TEACHER INPUT

FORM I
I-1
Student Name: Alex Martin Grade: 7
Teacher Name: Karla Wojtas/Cody Liverance Subject: Social Studies
1. Do you have any concerns about this student? Yes No
If yes, please specify the type of concerns below:
Academic concerns (please describe):
The only concern I have with Alex is that he rarely completes his work, whether it be in class or
something he was supposed to do on his own time. I am not always sure whether or not he
understands the material as he almost never asks questions or has any sort of dialogue that relates
to what we are doing in class. He also asks to leave class frequently (bathroom, go to his locker,
etc.) and I am not entirely sure why that is.
Behavioral concerns (please describe):
Alex is a nice boy and I usually have no major behavioral problems with him, just reminding him
to stop talking or get to work when he is supposed to. While I do this slightly more frequently
with Alex than I do with other students, it has not inhibited his or others learning in any major
ways from what I have seen.
Other concerns (please describe):
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2. Please list any accommodations, interventions, or strategies you have used to address the
above concern(s) and indicate how the student responded to the intervention.
Again, just reminding Alex to stop talking and get to work is the most that I usually do. He
usually responds well to being told not to talk, but when I say get to work, that does not seem to
resonate with him and even if it does, he is usually behind because he did not start working
immediately.
3. The students current grade in class is: F (25%)
4. Would the student have earned this grade without the accommodations, interventions, or
strategies you used to address the concern(s)? Yes No
5. Additional comments:
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Cody Liverance Date: 3/10/16
Teachers Signature
TEACHER INPUT