Teacher Questionnaire
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FormEmailer StatusTimestampStudent:Person completing assessment:Relationship to student:1. Comphending oral instructions2. Understanding school and content vocabulary3. Reading and comprehending written material4. Comprehending and doing math problems5. Understanding and participating in class discussions6. Providing organized oral explanations and adequate descriptions7. Expressing ideas in written form8. Learning new material9. Recalling and applying previously learned material10. Applying problem-solving skills in class discussions1. Paying attention when spoken to directly2. Sustaining attention during play/sports activities3. Focusing long enough to finish assigned activity or task4. Refocusing to task when necessary5. Carrying out single-step instructions6. Carrying out multi-step instructions7. Waiting to take turns8. Changing from one activity to another without being disruptive9. Organizing own things or school materials10. Completing class/homework assignments11. Completing work accurately without careless mistakes12. Working without distracting self or others.13. Working at a reasonable pace/finishing on time1. Playing cooperatively with other children2. Making and keeping friends3. Seeking attention appropriately4. Expressing anger appropriately5. Asking permission appropriately6. Following rules (classroom, games, sports)7. Respecting/obeying adults in authority8. Relating experiences and telling stories9. Using language appropriate to the situation and listener10. Introducing and maintaining relevant and appropriate topics of conversation11. Taking turns in a conversation12. Interpreting meaning of facial expression, body language, hints, sarcasm13. Using adequate vocabulary and grammar to express thoughts/ideas in general everyday conversation1. Moving body from one place to another(e.g., standing balancing, shifting weight, bending, kneeling, crouching, walking, running, jumping, climbing)2. Moving and manipulating things (e.g., pushing, pulling, lifting, carrying, transferring objects, coordinating eyes and hands to manipulate objects)3. Demonstrating strength, coordination, dexterity in activities or tasks4. Managing pace of physical activities or tasks5. Showing a sense of body's location and movement in space6. Integrating sensory input with motor input7. Planning, remembering, executing controlled motor movements1. Handling frustration appropriately2. Being patient when necessay3. Taking care of personal hygiene4. Caring for personal needs (e.g., dressing, eating)5. Cooperating in, or being responsible for, taking needed medications6. Using good judgement regarding personal safety and dangerous circumstances7. Identifying and appropriately asserting emotional needs.8. Responding appropriately to changes in own mood (e.g., calming self)9. Using appropriate coping skills to meet daily demands of school environment10. Knowing when to ask for helpPlease enter an email to which you wish to send the results.
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Email not sent9/1/2012 22:52:19TestTestTeacher44543534532421142134224131111111324211221131211242121
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Email not sent9/1/2012 23:29:57TEST2TEST2Parent12345432123454321234543212345432123454321234543212345
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Email sent9/11/2013 10:53:09AMB Van RheenenTeacher24421143333112111111313111111211111111111113221222232bvanrheenen@gwaea.org
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Email sent10/13/2014 8:49:09Levi RossJulie LandrumTeacher22233432232222132332332244222222222211111113241112221jlandrum@sps.k12.ar.us
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Data
FormEmailer
Summary
ACQUIRING AND USING INFORMATION
ATTENDING AND COMPLETING TASKS
INTERACTING AND RELATING WITH OTHERS
MOVING ABOUT AND MANIPULATING OBJECTS
CARING FOR HIMSELF OR HERSELF