Educational Needs Intolerance Assessment Form
Assess educational intolerance concerns and support needs in a school or learning context using the Educational Needs Intolerance Assessment Form.
Learner & Context
Respondent role
*
Student
Parent/Guardian
Teacher
Counselor
Other
Learner age group or grade level
*
Please Select
Early childhood
Elementary
Middle school
High school
College/University
Adult education
Other
Institution or classroom context
Intolerance Assessment
How often is intolerance experienced in educational settings?
*
Rarely
1
2
3
4
Very often
5
1 is Rarely, 5 is Very often
Main type of intolerance observed
*
Exclusion
Teasing
Bias in participation
Unfair discipline
Inaccessible instruction
Other
Impact on learning and participation
*
Rows
No impact
Mild impact
Moderate impact
High impact
Participation
1
2
3
4
Attendance
5
6
7
8
Concentration
9
10
11
12
Confidence
13
14
15
16
Academic engagement
17
18
19
20
Most common situation or trigger
Support Needs & Follow-up
Most Needed Supports
*
Classroom adjustments
Peer mediation
Staff support
Communication with caregivers
Schedule flexibility
Counseling referral
Accessibility support
Other
Overall Severity / Urgency
*
1
2
3
4
5
Next-Step Notes / Preferred Follow-Up
Submit
Should be Empty: