Teacher Input Form Section 504

Date

2/22/16

Stude
nt
Teach
er

TZiah Crawford
Long

Quarte 3
r
Grade 11
Subjec
t

English III

1. What strengths does this student exhibit in your class?

He seems to do his well on the work that he completes, to ask questions when
necessary, and to focus on assignments.
2. What is the students current grade in your course/class?
42
3. Please check all the factors that may account for the students current grade if
the student is performing below expected grade level:

Missing Assignments
Failure to Participate
Excessive Absences/ Tardiness

Late Assignments
Inappropriate behavior

4. List assessment results that also may be affecting this students performance
(ie: MAP testing, classroom assessments or tests, BOG testing, etc):
Unit Test and vocab
5. What challenges does this student exhibit in your class?
Making up work and finishing class work
6. Has the student demonstrated a consistent need for substantially more to
complete homework assignments than is required by non-handicapped
students?
No
7. Has the student demonstrated a consistent need for substantially more to
complete in-school assignments than is required by non-handicapped
students?
no
8. Is modified testing consistently necessary for the student to be able to
demonstrate knowledge?
No, although I do offer Tziah as well as several other students alternate
assignments to assess knowledge.
9. Does this student have testing accommodations? Yes No If yes, please
list:

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10.
List modifications or accommodations that this student utilizes regularly in
class:
n/a
11.
Are there any accommodations or modifications that the student regularly
declines or refuses to use?
n/a
12.
Please list any accommodations or modifications that you have
implemented on behalf of this student that is not listed on their plan:
I offer alternate assessments, and for Tziah especially separate setting even
though it is not listed in his plan. He has some issues focusing. I send him next
door to Mrs. Smith normally because it is her planning.
13.
Does the student exhibit significant difficulty with planning, organization
and execution of school-related activities and assignments?
He needs to make up the work that he missed from first week of school. They
are mostly papers that need to be signed for graduation project. I am not sure
about his organization, just lack of focus at times.
14.
Are there other indications that this students physical or mental
impairment substantially limits his learning?
no
15.
After intervention strategies have been implemented in regular education
does the student still exhibit significant learning difficulties?
no
16.
Are you using alternative teaching strategies: reasonable but substantial
accommodations in instructional delivery methods?
yes
17.
Include any additional comments or information regarding the students
progress:
I think he will be fine. He needs to make up the work he missed from
the first week of school. Once he does that, his grade will improve
significantly. He also needs to spend more time studying for tests. I
have talked to him regularly about focusing in class, and he has done
much better lately, even taking the initiative to come to me and asking
me to change his seat closer to my desk.

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