Teacher Comment Form

Thank you for participating in your student's assessment process. This forms contains questions about your student's academic, social, and behavioral functioning. Please share your observations, insights, and and opinions so that we have a solid understanding of the student's strengths and weaknesses in the school environment.

If you have questions about this assessment, or if you wish to speak with Dr. Greenfield directly, please contact our office at 321-345-9809 or info@DrGreenfield.com.

Please note: Your responses to these questions may be used in this student’s final assessment report, unless I receive communication from you directly requesting otherwise.

Today's Date

Student's full name

Your full name

Grade level / subject taught

How long have you known this student?

Is this student enrolled in your class currently?

Describe the student’s strengths:

Describe the student's challenges / your main concerns. Are there any specific cognitive, behavioral, or academic skills that you have concerns about or want evaluated to ensure appropriate progress is being made?

Provide examples of times when the student’s limitations impacted their performance at school:

In your opinion, how will the student’s limitations impact their future academic performance and/or ability to access the curriculum?

Does this student have difficulty understanding the language in assigned grade-level readings? If so, please write a brief explanation and/or example below:

Does the student have difficulty summarizing or repeating what they have read in their own words?

There are many cognitive processes that are involved in mathematics. What specific difficulties has this student demonstrated in math or when reasoning with quantitative information? (Use examples when possible)

Does this student struggle to express age-appropriate ideas on paper? (e.g., ability to create complex sentences, organize essays, use appropriate grammar and spelling, use strong and meaningful diction)

Please comment on the student’s ability to manage their time and tasks efficiently:

Does the student frequently take longer than their classmates to finish tasks/tests, miss due dates, and/or ask for extensions on assignments? Give specific examples of your observations:

Comment on any behaviors related to distractibility, impulse control, concentration, or sustained attention. (e.g., walking around during class; “tuning out,” off-task behavior)

Have you found any specific strategies particularly helpful when working with the student?

How does the student handle adversity in the classroom? (e.g., earning a poor grade, feeling lost during a lecture, failing to keep pace with peers, or experiencing rejection or conflict with classmates)

How is this student functioning socially in the school setting? (e.g., making/keeping friends, participating in social interactions, working in groups, managing conflict, displaying good sportsmanship, etc.)

Describe their socioemotional strengths/weaknesses, including specific functional consequences : (example: signs of worried thinking/anxiety, low self esteem, and declining mood impact her concentration in class, and their communication with peers.)

Have you observed this student engaging in any repetitive, compulsive, unusual, or “comfort” behaviors? If so, please describe each behavior in detail, including the estimated onset date, frequency, and severity.

Other comments or questions for Dr. Greenfield:

Please upload any relevant documents for review as a part of this assessment. For example: previous academic evaluations or service notes; narrative report cards; FAST/iReady reports; or informal student writing samples, etc...

Thank you again for your time and participation!