ASSESSMENT OF THE STUDENT’S LEARNING ENVIRONMENT

Student:                                                  DOB:                          Grade:          Date:                         

Teacher:                                                  School                                                         

Name of Observer/Position:                                                                                                 

Reason for Observation (circle one):         a. Full Case Study        b. Re-Evaluation Conference        c. Change of Program

Observation Start Time: __________        End Time: __________ Subject Area Observed:                                 

Type of Learning Environment

___ General Ed.        ___ Alternative Ed.                 ___ Special Ed.        ___ other                                 

Classroom Considerations (check all that apply)

___ 4 walls                ___ open classroom                ___ too hot                        ___ too cold

___ # computers        ___ rules posted                ___ work displayed                ___ posters/pictures posted

___ desks grouped        ___ desks in rows                ___ students at tables                ___ interest areas/centers

Where is student’s desk located in room?                                                                                 

Adequate light?  Yes    No                Classroom orderly?   Yes    No                Well fitting desk/chair?   Yes    No

Teacher/Student Considerations (check all that apply)

___ individual teacher                        ___ seated in the front                                ___ relaxed environment

___ co-teachers                        ___ seated in the back                                ___ structured environment

___ teaching assistant/aide                ___ fast rate of instruction                        ___ quiet environment        

___ # of students                        ___ slow rate of instruction                        ___ noisy environment

___ distractions to student (describe):                                                                                         

Instructional Format (check all that apply)

___ small group instruction        ___ large group instruction                ___ independent study                ___ free time

___ interest centers                ___ other                                                                                 

Method of Presentation (check all that apply)

___ visual on board                ___ modeling                        ___ prompting                        ___ cueing

___ questioning                ___ hands-on activity                ___ lecturing                        ___ demonstrating

___ other _________________________________________________________________________________

Student Observation (check all that apply)

___ follows oral directions                        ___ prepared                ___ confused                        ___ impulsive

___ works independently                        ___distractible                ___ task-oriented                ___ quiet

___ understands assignments                        ___ disruptive                ___ attention-seeking                ___ restless

___ eagerly participated in discussion                ___ preoccupied        ___ completed assignments

___ slow to begin assignment                        ___ disinterested        ___ individual help needed

___ follows written directions                        ___ respectful                ___ frequently out of seat

___ slow to complete assignment                ___ cooperative        ___ argumentative with teacher

Is the student concentrating appropriately in comparison to other students?                                                                                                                                                                                                                                                                                                 

Is the student more/less distracted than other students?  Provide examples.                                                                                                                                                                                                                                                                                                 

Is the student working with other appropriately in group activity?  Explain.                                                                                                                                                                                                                                                                                                 

Does the student seem to “fit in” with other children socially?  Provide examples.                                                                                                                                                                                                                                                                                         

Does the student seem able to do the work provided?  Explain.                                                                                                 

Please rate the student:

                                                        Not a Concern                                                                             Concern

Organization of the task                1        2        3        4        5        6        7        8        9        10

Independent work habits                1        2        3        4        5        6        7        8        9        10

Ability to complete tasks given                1        2        3        4        5        6        7        8        9        10

Distractibility                                1        2        3        4        5        6        7        8        9        10

Teacher support required to work        1        2        3        4        5        6        7        8        9        10

Peer support required to work                1        2        3        4        5        6        7        8        9        10

Describe any additional educationally relevant behaviors (both academic and behavioral) noted during the observation.  Describe how these behaviors affect his/her academic performance and/or interaction with peers:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         

Additional Notes: