Child Study Information Sheet by xgreen


									**This is a 2-sided document Child Study Data Sheet Student Name: Grade: _________ Academic Areas: Please check all those that apply READING level is Experiencing difficulty in: ___Literal Comprehension MATH level is Experiencing difficulty in: ___Mental Computation WRITING level is Experiencing difficulty in: ___Spelling ____Grammar General Student Strengths: ___Enthusiastic ___Cooperative ___Creative ___Humorous Other information: ___Communicative ___Logical ___Considerate ___Friendly ___Can accept re-direction ___Participates in extra-curricular activities ___Demonstrates desire to learn ___Athletic ___On ___Below ___Above ___Letter Recognition ___Phonics ___Word Identification ___Interpretive Comprehension ___Applying skills ___On ___Below ___Above ___Number Recognition ___Counting ___Word Problems ___Applying skills ___Math facts Teacher Name: ___________________

___On ___Below ___Above ___Legibility ___Spacing ___Organization ___Punctuation/Capitalization ___Applying skills

Work Habits: ___Works independently ___Completes homework ___Has organization skills ___Completes in-class work Other information:

___Follows group directions ___Doesn’t turn in homework ___Work often incomplete ___Unorganized

___Works slowly, but accurately ___Works quickly & accurately ___Works quickly, but inaccurately ___Works slowly, but inaccurately

Social/Emotional Development: ___Well behaved ___Lethargic ___Usually follows rules ___Gets out of seat ___Easily frustrated ___Needs routine ___Daydreams ___Inconsistent class behavior Other information: Ability to Work with Group ___ Shows leadership ___ Works well in a group Other information: ___Unable to work alone ___Prefers to work alone

___Impulsive/speaks w/o permission ___Avoids tasks ___Interacts inappropriately w/ peers ___Does not follow class rules

___Unable to work with group

**This is a 2-sided document

**This is a 2-sided document

Reaction to Discipline ___ Accepts responsibility ___Verbal aggression Other information:

___Resists authority ___ Denies actions ___Physical Aggression

___ Blames others

Amount of Support Needed ___Works independently ___Needs teacher 1:1 Other information: Self Confidence ___Willing to try new things ___Not afraid to make mistakes Other information:

___Needs reminders often ___Needs directions repeated

___Needs much reassurance

___Poor self concept ___Afraid to try new things

___Unable to accept praise ___Sensitive to criticism

Other relevant information:

Please return to: _________________________ by: _____________________________________

**This is a 2-sided document

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