Section 1 of 31
Elementary Teacher Input for ARD-STUDENT NAME
Please be aware that the information provided is subject to Open Records requests.
This form is automatically collecting emails from all respondents.Change settings
Student Name
Student Name
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Grade
Grade
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Please mark the areas that need to be addressed. (Problematic behavior will be addressed in a different section.)
Please mark the areas that need to be addressed. (Problematic behavior will be addressed in a different section.)
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Absences
Incomplete Assignments
Low daily grades
Low major grades
Failure to re-test/redo
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 2 of 31
Recent Test Scores
Comparing this student to their same-grade peers
Name a recent test given in your class (BOY/MOY testing, interim testing, a unit test, a benchmark test, a diagnostic test, etc.) and what their grade was on it.
For example: On the Biomes Test, he scored an 87.
Name a recent test given in your class (BOY/MOY testing, interim testing, a unit test, a benchmark test, a diagnostic test, etc.) and what their grade was on it.
For example: On the Biomes Test, he scored an 87.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Follow-up question... On the same recent test you gave in your class, what was the class average?
Continued example: On the Biomes Test, the class average was an 85.
Follow-up question... On the same recent test you gave in your class, what was the class average?
Continued example: On the Biomes Test, the class average was an 85.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
TWO ACADEMIC strengths (Must be content-based. A good way to determine this is to look at your gradebook and see what tests/topics they scored well on.)
For example: If you teach Reading, think about the skills you teach. Non-fiction text: comprehension, fluency, etc
DO NOT REPORT ON THEIR BEHAVIOR HERE! (That's a different section!)
TWO ACADEMIC strengths (Must be content-based. A good way to determine this is to look at your gradebook and see what tests/topics they scored well on.)
For example: If you teach Reading, think about the skills you teach. Non-fiction text: comprehension, fluency, etc
DO NOT REPORT ON THEIR BEHAVIOR HERE! (That's a different section!)
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Does this student demonstrate academic needs in your class related to their disability?
Does this student demonstrate academic needs in your class related to their disability?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 3 of 31
Weaknesses
What foundational or prerequisite skill(s) they are missing?
What foundational or prerequisite skill(s) they are missing?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Basic reading skills
Reading comprehension
Vocabulary
Making inferences
Writing a paragraph or essay
Math calculation
Math problem solving
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 4 of 31
General Behavior Strengths
Character/Personal Strengths: Select all that apply
Character/Personal Strengths: Select all that apply
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Is honest and trustworthy
Shows kindness and empathy toward others
Helps others when needed
Demonstrates perseverance when work is challenging
Shows resilience after setbacks
Takes responsibility for actions
Demonstrates independence
Is cooperative with adults and peers
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Social/Interpersonal Strengths:
Select all that apply
Social/Interpersonal Strengths:
Select all that apply
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Works well with peers
Shares and takes turns appropriately
Can compromise appropriately
Is a good listener
Asks for help appropriately
Accepts feedback or correction appropriately
Builds positive peer relationships
Uses humor appropriately
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Communication Strengths:
Select all that apply
Communication Strengths:
Select all that apply
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Expresses needs, wants, and ideas appropriately
Participates in class discussions
Initiates appropriate conversations
Advocates for needs appropriately
Asks clarifying questions when confused
Communicates frustration appropriately
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Learning/Executive Functioning Strengths:
Select all that apply
Learning/Executive Functioning Strengths:
Select all that apply
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Is a self-starter
Stays focused on tasks
Follows classroom routines independently
Transitions appropriately between activities
Is organized with materials/work
Follows multi-step directions
Uses time effectively
Learns from mistakes
Demonstrates flexible thinking
Completes tasks independently
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
As the classroom teacher, do you (or the inclusion para, if you have one) provide any additional behavior supports to this student so they can be successful in your class? (This does not include RISE behavior support.)
As the classroom teacher, do you (or the inclusion para, if you have one) provide any additional behavior supports to this student so they can be successful in your class? (This does not include RISE behavior support.)
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
frequent redirection
structured reinforcement/reward system
calm-down breaks
de-escalation support
adult proximity
transition support
social skills prompting
emotional regulation coaching
crisis intervention support
none needed
Other:
Add option
…
Answer key
(0 points)
Loading...
Does the student's behavior interfere with their learning or the learning of others?
Does the student's behavior interfere with their learning or the learning of others?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 5 of 31
Problem Behaviors
What behavior(s) are interfering with learning? Check all that apply.
What behavior(s) are interfering with learning? Check all that apply.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
disruptive talking/noise-making
leaving seat without permission
peer conflict
verbal aggression
physical aggression
elopement/wandering
defiance toward adults
shutting down/withdrawal
work refusal
off-task behavior
emotional outbursts
inattention/distractibility
anxiety-related behaviors
property destruction
Other:
Add option
…
Answer key
(0 points)
Loading...
What typically happens before the behavior(s)? Check all that apply.
What typically happens before the behavior(s)? Check all that apply.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
difficult academic tasks
independent work
transitions
unstructured time
peer conflict
adult correction/redirection
sensory overwhelm/noise
changes in routine
frustration/confusion
fatigue
unknown trigger
Other:
Add option
…
Answer key
(0 points)
Loading...
How often do the behavior(s) occur?
How often do the behavior(s) occur?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
multiple times per class period
daily
several times per week
weekly
occasionally
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
How long can the behavior(s) last?
How long can the behavior(s) last?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
under 5 minutes
5–15 minutes
15–30 minutes
30+ minutes
varies significantly
Other:
Add option
…
Answer key
(0 points)
Loading...
What helps the student regulate their emotions and behavior? Check all that apply.
What helps the student regulate their emotions and behavior? Check all that apply.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
adult redirection
breaks
calm-down space
adult proximity
structured reinforcement
visual reminders
repeated directions
chunking assignments
peer support
reduced workload
emotional coaching
transition warnings
sensory supports
Other:
Add option
…
Answer key
(0 points)
Loading...
Anything else important about this behavior?
Anything else important about this behavior?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Section 6 of 31
Student Support Needs
(New TEA Documentation Section)
Adult Support / Independence
Does this student require adult support beyond what typical peers need to be successful in your class? (Not including RISE behavior support)
Adult Support / Independence
Does this student require adult support beyond what typical peers need to be successful in your class? (Not including RISE behavior support)
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Brief support at times to get started or stay on task
Continue to next section
Repeated prompting/check-ins throughout class
Continue to next section
Direct adult support for a significant portion of class
Continue to next section
Continuous or near-continuous adult support
Continue to next section
No extra adult support needed
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 7 of 31
Explain Adult Support
What does that adult support for this student look like in your class?
What does that adult support for this student look like in your class?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
task initiation prompts
repeated redirection
assignment organization help
visual reminders/checklists
transition reminders
repeated directions
breaking work into smaller steps
monitoring work completion
emotional regulation support
teacher-led classroom behavior support
adult proximity to maintain engagement
escorting/transitions between settings
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 8 of 31
Communication Supports
Which of the following communication supports (beyond typical classroom instruction) do you provide this student?
Which of the following communication supports (beyond typical classroom instruction) do you provide this student?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
simplified/reworded directions
repeated verbal prompts
sentence starters
modeled responses
visual schedules
visual supports/cues
communication device
teacher cueing to communicate
peer communication support
social communication prompting
none needed
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 9 of 31
Class Type
What type of class do you teach?
What type of class do you teach?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Reading
Continue to next section
Math
Continue to next section
Science
Continue to next section
Social Studies
Continue to next section
Self-Contained
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 10 of 31
Inclusion
Inclusion means an additional adult comes in to help during the student's class period.
Does the student receive inclusion support?
Does the student receive inclusion support?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Yes
No
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
What content area do they receive inclusion support for?
What content area do they receive inclusion support for?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Reading
Math
Science
Social Studies
Specials/PE
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 11 of 31
Inclusion Supports
What support does inclusion staff provide?
What support does inclusion staff provide?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
reteaching concepts
small-group instruction
assignment modification
accommodation implementation
minor behavior support
prompting/on-task support
organization support
test support (small group testing, oral admin from adult, etc.)
emotional regulation support
transition support in hallways
communication support
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 12 of 31
Inclusion-How much?
How much inclusion support do they need?
How much inclusion support do they need?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
a small portion of the class (~15-20min)
testing only (for small group testing)
half of a class period
all class period
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 13 of 31
Instructional Accommodations
Do they need oral administration?
Do they need oral administration?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 14 of 31
Oral Admin-Why?
How does oral admin help the student be successful?
How does oral admin help the student be successful?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
They have significant reading struggles (i.e., decoding, fluency, comprehending).
It slows them down to focus on one question at a time.
It helps reduce their test anxiety.
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 15 of 31
Small Group Testing
Do they need to be in a small group for routine tests/quizzes? (This should be rare. If they need oral admin, they need to use headphones, just like on STAAR.)
Do they need to be in a small group for routine tests/quizzes? (This should be rare. If they need oral admin, they need to use headphones, just like on STAAR.)
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 16 of 31
Small Group Testing-Why?
Explain why they need small group testing?
Explain why they need small group testing?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
They need a quiet environment with fewer distractions.
They need extra time to complete their tests or quizzes.
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 17 of 31
Spelling Assistance
Do they need spelling assistance?
Do they need spelling assistance?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 18 of 31
Note-Taking Assistance
Do they need note-taking assistance in your class?
Do they need note-taking assistance in your class?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 19 of 31
Note-Taking Assistance-Why?
How does note-taking assistance help them be successful?
How does note-taking assistance help them be successful?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
It allows them to focus on actively listening and processing information during lectures or lessons, rather than frantically trying to write down everything.
I want them to end up with a completed copy to study.
They have dexterity issues/it is difficult to read the student’s handwriting.
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 20 of 31
Extended Time
Does they need extended time?
Does they need extended time?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
YES, they need extended time on tests and/or assignments.
Continue to next section
NO, they don't need extended time on anything.
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 21 of 31
Extended Time-Why?
How much extra time do they need for routine tests and assignments?
How much extra time do they need for routine tests and assignments?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
1 extra day
2 extra days
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 22 of 31
Shortened Assignments
Do they need shortened assignments?
Do they need shortened assignments?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 23 of 31
Shortened Assignments-Why?
Please explain why they need shortened assignments.
Please explain why they need shortened assignments.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
They have struggles with their attention span.
Quality work is more important to me than the full quantity of the work in my class.
I use reducing their assignment as a motivation tool (at least sometimes).
When unfinished work is sent home for homework, it never returns.
Other:
Add option
…
Answer key
(0 points)
Loading...
By how much do their assignments and assessments need to be shortened?
By how much do their assignments and assessments need to be shortened?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
25%
50%
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 24 of 31
Oral Response
Do they need extra time for oral response?
Do they need extra time for oral response?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 25 of 31
Preferential Seating
Do they need preferential seating?
Do they need preferential seating?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 26 of 31
Preferential Seating-Why?
What kind of preferential seating do they need and why? Check all that apply.
What kind of preferential seating do they need and why? Check all that apply.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
They distract the peers nearby.
The peers nearby distract this student.
Near the front so they can see the board.
Near the front to keep them on task.
Near an adult to keep them on task.
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 27 of 31
Other Accoms?
Do you provide any of these other accommodations to this student regularly?
Do you provide any of these other accommodations to this student regularly?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
visual supports (timers, written directions, graphic organizers, picture cues, visual schedules, checklists, or visual reminders).
time management support (extended time)
assistive technology (audiobooks, text-to-speech, speech-to-text, calculators, adaptive keyboards, visual schedules, pencil grips, magnification tools)
health/personal care support (diabetes, seizures, meds, hygiene, allergies, mobility)
guided notes (fill-in-the-blank notes)
executive functioning support (teaching them strategies to improve attention, behavior, and organization)
sensory supports (noise-cancelling headphones, movement breaks, flexible seating, fidgets, sensory tools, etc.)
frequent check-ins (intentional, brief interactions with the student used to monitor their academic progress, emotional regulation, and behavior)
structured breaks (planned, predictable periods of rest designed to support sensory, emotional, and cognitive regulation)
alternate response format (verbal tests, allowing them to present to teacher alone, etc.)
chunked assignments (breaks long-term assignments, projects, or dense text into smaller, more manageable parts)
none needed
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 28 of 31
Consultation with SPED Staff
Do SPED staff regularly provide academic or behavior support/consultation related to this student?
Do SPED staff regularly provide academic or behavior support/consultation related to this student?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Yes
Continue to next section
No
Continue to next section
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Section 29 of 31
Explain SPED Support/Consult
How? Check all that apply:
How? Check all that apply:
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
modifying assignments/materials
accommodation planning
behavior problem-solving
reviewing student progress
creating supports/materials
communication planning
testing support planning
other needs or consultation
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Frequency?
Frequency?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
weekly
biweekly
monthly
as needed
Other:
Add option
…
Answer key
(0 points)
Loading...
Section 30 of 31
Further Thoughts
Is there anything else you'd like to add about this student?
Is there anything else you'd like to add about this student?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Section 31 of 31
Thank you for your time and thoughtfulness! We appreciate the data!
Link to Sheets
Summary
Question
Individual
Insights
Total points distribution
Loading...
Settings
Responses
Manage how responses are collected and protected
Presentation
Manage how the form and responses are presented
Defaults
Form defaults
Settings applied to this form and new forms
Question defaults
Settings applied to all new questions