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Teacher Questionnaire

Answer Required

Teacher Name*

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School*

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Subject(s) Taught*

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Student's Name*

Answer required for "Student's Name"

1. Academic Performance

How would you rate the student's overall academic performance in your class?*

Answer required for "How would you rate the student's overall academic performance in your class?"

Excellent (Exceeds expectations, consistently high scores)

Good (Above average, performs well with minimal assistance)

Average (Meets expectations, sometimes needs help)

Needs Improvement (Struggles with concepts, requires frequent help)

SIgnificantly Behind (Falling behind, needs significant support)

What are the student's academic strengths? (Check all that apply)*

Answer required for "What are the student's academic strengths? (Check all that apply)"

Strong reading comprehension

Critical thinking and problem-solving

Strong math skills

Creativity in assignments

Writing and communication skills

Memorization and recall

Other:

In what areas does the student need the most improvement? (Check all that apply)*

Answer required for "In what areas does the student need the most improvement? (Check all that apply)"

Reading comprehension

Writing skills (grammar, sentence structure, clarity)

Math concepts and problem-solving

Following directions and staying on task

Test-taking and study skills

Other:

Has the student's academic performance changed over time?*

Answer required for "Has the student's academic performance changed over time?"

Improved significantly

Slight improvement

Stayed consistent

Declined slightly

Declined significantly

If performance has changed, what do you think contributed to the change?

Answer required for "If performance has changed, what do you think contributed to the change?"

2. Grades & Assignments

How consistent are the student's grades on assignments and tests?*

Answer required for "How consistent are the student's grades on assignments and tests?"

Always high (90-100%)

Mostly good (80-89%)

Inconsistent (Varies between high and low)

Frequently low (Below 70%)

Does the student complete and turn in assignments on time?*

Answer required for "Does the student complete and turn in assignments on time?"

Always (Rarely misses a deadline)

Often (Misses 1-2 assignments per grading period)

Sometimes (Several missing/late assignments)

Rarely (Frequently late or missing work)

How well does the student follow instructions on assignments?*

Answer required for "How well does the student follow instructions on assignments?"

Follows directions carefully

Needs reminders but usually follows directions

Frequently misunderstands instructions

Often skips steps or doesn’t follow directions

How does the student respond to feedback or corrections?*

Answer required for "How does the student respond to feedback or corrections?"

Applies corrections and improves

Acknowledges feedback but struggles to apply it

Sometimes ignores feedback

Becomes frustrated or resistant to corrections

3. Attendance & Punctuality

How often is the student present in class?*

Answer required for "How often is the student present in class?"

Almost Always (0-2 absences per quarter)

Occasionally Absent (3-5 absences per quarter)

Frequently Absent (6+ absences per quarter)

Does the student arrive on time to class?*

Answer required for "Does the student arrive on time to class?"

Always on time

Sometimes late (1-2 times per month)

Often late (More than 2 times per month)

If attendance or punctuality is an issue, has it affected the student’s performance?*

Answer required for "If attendance or punctuality is an issue, has it affected the student’s performance?"

4. Participation & Engagement

How actively does the student participate in class discussions and activities?*

Answer required for "How actively does the student participate in class discussions and activities?"

Highly engaged (Frequently volunteers, asks questions)

Somewhat engaged (Participates when encouraged)

Rarely engaged (Needs frequent prompting)

Disengaged (Avoids participation)

How does the student handle independent work?*

Answer required for "How does the student handle independent work?"

Completes work efficiently and correctly

Works well but needs occasional guidance

Frequently needs assistance and reminders

Struggles to focus and complete work

How does the student interact in group activities?*

Answer required for "How does the student interact in group activities?"

Works well with peers and contributes effectively

Participates but needs guidance

Prefers working alone but completes tasks when required

Avoids group work or disrupts group activities

Does the student seek help when needed?*

Answer required for "Does the student seek help when needed?"

Yes, frequently asks for help when confused

Sometimes asks but often struggles alone

Rarely asks for help even when struggling

Refuses help, even when necessary

5. Behavior & Classroom Conduct

How would you describe the student’s behavior in class?*

Answer required for "How would you describe the student’s behavior in class?"

Excellent (Follows rules, respectful)

Good (Occasionally needs redirection)

Needs Improvement (Frequently off-task)

Disruptive (Regular behavioral issues)

Does the student interact respectfully with teachers and classmates?*

Answer required for "Does the student interact respectfully with teachers and classmates?"

Always

Most of the time

Sometimes struggles

Often disrespectful

How does the student handle corrections or discipline?*

Answer required for "How does the student handle corrections or discipline?"

Accepts responsibility and corrects behavior

Acknowledges but struggles to improve

Becomes defensive or frustrated

Ignores correction or repeats behavior

Does the student exhibit any of the following behaviors? (Check all that apply)*

Answer required for "Does the student exhibit any of the following behaviors? (Check all that apply)"

Talks out of turn frequently

Easily distracted or distracts others

Uses appropriate language and tone

Shows kindness and empathy toward peers

Engages in conflicts with classmates

Demonstrates leadership qualities

How does the student handle frustration or challenges?*

Answer required for "How does the student handle frustration or challenges?"

Demonstrates perseverance and problem-solving skills

Gets frustrated but attempts to work through it

Frequently gives up or shuts down

Becomes angry or disruptive

Have there been any behavioral concerns or disciplinary actions? If so, please describe:*

Answer required for "Have there been any behavioral concerns or disciplinary actions? If so, please describe:"

6. Communication

How well does the student express themselves verbally in class?*

Answer required for "How well does the student express themselves verbally in class?"

Clearly and confidently

Adequately but sometimes unclear

Struggles to articulate thoughts

Rarely speaks or avoids verbal communication

Does the student understand and follow verbal instructions?*

Answer required for "Does the student understand and follow verbal instructions?"

Consistently and accurately

Sometimes needs clarification

Frequently misunderstands instructions

Rarely follows verbal instructions correctly

How is the student’s non-verbal communication (e.g., eye contact, gestures, body language)? *

Answer required for "How is the student’s non-verbal communication (e.g., eye contact, gestures, body language)? "

Appropriate and engaged

Sometimes unclear or inconsistent

Frequently avoids or misuses non-verbal communication

Shows significant difficulty with non-verbal cues

Have you noticed any challenges with the student’s listening skills?*

Answer required for "Have you noticed any challenges with the student’s listening skills?"

Occasionally distracted

Attentive and responsive

Frequently inattentive or needs repeated directions

Consistently struggles to listen and comprehend

7. Motor

How is the student’s fine motor coordination (e.g., handwriting, cutting, using small objects)?*

Answer required for "How is the student’s fine motor coordination (e.g., handwriting, cutting, using small objects)?"

Excellent (Neat, controlled movements)

Good (Occasionally sloppy but functional)

Needs Improvement (Frequently struggles with fine motor tasks)

Significant Difficulty (Avoids or cannot perform fine motor tasks)

How is the student’s gross motor coordination (e.g., posture, balance, participation in physical activities)?*

Answer required for "How is the student’s gross motor coordination (e.g., posture, balance, participation in physical activities)?"

Strong and confident

Adequate but sometimes uncoordinated

Needs Improvement (Frequently awkward or clumsy)

Significant Difficulty (Avoids or struggles significantly with gross motor tasks)

Have you noticed any difficulties with the student’s stamina or physical endurance in class activities?*

Answer required for "Have you noticed any difficulties with the student’s stamina or physical endurance in class activities?"

No concerns

Sometimes fatigued or disengaged

Frequently tired or unable to sustain physical effort

Significant difficulty maintaining energy or participation

Does the student show any sensory sensitivities that might affect their performance (e.g., touch, sound, light)?*

Answer required for "Does the student show any sensory sensitivities that might affect their performance (e.g., touch, sound, light)?"

No concerns

Mild sensitivities but manages well

Noticeable sensitivities that impact participation

Significant sensory challenges requiring accommodations

8. Additional Comments

Do you have any other observations or recommendations for this student’s success?

Answer required for "Do you have any other observations or recommendations for this student’s success?"

Confirmation Email

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