STUDENT CHECK

Student__________________________ Teacher________________________
Subject(s)______________________________________ Date:____________
Dear____________________________,
Since____________________________ was retained last year, I am checking
on him/her, hoping that similar problems do not reoccur. Please complete this form
and return it to me as soon as possible. Thank you for helping this child have a
successful year!
Thank you,
[Your name]
------------------------------------------------------------------------------------------------Please check all of the statements below that apply to______________________.

Completing most homework assignments

Completing most work in class
Currently passing
Not currently passing
Smiles sometimes and acts happy
Acts bored
Decreased concentration
Not prepared for class
Have had communication with parents
Needs instruction in study skills and/or organization
Requests a meeting with the counselor

Comments:_______________________________________________________
_______________________________________________________________
_______________________________________________________________
Grading period (please circle)

Current grades: Math_____ English_____ Reading_____

Social Studies

3
Science_____