Teacher Input Form1213OD

According to our records, you taught a child during the 2011-12 school year that will be attending the new Palencia Elementary School in St. Johns County next year. To help us place this child with the most appropriate teacher, we are asking that you complete the brief survey below. Thank you for your assistance and help. All information will remain confidential. Don Campbell, Principal


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.*
    Kindergarten
    First Grade
    Second Grade
    Third Grade
    Fourth Grade
    Fifth Grade


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


  1. Pleae list the child's latest Normed Reference 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. What kind of a teaching style would be best for 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. Name of the school where the child attended during 2011-12





Mr. Campbell
Principal
Elementary
Saint Augustine, FL