Teacher Rating of School Behaviors and Attitudes

TEACHER RATING OF STUDENT ACADEMICS,

BEHAVIORS AND ATTITUDES

Please complete this survey on (student’s name) and return it to , PASS staff by ______(deadline date). Thank you.

The information will become part of the student’s confidential PASS file.

Teacher’s name: Date:

How long have you worked with this student:

£ Less than 1 year £ 1 year £ 2 years £ 3 years £ 4 or more years

In the table below, please rate the student’s math and reading skills level on a scale of 1-to-10 upon intake into PASS and again upon discharge from PASS (e.g., 1=poor ® 5=fair ® 10=excellent).

Student’s Academic Improvement / Pass Intake / Pass Discharge
Math Skills
Reading Skills
Please rate the areas below according to how much it interferes with the student’s ability to succeed in school. Please add any areas that are not included that are a problem for this student: / Never a problem / Sometimes a problem / Frequently a problem / Always a problem
Attendance
Attitude towards school
Interactions with peers
Interactions with teachers
Motivation to please teacher
Motivation to accomplish school work
Please rate the following areas according to whether or not this is a strength for the student and add any that are not mentioned. / Always a strength / Frequently a strength / Sometimes a strength / Not a strength
Leadership skills
Personal problem solving skills
Communicates clearly orally
Communicates clearly in writing
Empathizes (cares for) with others
Creative
Follows directions well
Positive attitude towards school
Other:
Other:
What are two strengths (positive things)
about this student: / What are two areas you feel this student
needs to work on:
1.
/ 1.
2.
/ 2.

Can we share these with the student? £ yes £ no