STUDENT OBSERVATION FORM
Student: ______________________________ Grade: ________ Date: ____________
Teacher: ______________________________ Observer: ___________________________
Time Observed:: _____________________________________
Subject: ______________________ Student to Staff Ratio: ______________________
Area of academic concern:
[ ] Oral expression [ ] Social Skills [ ] Written Expression [ ] Basic Reading Skill
[ ] Reading Fluency [ ] Math Calculations [ ] Math Problem Solving [ ] Behavior
[ ] Listening Comprehension
Appearance Relationship with teachers
Describe _________________________________ __ Cooperative
__ Withdrawn
Student’s Level of Activity __ Seeks attention
__ Hyperactive __ Needs individual attention
__ Appropriate __ Refuses to follow instructions
__ Lethargic/Tired
__ Other __________________________________ ehavioral concerns
B
__ Inappropriate vocalizations
Attention Describe _________________________________
__ Listens to instructions
__ Understands directions __ Repetitive motor movements
__ Able to stay on task Describe _________________________________
__ Easily distracted
__ Able to work independently __ Aggression
__ Understands concept presented Describe _________________________________
__ Staring blankly/daydreaming
__ Fiddles with objects __ Self-injurious behaviors
__ Doodling Describe _________________________________
__ Distracts other children
__ Avoids peer interactions
Effort/Motivation Describe _________________________________
__ Tries hard
__ Gives up easily Temperament
__ Careless in work __ Happy
__ Eager to please __ Depressed/withdrawn
__ Hesitant to begin working __ Angry/hostile
__ Apathetic/Indifferent __ Anxious
__ Works at reasonable pace __ Confused
__ Works slowly __ Easily upset
Relationship with peers Transitions/Movement
__ Works/plays alone __ Moves around room appropriately
__ Participates in group activities __ Starts new tasks
__ Interacts well with others __ Prepares materials for beginning/end off lesson
__ Hitting, poking, distracting peers Describe ________________________________
__ Initiates social interaction
__ Waits for others to initiate
Classroom Noise Level: much some little none
Movement in Classroom: much some little none
Detailed sequence of events that occurred during the observation:
