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Student First Name:
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Student Last Name:
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Grade:
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Student ID:
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Date:
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Strengths: In this section, please mark any and all strengths that you have seen the student demonstrate.
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BehaviorEnglishMathSocial StudiesScienceElectivePE
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Teacher:
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Good attendance
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Prepared for class
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Participates in class discussions
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Participates in hands-on activities
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Does well on tests
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Turns in high quality work
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Meets deadlines for work turn in
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Demonstrates creativity
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Strengths: In this section, please mark any and all strengths that you have seen the student demonstrate.
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AcademicEnglishMathSocial StudiesScienceElectivePE
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Easily grasps new concepts
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Demonstrates academic skills commensurate with grade level.
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Strong reading skills
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Strong writing skills
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Strong math skills
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Connects previously learned skills/concepts to new learning
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Other Strengths: If the items above do not describe the student's strength, please type a statement below which describes the student's strengths.
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English
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Math
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Social Studies
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Science
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Elective
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PE
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Concerns: In this section, you will find a number of items that describe skills related to academic functioning, work habits, and social skills. Please mark those items about which you have concerns for this student in your classes; leave any items blank about which you have no concerns for this student.
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Reading/WritingEnglishMathSocial StudiesScienceElectivePE
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No concerns
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Reading: Decoding skills
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Reading: Comprehension
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Writing: Hand-writing is difficult to read
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Writing: Spelling/Grammar/Mechanics errors impact readability
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Writing: Lacks organization and/or development
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Math SkillsEnglishMathSocial StudiesScienceElectivePE
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No concerns
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Lacks basic calculation skills
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Doesn't understand new concepts
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Cannot build upon previous knowledge (scaffolding)
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Low test scores
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Communication:EnglishMathSocial StudiesScienceElectivePE
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No concerns
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Articulation: Difficulty saying sounds of words
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Fluency: Hesitations, word repetitions, stuttering
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Vocal Quality: Speaks too softly; speech lacks typical intonation
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Receptive Skills: Struggles to understand what is said to him/her
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Expressive Skills: Has difficulty putting thoughts into words to convey information clearly and accurately
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General: It is difficult to understand him/her
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Motor SkillsEnglishMathSocial StudiesScienceElectivePE
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No concerns
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Fine Motor: Poor or incorrect use of writing utensils
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Fine Motor: Difficulty holding objects
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Gross Motor: Uncoordinated or is clumsy
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Gross Motor: Poor balance, trips, falls
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Gross Motor: Skills not equivalent to typical peers
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Work Habits: In ClassEnglishMathSocial StudiesScienceElectivePE
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No concerns
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On Task: Has difficulty focusing, maintaining attention, and/or is easily distracted
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Inconsistent Effort: needs re-direction/teacher prompting to complete work
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Following Directions: Needs frequent repetitions, forgets previously taught procedures
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Independence: Has difficulty starting/completing in-class work, needs frequent re-assurance
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Organization Issues impact work completion/quality of work
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Work Habits: HomeworkEnglishMathSocial StudiesScienceElectivePE
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No concerns
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Completion: Student has not turned in most homework assigned during this grading period
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Completion: Student has some missing/late homework
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Completion: What homework has been turned in has been incomplete
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Quality: Work is not neat, not well-organized
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Mastery: Work does not reflect grasp of concepts
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Interacting with OthersEnglishMathSocial StudiesScienceElectivePE
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No concerns
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Group Work: Does not work well in groups
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Discussion: Does not appear to listen to others and/or let others speak
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Argues: Engages in arguments with adults and/or peers
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Respecting Others: Does not respect righs and property of others
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Taking Responsibility: Does not apologize for inappropriate behavior
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Other students respond negatively to him/her
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Behavior Select all that are concerns.EnglishMathSocial StudiesScienceElectivePE
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No concerns
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High activity level impacts learning
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Withdrawal: Avoids interacting/participating
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Does not follow classroom and school site rules
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Has difficulty demonstrating self-control
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Has difficulty managing emotions
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Other Concerns: Type below any additional concerns you have with regard to this student Example: Mrs. Smith/PE: Poor hygiene.
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English
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Math
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Social Studies
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