SCAMP Teacher Questionnaire
The student(s) indicated in the email you received has applied to the Bloomfield SCAMP program for this upcoming summer. In order to  determine if SCAMP is right for the applicant and to best meet the needs of the camper, we gather  information from both the child’s parents and their teacher. We greatly value any honest teacher input  that can be provided to us to help make the summer beneficial and enjoyable.
If you have more than one student applying for SCAMP, please complete a separate form for each student.
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Email *
Student you are completing this questionnaire for *
Teacher Name *
School Name and Address *
Student's present type of program: *
What is your classroom makeup? *
What is the staff to student ratio? *
Does the student require a one on one? *
If not assigned a specific one on one does the student require a significant amount of one on one  attention during the day to complete activities?   *
If so, please list the most difficult activities for the student, i.e. lunch, transitions, gym, reading, etc.
BEHAVIOR:
To attend SCAMP a child may not be a danger to themselves or others. SCAMP welcomes one-on-ones  from outside sources, however does not provide them. Campers must be able to function within a 3:1  ratio.
Please check all that apply: *
Required
What is the frequency that these behaviors occur?  *
If a behavior occurs in your classroom, what are some positive behavior strategies that we can use to modify the participant's behavior? List any strategies that have been found to be successful at school or at home. *
Please share any behavior intervention plans that you feel would be useful to our staff in managing behavior at camp.  
Send via email to eprice@bloomfield.org
ESY/Enrichment: Does the student qualify for ESY services or summer enrichment opportunity? *
If yes, please make sure to include all goals and data tracking sheets prior to the start of camp with an indication of the person responsible. SCAMP staff is not responsible for tracking IEP goals/objectives.
Send via email to eprice@bloomfield.org
Describe some of the goals that you have been working on this past year in the area of reading. Include specific activities that you would like us to reinforce this summer. *
Describe some of the goals or activities that the student has been working on in the area of math and that you would like to see reinforce this summer. *
What social skills would you like SCAMP to reinforce this summer for this camper? *
Is there any other piece of information that you think SCAMP should know that will help us provide the  best possible summer program for this child/adult? *
Please email/mail any additional information (behavior intervention plans/medical plans/ESY goals and data) to:
 eprice@bloomfield.org OR mail to Bloomfield SCAMP, 7273 Wing Lake Road, Bloomfield Hills, MI 48301
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