concepts that are taught?
3.
To what extent does the student maintain focus in the classroom?
4.
Is the student able to follow classroom rules & procedures?
5.
Is the student making progress throughout this school year?
Grades
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
Additional Comments:
Social Performance
1.
How does this student behave in the classroom?
2.
How does the student relate to adults? To peers?
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1.
What interventions have worked with this student?
Attendance
1st Quarter
2nd Quarter
3rd Quarter
4th Quarter
Absences
Late
Cuts
Comments:_________________________________________________________________________
________________________________________________________
_____________________________________________________________________
Supports/Accommodations (What methods or accommodations are you making/using in your
classroom to assist the student in accessing the curriculum?)
Some examples are:
Textbooks for at-home use, Additional time for assignments, Review of directions, Weekly
home-school communication tools (notebook, daily log, phone calls or email messages),
Graphic organizers, Preferential seating, Reduction of distractions, Verbal and visual cues
regarding directions and staying on task.
Please describe anything else you have done to support the learning process for the student.
Teacher Signature________________________Date____________
Principal Signature____________________________________Date_______________