Regular Education Teacher Input Form to the IEP Team - AJL

Please fill out this survey to help describe how this student is functioning in your class. For privacy reasons please do not use the student's name. You may use initials.

Name


What kind of support does this student receive in your classroom?
learning support teacher is in the classroom
educational assistant is in the classroom
no support in the classroom


In my classroom, this student can work in a large group.
  1 2 3 4 5  
Strongly agree   Strongly disagree


Provide any comments that you feel help explain your choice for the above question.


In my classroom, this student can work in a small group.
  1 2 3 4 5  
Strongly agree   Strongly disagree


Provide any comments that you feel help explain your choice for the above question.


In my classroom, this student follows directions given orally.
  1 2 3 4 5  
Strongly agree   Strongly disagree


In my classroom, this student follows written directions.
  1 2 3 4 5  
Strongly agree   Strongly disagree


In my class, this student maintains attention.
  1 2 3 4 5  
Strongly agree   Strongly disagree


Provide any comments that you feel help explain your choice for the above question.


In my class, this student completes assignments on time.
  1 2 3 4 5  
Strongly agree   Strongly disagree


Provide any comments that you feel help explain your choice for the above question.


In my class, this student follows the classroom rules.
  1 2 3 4 5  
Strongly agree   Strongly disagree


In my classroom, this student interacts appropriately with peers.
  1 2 3 4 5  
Strongly agree   Strongly disagree


In my classroom, this student responds appropriately to authority.
  1 2 3 4 5  
Strongly agree   Strongly disagree


In my classroom, this student tolerates frustration.
  1 2 3 4 5  
Strongly agree   Strongly disagree


Provide any comments that you feel help explain your choice for the above question.


What do you see as this student's strengths?


What do you see as this student's instructional needs?


List any strategies that have been successful for this student in your classroom.


Do you have any other suggestions or input for the IEP team?





Doylestown, PA