Evaluation Teacher Data Form
Student's Name:
*
First Name
Last Name
Grade Level:
*
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Transition
Comment on the student's current academic skill level, homework completion, and grade. Include the student's areas of strengths and weaknesses.
*
What interventions/accommodations have you used in your classroom with the student?
*
Social/Behavioral Strengths:
*
Rows
Yes
Sometimes
No
Socializes appropriately with peers
1
2
3
Is friendly and good-natured
4
5
6
Maintains consistent effort
7
8
9
Has a good self concept
10
11
12
Is confident about accomplishments
13
14
15
Participates in class discussions
16
17
18
Cooperates with school personnel
19
20
21
Social/Behavioral Concerns
*
Rows
Yes
Sometimes
No
Disruptive in class, talks out
22
23
24
Fidgety, can't stay in seat
25
26
27
Constantly seeks attention
28
29
30
Overly aggressive to peers
31
32
33
Defies adult authority
34
35
36
Impulsive
37
38
39
Limited attention span
40
41
42
Isolates self from others
43
44
45
Anxious, worried, frightened, sad
46
47
48
Will not take responsibility for actions
49
50
51
Vocational/Work Habit Strengths:
*
Rows
Yes
Sometimes
No
Brings necessary materials for tasks
52
53
54
Accepts assignments without complaint
55
56
57
Performs work independently
58
59
60
Checks own work upon completing tasks
61
62
63
Benefit from constructive feedback
64
65
66
Turns assignments in on time
67
68
69
Takes pride in quality of work
70
71
72
Vocational/Work Habits Concerns:
*
Rows
Yes
Sometimes
No
Has difficulty transitioning
73
74
75
Needs much repetition
76
77
78
Poorly motivated to achieve
79
80
81
Lacks organization
82
83
84
Difficulty following directions (oral/written)
85
86
87
Quality of work varies from day to day
88
89
90
Rushes to complete tasks
91
92
93
Refuses to complete tasks
94
95
96
Functional Academic Concerns:
*
Rows
Yes
Sometimes
No
Does not complete/turn in assignments
97
98
99
Fails tests or quizzes
100
101
102
Does not ask for help
103
104
105
Needs repeated drill and practice
106
107
108
Needs extended time for tests/assignments
109
110
111
Difficulty taking notes
112
113
114
Do you feel that the student's needs can be met within the general education setting WITHOUT special education supports?
*
Yes
No
Why?
*
Please share any other pertinent information.
Person completing this form:
*
First Name
Last Name
Signature
Date
*
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Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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