Teacher Input Checklist

Teacher: Approximate Grade in your class:

Student:

Please check any/all that apply

* Strengths:

☐Attends class regularly ☐Communicates well ☐Punctual

☐Grasps concepts ☐Takes responsibility ☐Arrives to class prepared

☐Cooperates with peers ☐Self-Starter ☐Helpful to others

☐Participates in class ☐Well organized ☐Maintains good appearance

☐Completes assignments on time ☐Turns in assignments on time ☐Takes pride in accomplishments

☐Shows Leadership ☐Is very cooperative ☐Positively motivated

* Areas of Concern:

☐Disrespects teacher ☐Disrespects peers ☐Poor attendance (3 or more days)

☐Speaks at inappropriate times ☐Tardy regularly (3 or more) ☐Uses inappropriate language

☐Disorganized ☐Poor study skills ☐Disrupts learning environment

☐Low scores on class work ☐Conflicts with peers ☐Low scores on homework

☐Low scores on tests ☐Missing assignments ☐Often out of seat/wandering

☐Easily frustrated ☐Arrives unprepared ☐Missing homework

☐Gives up easily ☐Fails to ask for help ☐Achieves below ability

☐Has difficulty following instructions ☐Breaks classroom/school rules ☐Attendance/tardiness affecting

grade

Additional Comments:

Please send to D100 (Mr. Bowman)