K-12 Student Assessment Questionnaire
Please complete the K-12 Student Assessment Questionnaire to help us understand the student’s academic experience, learning needs, and classroom support requirements.
K-12 Student Assessment Questionnaire Form
Student Full 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
Which subject does the student enjoy the most?
*
Math
Science
English/Language Arts
Social Studies
Arts
Physical Education
Other
How would you rate the student’s overall academic progress this year?
*
1
2
3
4
5
Please indicate how much you agree with the following statements about the student’s classroom experience.
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The student participates actively in class.
1
2
3
4
5
The student feels comfortable asking questions.
6
7
8
9
10
The student works well with classmates.
11
12
13
14
15
The student stays organized with assignments.
16
17
18
19
20
Which area does the student need the most support in?
*
Reading/Writing
Mathematics
Science
Social Skills
Organization/Time Management
Other
How satisfied are you with the classroom support the student currently receives?
*
Not Satisfied
1
2
3
4
Very Satisfied
5
1 is Not Satisfied, 5 is Very Satisfied
Please rate the student’s confidence in the following areas.
*
Rows
Very Low
Low
Average
High
Very High
Reading
21
22
23
24
25
Mathematics
26
27
28
29
30
Science
31
32
33
34
35
Social Interaction
36
37
38
39
40
Is there any additional information you would like to share about the student’s learning needs?
Submit Assessment
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