Student Evaluation Form

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Please give as much information and data as you can. The more date we are able to collect, the better the evaluation will be. Anything that is not known leave blank.

After the information is received, you will be contacted for a follow up zoom interview.

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Student Name

Age

Grade

Option 1

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Has student been retained in any grade?

yes

No, but there was discussion about it

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3rd grade Math EOG score (give as much info as you can. Percentile student ended with, level)

4th grade Math EOG score (give as much info as you can. Percentile student ended with, level)

5th grade Math EOG score (give as much info as you can. Percentile student ended with, level)

Give any other EOG data for any other grades, not listed (7th grade, 8th grade)

Give any other data you may have from other testing done in or out of school (Iowa skills, another state test, an end of year math test made by the teacher, etc)

Generally, what are your child's grade each year for their academic classes?

Straight As or mostly straight As

As and Bs, maybe a C

Mostly Cs

Passing

Not passing or mostly not passing

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Does your child have a diagnosis of any kind of disability? if so, what is it?

Do you suspect your child has a disability of some kind but is not clinically diagnosed? if so, what do you suspect?

Does your child play sports on 1 or more athletic team?

yes

no, but has before

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Does your child generally like school?

yes

some years yes, some years no

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Does your child know how to play chess or any other strategic board games?

yes

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How would you rate your child's independence?

Great! They can get up, pack their lunch, and complete all work without being told

Good! I have to help with them with some items, but generally they do a good job

OK. They can do some things on their own, but I am checking behind them often

Not good. They are not independent

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Has your child ever experienced sexual abuse or been exposed to inappropriate sexual exposure? (Feel free to explain as much or as little)

Enviar

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