GO Project Student Evaluation Student Name ______

GO Project Student Evaluation Student Name ______

GO Project Student Evaluation Form2018-2019

(To be completed by student’s teacher)

Name of Student: ______School: ______Grade:_____ OSIS:______

Name of Teacher: ______Teacher’s Email:______Date:______

Program Services Disclaimer:

• GO Project is UNABLE to provide:
• Behavioral or health paraprofessional services
• Intensive counseling services (e.g. long term individual counseling)
• Specific learning devices (e.g. FM Unit or iPad for AT support)
• Administration of medication during our Saturday Program
• Transportation services

1.What is the student’s attendance?

100-95% 94-90% 89-85% 84-80% Below 80%

2.On average, how often does the student arrive on time (per week)?

Almost every day 2-3 times a week Once a week Never

3.Did you meet with the student’s parents for parent-teacher conferences?

Fall Winter Spring Multiple None N/A

4.Is the child currently promotion in doubt?(If yes, please circle the reason for PID)

Yes (Academic/Attendance/Both) No

5.Has the child repeated a grade? If so, what grade year? Yes No (Year)______

6.What is the child’s academic placement? General Ed ICT 12:1 12:1:1 Other______

7.Does the student have an IEP? Yes No In Process

1. If yes, what is their classification?

Learning Disability Speech and Language Impairment Other Health Impairment

Autism Emotionally Disturbance Other: ______

1. What related services is the child receiving?

Speech OTPT Counseling Adaptive PE SETSS

1. What additional accommodations does the child currently receive? (Formally or Informally)

Visual Schedule Visual Cues Behavior Chart Modified Classroom Assignments

Noise Cancelling Headphones Paraprofessional (Health) Paraprofessional (Behavior)

Assistive Technology FM Unit Other ______

8.If the student receives ELL services at school, what is their proficiency level?

Beginner Intermediate Advanced N/A

9.What is the child’s current reading level (Fountas & Pinnell)?______Date assessed:______

10.Has this student received any disciplinary action this year? Yes No

1. If “Yes”, what type of disciplinary action? (Please check all that apply)

Classroom Removal (When: ______) Principal Suspension (When: ______)

Superintendent Suspension (When: ______) Early Dismissal (When: ______)

Please use the following rating scale to answer the question below:

1 – Far below grade-level standards
2 – Approaches grade standards
3 – Meets grade-level standards
4 – Exceeds grade-level standards

Social Emotional Progress

Behaviors and Mindsets / Rating
(Use Evaluation Key) / Overall Rating
Self-Regulation / Self-Regulation
Is able to successfully transition in the classroom
Waits patiently to be called on or to participate
Follows classroom rules and routines
Confidence & Persistence / Confidence & Persistence
Demonstrates confidence
Shows initiative and self-direction
Seeks and accepts challenges
Seeks help when needed
Willing to attempt new strategies to complete tasks
Interpersonal (Social competence) / Interpersonal (Social competence)
Works collaboratively
Actively listens to peers and adults
Resolves conflict without becoming aggressive
Is thoughtful (empathetic) of peers feelings
Academic/Classroom Behaviors / Academic/Classroom Behaviors
Uses time productively
Maintains attention
Actively asks and answers questions
Completes assignments within allotted time
Completes homework (for public schools only)

Academic Progress

Academic Subject / Rating
(Use Evaluation Key) / Overall Rating
Reading / Reading
Reads and comprehends texts on his/her independent reading level and demonstrates understanding through talk and writing.
Demonstrates comprehension of grade – level texts read aloud through talk and writing.
Demonstrates mastery of grade-level standards in reading
Writing / Writing
Writes independently for different tasks, purposes, and audiences appropriate for grade level
Writing demonstrates the characteristics of a grade level text in structure and development.
Writing demonstrates knowledge and use of grade-level specific writing conventions (spelling and punctuation).
Mathematics / Mathematics
Demonstrates mastery in problem solving grade-level math tasks/ problems
Usesefficient grade level strategies and represents thinking clearly.

The GO Project works with students who are performing below grade level in at least one academic area and who can make the commitment to Saturdays Summer programming. Classes are small with no more than 15 students in a class, a Head Teacher, and 3-4 trained volunteers.

With this in mind, please provide more detailed information on the following, paying particular note to the areas above which were marked 1 or 2:

Academic Needs:
Social-Emotional/Behavioral Needs:

Thank you for taking the time to complete this form!

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