CENTER OF SPECIAL EDUCATION

S.N.D.T WOMEN’S UNIVERSITY

MUMBAI

Juhu Road, Santacruz (West), Mumbai – 400 049

“VISIT FORM”

Name of the Student-teacher:

Course:
Date:
Sr. No: Time: From ___________ To __________

A. Objective of the visit: To observe and appraise:

1. The children
2. The Activities
3. Teaching Technique Uses
4. Rapport and Interaction between the Teacher and the aught
5. Interdisciplinary Approach
6. Interdisciplinary Co-operation

B. Institution:

1. Name and Address: ________________________________________________________

_____________________________________________________________________________________
_____________________________________________________________________________________
______________________________________________

2. Timings of the Institution/ School: From ________________ To ____________________

________________________________________________________________________
________________________________________________________________________
3. Type: a) Ordinary/ Integrated/ Learning disabilities/ Speech Impaired/ Hearing Impaired/ Visually
impaired/ physically handicapped
(specify) _________________________________________________________________
b) Workshop/ School and Workshop

4. A) Private: 1) Aided by government 1: Local

2) Unaided 2: State

3: Central

B) Recognised/ Non-recognised : ______________________________________________

_______________________________________________________________________

5. Sated aims: _________________________________________________________________

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
 6. No of children: __________ Boys ______________ Age group __________________
Girls_______________ Age group _________________

7. Cumulative Record Maintained: Yes/ No

___________________________________________________________________________
___________________________________________________________________________

C. Physical setting

1. Area: Adequate/ Inadequate/ Spacious

2. Special Provisions for Special Children (Wherever Applicable, Ramps/ Hand Railings/ Toilets/Special Lighting/
Special Boards)

3. Special Furniture (Wherever Applicable) __________________________________________

___________________________________________________________________________
___________________________________________________________________________

4. Outdoor Provisions: a) Space Adequate/ Inadequate/ Spacious

___________________________________________________________________________
___________________________________________________________________________

5. Class Room and Teaching Material:

a) Quantity: _________________________________________________________________

b) Quality: __________________________________________________________________

c) Any Other (specify) _________________________________________________________

_________________________________________________________________________
_________________________________________________________________________

6. Therapy Rooms: Type Quality Quantity

a) Physiotherapy _____________________ _________________

b) Occupational ______________________ _________________

c) Speech _______________________ _________________

d) Any other _______________________ _________________

__________________________________________________________________________

7. Library rooms ______________________ _________________

8. Gymnasiums and Game Rooms ______________________ ________________

9. Auditorium _______________________ ________________

10. Workshop ________________________ ________________

_______________________________________________________________________________
_______________________________________________________________________________
 D. Personnel

1. Teacher (Academic) No. ________________________________________________________

Professional qualification ______________________________________________________

2. Non-Academic Teachers:

a. Music Qualification _____________________________________________

b. Craft Qualification _____________________________________________

c. Drawing Qualification _____________________________________________

d. Physical education Qualification _____________________________________________

e. Any other _________ Qualification ____________________________________________

____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

3. Therapists

Psychotherapists/ Social Workers/ Other Specialists (Specify)

Total no. of Specialists ____________________________________________________________

4. Number of Volunteers ___________________________________________________________

5. Teachers Aids ______________________________ Number _____________________________

6. Placement of Traniees:

Yes/ No Types _____________________ o. _______________ Total Number _______________

E. Daily Programme:

1. Curriculum: Regular/ Special

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2. Types of Activities: ______________________________________________________________

______________________________________________________________________________
______________________________________________________________________________

3. Special Emphasis: Communication/ Vocation/ Academic/ Any Other _______________________

______________________________________________________________________________

4. Interdisciplinary Approach: Yes/ No , Team ersonelle ___________________________________

_______________________________________________________________________________
F. Evaluation

1. Provisions: _____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2. Achievement of Aims: ____________________________________________________________

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

3. Effectiveness of ongoing Programmes: _______________________________________________

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

G. Remarks/ Comments: ______________________________________________________________

________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

H. Recommendations: _______________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________