Teacher Forms for School Intervention Team Francis Lewis HS Teacher Report for School Intervention Team The School Intervention Team is in the process of determining the needs of the student named in the SUBJECT FIELD of the email you received. Your input is a vital part of our assessment. Fields marked with an * are required. Please complete this form and hit SEND ASAP. A copy will be automatically emailed to you upon submission. This form becomes part of the official record. Thank you, in advance, for your interest and involvement. Dr. Robert Kassoff / Lindsey Kretzmer / Annette Palomino, APG / Dr. David Marmor THIS SHOULD ONLY TAKE ABOUT 5-7 MINUTES TO CLICK THROUGH !! Teacher/Student InformationDate *Submitted OnStudent *First LastTeacher Name *First LastMy School Email Address *Insert your email name in the beginning of the fieldSubject Class *Subject NamePeriod *Per 1Per 2Per 3Per 4Per 5Per 6Per 7Per 8Per 9Per 10Per 11Student's Guidance Counselor Email *Enter the email address of the student's guidance counselor (GC name is displayed in Skedula at top of student screen) Attendance PracticesClass Attendance *Check all that applyregularly attendssome absencefrequent absenceoften latesometimes lateoveruses passusually has absence notesusually does not have absence notesnever attended Academic CharacteristicsClass GradesCurrent Grade Number (##) or Letter (A)Predicted Performance *How will student do, based upon work so far, for the semester.please click for a choicewill pass classpassing in doubtcurrently will fail classcannot predictinadequate attendance - cannot determineRecent Test/Quiz grades Performance StylesClass Participation *check all that applywill answer if called uponvolunteers (raises hand)engages in class discussionscontributions relevant to discussionsconnects current topics to prior learningconnects current topics to personal experiencegoes to the boardeager to learnresists participation even when promptedwill participate if encouragedinadequate attendance - cannot determineThis student's understanding of their personal strengths and deficits is please click for a choicegoodfairpoorcannot determineThis student's overall test taking skills are *please click for a choicegoodfairpoorcannot determineUse of Testing Accommodations *Check all that apply to describe how they utilize any allowed accommodationsNO PERMITTED TESTING ACCOMMODATIONSALWAYS utilizes permitted testing accommodationsSOMETIMES utilizes permitted testing accommodationsNEVER utilizes permitted testing accommodationsMOSTLY utilizes permitted testing accommodationsDOESN'T have any testing accommodationsWhen using accommodations, only uses some of themWhen using accommodations, uses all of theminadequate attendance - cannot determinenot enough tests yet to determineTest Taking Style *check all that applydemonstrates functionally limiting test anxietydoes better with multiple choicedoes better with short answerworks appropriatelyworks carelesslykeeps pace with classmatesworks quicklyworks slowlyhas not taken enough tests to determineinadequate attendance - cannot determineComments on Testing Accommodations Utilization optionalThis student's computer skills are *please click for a choicegoodfairpoordon't knowThis student's response to constructive criticism is *please click for a choicegoodfairpoorcannot determineAssistance *requests assistance when neededresists assistance when offeredaccepts assistance when offeredcannot determineTeam Teacher/Paraprofessional Assistance When this student accesses the assistance of the additional staff during class, they?NO PARA ASSISTANCE IS AVAILABLE IN THIS CLASSROOMNO TEAM TEACHER IS AVAILABLE IN THIS CLASSROOMaccept it willingly.avoid contact.rely much too heavily on the para/team teacher.expect the para/team teacher to do the work for them.HomeworkCompleted *please click for a choicealways done (100%)frequently handed in (75%)frequently not handed in (50%)mostly not handed in (25%)almost never handed in (0%)cannot determineTimeliness *please click for a choiceon-timesometimes latealways latecannot determineAccuracy *Check all that applycompletepartially donecorrectfrequently incorrectadequate amountmarginal amountinadequate amountmakes up missing homeworkcannot determineExecutive FuntionTime Management check all that applydemonstrates adequate planning skillspossesses good time management skillsrequires reminders to keep up with workoften runs out of time in classworkoften runs out of time on tests/quizzescannot determineThis student's focus *please click for a choiceis almost always on taskneeds some redirectionneeds frequent redirectionneeds constant redirectioncannot determineIs backpack/bookbag generally neat? *please click for a choiceyesnodon't knowMaterials are organized on desk *please click for a choiceyesnoinadequate attendance - cannot determineStudent comes prepared to class *please click for a choiceyesnoonly sometimesinadequate attendance - cannot determineNotebook is organized *please click for a choiceyesnomarginaldon't knowWhen work is difficult, this student demonstrates *please click for a choicegood frustration tolerancefair frustration tolerancepoor frustration toleranceinadequate attendance - cannot determine Social / Behavior / EmotionalSocial *check all that applyworks well with othersprefers to work aloneinteracts well with classmatesinteracts poorly with classmatesinteracts well with teacherinteracts poorly with teachercannot determineNarrative description of social style Optional - but desiredBehavior *check all that applyfollows rulesignores rulesbehavior is easy to managebehavior is difficult to manageresponds well to limit settingresists limit settingcannot determineNarrative description of behavior style Optional - but desiredEmotional check all that applymood is generally appropriate to situationmood is generally inappropriate to situationstudent is over-reactive to situationsstudent is under-reactive to situationsstudent is generally sadstudent is generally happystudent appears "disconnected" to othersmood appears flatcannot determineNarrative description of Emotional style Optional - but desired Subject Area ProficienciesESTIMATE FUNCTIONAL GRADE LEVELS FOR THE FOLLOWING SKILLS (IF APPLICABLE TO YOUR SUBJECT/KNOWLEDGE OF THE STUDENT)Math (Functional Grade Level enter a #)Math Concepts Functional Grade LevelMath computation (w/calculator) Functional Grade LevelMath computation (w/o calculator) Functional Grade LevelGeneral Algebra Skills Functional Grade or Competency levelGeneral Geometry Skills Functional Grade or Competency levelGeneral Trigonometry Skills Functional Grade or Competency levelGeneral Math Level optionalwell below grade level1-2 years below grade levelon grade level1-2 years above grade levelwell above grade levelNarrative Description of Math Skills Optional - Please Include Functional Grade EstimateReadingDemonstrates Reading DEFICITS in check all that apply. If not checked that area will be considered adequate.phonemic awarenessdecoding isolated wordsdecoding words in sentencesfluent sentence readingreading comprehensioncannot determineReading Comprehension (Functional Grade Level enter a #) Reading Decoding (Functional Grade Level ##) General Reading Skills optionalwell below grade level1-2 years below grade levelon grade level1-2 years above grade levelwell above grade levelNarrative Description of Reading Skills Optional - Please include functional grade estimateWritingWriting / Spelling Check all that applyspells phoneticallyknows irregular wordsuses dictionary competentlyuses thesaurus competentlycan create a sentence w/ correct punctuation and grammarsentences are short and declarativesentences are compoundcannot determineGeneral Writing Skills optionalwell below grade level1-2 years below grade levelon grade level1-2 years above grade levelwell above grade levelNarrative Description of Writing / Spelling Skills Optional Final Comments for School Intervention Team / Work Sample UploadAny Other Comments for the School Intervention Team Work Sample Optional - you may upload a file using this link. (pdf, jpg, gif, png) Verification - PRESS SUBMIT ONLY ONCE !!! and wait for responsePlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
