STATEMENT OF STATUS CHECKLIST
(1990 Revision)
Harry L. Dangel, Ed.D. and E. Eugene Ensminger, Ed.D.
INTRODUCTION
The Statement of Status Checklist is a revised version of the Screening Checklist—Seven Areas of Learning and the Indepth
Checklist—Seven Areas of Learning developed in 1990. This revised version incorporates the earlier checklists into one form.
PURPOSE
The Statement of Status Checklist was developed to provide an informal procedure for documenting the present status of student
achievement in the seven areas of learning specified in the Federal Register (1990) and the Regulations and Procedures: Division for
Exceptional Students of the Georgia Department of Education (1988). This Checklist is designed for use by the regular classroom teacher as
a part of the referral process for students experiencing difficulty in the regular academic curriculum. It is designed for use in grades K-12.
SUGGESTED PROCEDURES
1.
When a student is referred to the Student Support Team (SST), the team should assist the regular classroom teacher in
documenting the student’s performance in the seven learning areas. The teacher’s classroom observation, knowledge of classroom
performance, and knowledge of performance on standardized achievement measures should permit her/him to rate the overall
performance in each area of learning should it become necessary.
2.
The numbered items under each area of learning represent a broad assessment of the area. The teacher is to indicate whether
she/he views the student’s performance in this area as “No Problem”, a “Moderate Problem”, or a “Severe Problem”. The criterion
for judgment is a comparison of performance with the student’s grade-level peer group. If the teacher judges the student to be in
the lowest third of his grade level peer group, then the rating on the item would be considered a “Moderate Problem”. If the
student’s performance on an item is judged to be in the bottom tenth of the grade level peer group, then the item would be rated as
a “Severe Problem”. Should the teacher view the student as having “No Problem” on any of these broad assessment items, then
there is no need to proceed to the more specific items in that area of learning.
3.
Should the teacher view any of the broad assessment items as presenting a “Moderate” or “Severe Problem”, then he/she should
proceed to the more specific items listed alphabetically below the numbered items. For items checked as representing a “Moderate”
or “Severe Problem”, documentation should be provided by describing the types of problems demonstrated by the learner.
Documentation may include work samples, anecdotal records, curriculum based assessment, criterion referenced assessment
(including Georgia CRTs), standardized test scores, rating scales, writing samples, audio or video tape recordings, etc.
4.
The items checked as representing “Moderate” or “Severe Problems” should become the focus of the Student Support Team in
trying alternative instructional guidance. Attempts to modify instruction and the success or non-success of these modifications may
also be included as documentation of the student’s performance.
5.
The last section of the Checklist includes a list of Related Behaviors, i.e., attention, memory, working style and social skills, that may
be associated with a student’s deficit performance. If the teacher has indicated at least a “Moderate Problem” in one or more of the
seven areas of learning, then the teacher should complete this portion of the Checklist. Should the Related Behavior item be
considered to represent a problem for the student, then a brief description or example should be provided to substantiate this
judgment.
WHAT THE STATEMENT OF STATUS CHECKLIST DOES NOT DO
1.
The Checklist is not designed to determine if students are eligible for special education services. It is designed to narrow the focus
of the student’s present problems in learning, to guide the intervention attempts by the Student Support Team (SST), and to guide
the assessment of the Eligibility Team, should the student be referred to Special Education following the SST stage of exploration.
2.
The Checklist is not designed for use when re-evaluating students for special education services. The purpose of the broad
screening approach to documentation of student performance is in comparing the target student with his/her grade-level peer group.
In re-evaluations, the special education personnel should already have sufficient records to document the student’s performance in
the seven areas of learning.
3.
The Checklist is not designed for use in non-academic or atypical settings. The Checklist was designed for use in grades K-12
where the student’s performance is being contrasted with the performance of students generally performing adequately.
The contents of this publication were developed under a grant from the Department of Education. However,
those contents do not necessarily represent the policy of the Department of Education, and you should not
assume endorsement by the Federal Government.
A Product of
Metro West
Georgia Learning Resources System
STATEMENT OF STATUS CHECKLIST
Student’s Name
Date of Birth
Specify the grade-level of the class to which this student is compared
The typical achievement level of students in this class is: (check one)
above average
average
below average
Name of person completing this form:
No Problem
Moderate
(Bottom 1/3)
Severe
(Bottom 1/10)
WHEN THIS STUDENT IS COMPARED TO PEERS . . .
Rank the student compared with regular grade classmates by checking the appropriate columns at the left. If the student has a severe
achievement problem (i.e., is in the lowest 1/10th of the regular class), check the left-hand column next to the item(s) describing the
problem(s); if the student has a moderate achievement problem, (i.e., is in the lowest 1/3rd of the regular class), check the middle column; and
if the student does not have an achievement problem in that area (i.e., is in the upper two-thirds of the regular class), check the right-hand
column.
Respond to each numbered item. Respond to those items with letters only in the areas in which the student has problems.
SEVEN ACHIEVEMENT AREAS
Please describe:
ORAL EXPRESSION (The ability to verbally communicate)
1. Verbally expresses ideas comparable to other students in class.
2. Displays speech which is typical of cultural peer group (or similar to other family members).
If either 1 or 2 above indicated a problem (the lower
1/3 of the class), respond to the following items:
a. Verbal production is comparable to peers.
b. Verbal production adequate when cueing is
provided (e.g., picture stimuli).
c. Vocabulary development is comparable to
peers.
d. Verbal fluency is comparable to peer group
(has little difficulty finding appropriate words
to express ideas).
e. Grammatical structure used is comparable
to peer group (considering cultural and family
communication style).
f. Verbal organization is comparable to peers
when relating experiences or stories
(e.g., sequential order).
g. Ideas expressed adequately in settings
other than the classroom, such as
interacting with peers.
LISTENING COMPREHENSION (The ability to understand verbal discourse)
1. Demonstrates ability to follow verbal directions.
2. Demonstrates understanding of the main idea of an orally presented material (e.g., story or lecture appropriate for age).
3. Demonstrates an understanding of conversation in peer group.
If either 1, 2, or 3 above places the student in the lower
1/3 of the class, respond to the following items:
a. Follows simple verbal directions requiring
a single response.
b. Follows multiple verbal commands.
c. Selects appropriate picture to identify the
meaning of orally presented information
(i.e. a word, sentence, or story)
d. Orders a series of pictures (or sentences)
to demonstrate understanding of orally
presented information (story or lecture).
e. Verbally paraphrases information
(sentence or stories) presented orally.
WRITTEN EXPRESSION (The ability to express ideas in writing). This area is evaluated only after written composition
skills have been taught, typically third grade or higher.
1. Effectively communicates ideas when using written expression, i.e., meaningful, age-appropriate sentences or
paragraphs disregarding handwriting, capitalization, punctuation, spelling, and grammar.
2. Organizes written expression, e.g., idea development is logical.
3. Produces an appropriate quantity of writing (number of words, sentences, and words per sentence).
If either 1, 2, or 3 above places the student in the lower
1/3 of the class, respond to the following items:
a. Demonstrates motor coordination and
fluency when writing.
No Problem
Severe
(Bottom
1/10)
Moderate
(Bottom 1/3)
Student’s Name:
Please describe:
b. Writes sentences/paragraphs when
given age-appropriate cues (e.g., picture
word, sentence starter, or topic).
c. Spells words correctly in written
expression activities.
d. Demonstrates mastery of the conventions
of written expression (i.e., punctuation,
capitalization, etc.).
e. Uses appropriate vocabulary when writing.
f. Writes sentences of varying type and
complexity.
g. Writes sentences/paragraphs of
appropriate length.
h. Writes effectively following prewriting
preparation (e.g., a verbal discussion
of content with the teacher).
i. Uses descriptive words (adjectives,
adverbs) in writing.
BASIC READING SKILLS (The ability to recognize and decode words). Students should be in the second half of first
grade or above to evaluate this section.
1. Has performed appropriately during this and previous years, on standardized group measures of word recognition and
word attack skills.
2. Accurately decodes reading material above 90%.
3. Orally reads an appropriate number of correct words-per-minute in oral reading.
If either 1, 2, or 3 above places the student in the lower
1/3 of the class, respond to the following items:
a. Recognizes letters and
letter order in reading (i.e., no letter
reversals or letter order transpositions).
b. Reads and scans fluently without
excessive omissions and substitutions
or without losing place.
c. Sounds out unfamiliar phonetic regular
words.
d. Smoothly blends sounds when attacking
new words.
e. Masters frequently used irregular
words (especially th- and wh- words).
f. Silently reads with appropriate fluency
(e.g., no inappropriate sub vocalization).
g. Accurately reads new words in context
after they have been introduced by
the teacher.
READING COMPREHENSION (The ability to understand and relate information about what has been read) Students
should be in the second half of first grade or above to evaluate this section.
1. Has performed appropriately on standardized group measures of reading comprehension.
2. Accurately paraphrases content after reading it.
3. Predicts unknown or missing word (cloze) from context.
If either 1, 2, or 3 above places the student in the lower
1/3 of the class, respond to the following items:
a. Comprehends the meaning of words
in the reading vocabulary.
b. Recalls facts after reading orally.
c. Self-corrects word recognition errors
so that miscues don’t distort meaning.
d. Follows written instructions.
e. Finds a main idea statement.
f. Infers details beyond the text.
g. Comprehends statements
with conditional words such as only,
never, always, either, or, etc.
h. Uses supplemental information to aid
comprehension (e.g., pictures, graphics,
questions, textual organization).
MATHEMATICS CALCULATION (The ability to use basic arithmetic operations). This section is completed on students in
the second half of first grade or higher.
1. Has performed appropriately on standardized group measures of mathematical calculations.
2. Accurately completes daily assignments in arithmetic operations, including elements such as numeration, addition,
subtraction, etc.
No Problem
Severe
(Bottom
1/10)
Moderate
(Bottom 1/3)
Student’s Name:
Please describe:
If either 1, or 2 above places the student in the lower
1/3 of the class, respond to the following items:
a. Computes math computations at an
appropriate rate (i.e., fluency).
b. Has mastered the elements of
numerations (i.e., rote and rational counting,
ordering, and recognizing numerals).
c. Comprehends place value.
d. Estimates whether an answer is
approximately correct.
e. Correctly completes operations requiring
multiple steps (e.g., long division or
subtraction with regrouping).
MATHEMATICAL REASONING (The ability to comprehend a problem statement and to determine what operations and
numerals are necessary to solve this problem). This section is completed on students in second grade or higher.
1. Has performed appropriately on standardized group measures of mathematical reasoning and problem solving.
2. Displays accuracy in solving mathematical word problems.
3. Has mastered the language of mathematics (e.g., time, money, measurement, terms of quantitative relationships,
geometry, etc).
If either 1, 2, or 3 above places the student in the lower
1/3 of the class, respond to the following items:
a. Recognizes and comprehends key words
which identify the operation used in a word
problem.
b. Selects numerals and sets up a numerical
statement from information given in a word
problem.
c. Expresses the equivalent parts of
fractions, percentages and decimals.
d. Solves life-related problems involving time,
money and measurement.
e. Accurately estimates responses to
everyday problems in time, money and
measurement, e.g., How long until lunch?,
How far do you live from school?, etc.
f. States the function and uses of
measurement terms, e.g., pounds,
miles, minutes, etc.
RELATED BEHAVIORS
Complete this section for students with problems in any of the seven academic areas above by checking any of the behaviors below which are
problems for the student. Describe how the student exhibits each behavior that is selected.
No Problem
Problem
Is this a
problem?
Please Describe:
ATTENTION
a. Amount of time on task is appropriate.
b. Ability to focus attention on relevant
stimuli and screen out irrelevant stimuli is
age-appropriate.
c. Ability to shift attention from one task or
situation to another occurs appropriately.
d. Attentive behavior occurs only during
specific situations or specific time periods.
If true, please specify.
MEMORY
a. Student is able to remember as comparable to
others in age group.
Student’s Name:
No Problem
Problem
Is this a
problem?
Please Describe
b. Student’s memory is unusually affected
by one or more of the following environmental
conditions: noise, excitement, emotional
upset, interpersonal problems or other
distractions. If true, please specify.
c. Student does not respond appropriately when
amount and complexity of material to be
learned is reduced.
d. Student does not respond appropriately when
task and content are meaningful and of
interest to the student.
e. Student’s memory is improved when recall
strategies (e.g., mnemonic or verbal rehearsal)
are practiced.
WORKING STYLE
a. Student plans work with consideration to time
available and importance of assignment.
b. Work is completed in a neat and organized
manner.
c. Quality of work is accurately evaluated by
the student.
d. Accuracy and/or quantity of work is
improved by close teacher supervision.
e. Quality and quantity of student’s work is
improved by providing an appropriate
contingency.
f. Work of student is more efficient in a small
group rather than in a large group.
g. Accuracy of work is improved when the
amount of work is reduced.
h. Responses to questions (verbal or written)
are given careful consideration rather than
responding impulsively.
i. Previously learned material is easily applied
to new situations.
j. Performance on similar tasks is consistent
from day to day.
SOCIAL SKILLS
a. Appropriately follows the rules established for
classroom operation.
b. Works cooperatively with other students.
c. Understands and accepts teacher’s
corrective feedback.
d. Has developed friendships among classmates.
e. Tries a new task or activity after it has
been presented by the teacher.
f. Responds to nonverbal cues present in
social interactions.