Teacher Input Form1213

For each child in your class that will be attending Palencia Elementary School, I would request that you complete the information below to assist us with placing each child with the most appropriate teacher. This information will only be shared with Palencia Administrative staff and your comments will remain confidential. Thank you for your assistance. Don Campbell


A red asterisk (*) indicates required questions.

  1. Please list the child's legal FIRST name.*


  1. Please list the child's legal LAST name.*


  1. Please list the grade level the child will be going INTO next year (I know this seems stupid that we should already know this but it populates an Excel file automatically for us if you can answer it here! Thanks!).*
    First Grade
    Second Grade
    Third Grade
    Fourth Grade
    Fifth Grade


  1. Please list the child's latest Thinklink Scale Score in READING.


  1. Pleae list the child's latest Thinklink Scale Score in MATH.


  1. How would you rate this child's behavior in the classroom.
    Very well behavior all of the time
    Well behaved most of the time.
    Some minor behavior problems during the year
    Needs constant redirection for behavior
    Serious behavior issues.


  1. How would you rate this child's CREATIVITY?
    Extremely creative
    Somewhat creative
    Not very creative


  1. How would you rate this child's LEADERSHIP abilities?
    A strong leader in our classroom.
    Can be a leader if given the chance.
    Sometimes shows leadership characteristics.
    More of a follower than a leader.


  1. How would you rate this child's motivation for learning?
    Highly motivated to learn.
    Somewhat motivated to learn.
    Occasionally motivated to learn.
    Not very motivated to learn.


  1. How would you rate this child's ORGANIZATIONAL skills?
    Very organized.
    Somewhat organized.
    Not very organized.


  1. How would you rate the parent support for this child?
    Very good parent support.
    Average parent support.
    Lacking consistent parent support.


  1. Are there any other children that you are aware of that should not be in the same classroom as this child?


  1. Are there any health or physical issues we should be aware of?


  1. Is there anything else you can tell us that would help placing this child with the most appropriate teacher next year? Thank you so much for completing this survey.


  1. Name of the person completing this survey.


  1. School where the child attended in 2011-12
    Mill Creek
    Ketterlinus
    Crookshank
    Bowles
    Cathedral Parrish
    St Joseph Academy
    Other





Mr. Campbell
Principal
Elementary
Saint Augustine, FL