Social Skills & Impulse Control Group Pre-Survey X Tom ay “ Date:_1/ 1/2015 teacher, Ms. Smith a rade:_‘t Based on your observation of the student’s behavior in the classroom. Rate his or her skills on a scale from 1 to 5. Student: Circle 1 if the student is almost never good at using the skill. Circle 2 if the student is rarely good at using the skill. Circle 3 if the student is sometimes good at using the skill. Circle 4 if the student is often good at using the skill. Circle 5 if the student is almost always good at using the skill. 1) Does the student wait his/her turn before speaking? @2345 2) Does the student ignore classroom distractions? 12@45 3) Does the student join a group on his/her own? © 4) Does the student solve conflicts with peers independently? @2345 5) Does the student listen to his/her teacher without talking to a neighbor? 12@45 6) Does the student interact positively with his/her peers? 12@45Social Skills & Impulse Control Group Mid-Survey Xv Mu Student:_ Tomy pate:_2/5/15 Teacher:_ \ Ms, ents Grade‘ Based on your observation of the student's behavior in the classroom. Rate his or her skills on a scale from 1 to 5. Circle 1 if the student is almost never good at using the skill. Circle 2 if the student is rarely good at using the skill. Circle 3 if the student is sometimes good at using the skill. Circle 4 if the student is often good at using the skill. Circle § if the student is almost always good at using the skill. 1) Does the student wait his/her turn before speaking? 2) Does the student ignore classroom distractions? 3) Does the student join a group on his/her own? 4) Does the student solve conflicts with peers independently? 5) Does the student listen to his/her teacher without talking to a neighbor? 6) Does the student interact positively with his/her peers?Social Skills & Impulse Control Group Pre-Survey Way” suden_ Hre pate_1/1/ 2015 Teacher:. \\ a Grade: Mg, Suit Based on your observation of the student's behavior in the classroom. Rate his or her skills on a scale from 1 to 5. Circle 1 if the student is almost never good at using the skill. Circle 2 if the student is rarely good at using the skill. Circle 3 if the student is sometimes good at using the skill. Circle 4 if the student is often good at using the skill. Circle 5 if the student is almost always good at using the skill. 1) Does the student wait his/her turn before speaking? 12@45 2) Does the student ignore classroom distractions? @2345 3) Does the student join a group on his/her own? 1@345 4) Does the student solve conflicts with peers independently? 345 5) Does the student listen to his/her teacher without talking to a neighbor? 1@345 6) Does the student interact positively with his/her peers? 12@45Social Skills & Impulse Control Group Mid-Survey un” student:_ Mine ‘eacher:. ° ene Ms, Guith “ Grade:. 5 pate_ 3/5/15 Based on your observation of the student's behavior in the classroom. Rate his or her skills on a scale from 1 to 5. Circle 1 if the student is almost never good at using the skill. Circle 2 if the student is rarely good at using the skill. Circle 3 ifthe student is sometimes good at using the skill. Circle 4 if the student is often good at using the skill. Circle 5 if the student is almost always good at using the skill. 1) Does the student wait his/her turn before speaking? 2) Does the student ignore classroom distractions? 3) Does the student join a group on his/her own? 4) Does the student solve conflicts with peers independently? 5) Does the student listen to his/her teacher without talking to a neighbor? 6) Does the student interact positively with his/her peers?Social Skills & Impulse Control Group Pre-Survey Student:_ SSanes” pate:_/Z, He 4 Teacher. * Mp, Tayler Grade:_‘t Based on your observation of the student's behavior in the classroom. Rate his or her skills on a scale from 1 to 5. Circle 1 ifthe student is almost never good at using the skill. Circle 2 if the student is rarely good at using the skill. Circle 3 if the student is sometimes good at using the skill. Circle 4 if the student is often good at using the skill. Circle 5 if the student is almost always good at using the skill. 1) Does the student wait his/her turn before speaking? 12@45 2) Does the student ignore classroom distractions? 12@)45 3) Does the student join a group on his/her own? 123@5 4) Does the student solve conflicts with peers independently? 123(5 5) Does the student listen to his/her = teacher without talking to a neighbor? 123)s 6) Does the student interact positively with y= his/her peers? 12 3G@)5