Educational Interpreter Input Form

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This form is used to collect the Educational Interpreter's observations of the D/deaf/hard of hearing student's use of interpreting services and communication strategies.

Source: Katherine McMullen, Lead Educational Interpreter, Lynchburg City Schools. Questions may be directed to her at kmcmullennic@gmail.com.

Student's Name

Name of TODHH

TODHH's email

Name of Educational Interpreter

Educational Interpreter's email

Do you work with a team?

Yes

Clear selection

Who is the team interpreter?

Please list all subject's you provide interpreting services for this student.

EXPRESSIVE LANGUAGE: Please describe the student's current expressive language preferences.

RECEPTIVE LANGUAGE: Please describe the student's current receptive language preferences.

Please describe the student's general communication effectiveness with peers, staff, interpreter, etc.

If the student does not understand classroom instruction or an assignment, what do they typically do?

Please select all that apply.

Ask you (the interpreter) for clarification or repetition.

Raise their hand and ask the teacher.

Nothing.

Other:

Clear selection

If "Other" was selected, please elaborate.

When presented with new signed content vocabulary, the student:

Please select all that apply.

Needs frequent repetition to recall.

Will spontaneously (without prompting) use the signed vocabulary within 2-3 exposures.

Does not remember/use new signed vocabulary.

Other:

Clear selection

If "Other" was selected, please elaborate.

Student's receptive communication (with educational interpreters)

I am unsure of what the student understands (no feedback)

The student 'appears' to understand (e.g., nodding, maintaining eye gaze, saying 'yes', etc.) but they struggle when it comes time for independent work.

The student understands nearly everything being presented and can answer questions about what has been presented in ASL correctly, without prompting or expansion.

Other:

Clear selection

If "Other" was selected, please elaborate.

Student's expressive communication (when the student signs):

The student does not demonstrate language to express their thoughts/grade level concepts

The student needs extensive support to express their thoughts because they omit important details or have significant vocabulary deficits(i.e, time of an event, etc.)

The student signs near grade/age level but requires some prompting or additional questions for more details or vocabulary support

The student has language to clearly express all of their thoughts/grade level concepts without the need for clarification

Other:

Clear selection

What level of message modification (simplification of language/concepts, extensive use of expansion and/or compression techniques, frequent repetition) during spoken instructions does the student need to effectively access SPOKEN instruction?

Consistent, significant message modification is required for comprehension.

Moderate amounts of message modification is required, especially during new, unfamiliar topics.

Minimal or language/age appropriate amount of message modification is required for message comprehension.

Other:

Clear selection

What level of message modification (simplification of language/concepts, extensive use of expansion and/or compression techniques, frequent repetition) does the student need to effectively access WRITTEN instruction or assignment?

Consistent, significant message modification is required for comprehension.

Moderate amounts of message modification is required, especially during new, unfamiliar topics.

Minimal or typical language modification is required for message comprehension.

Other:

Clear selection

Does the student initiate conversation/communication with peers (spoken or by using interpreter)?

Yes

Unsure

Clear selection

Does the student initiate conversation/communication with teachers and staff (spoken or by using interpreter)?

Yes

Unsure

Clear selection

When the student does NOT understand instruction or needs assistance, the teacher is informed:

Immediately

After class

That is left up to the student

If I am asked by the teacher

Depends on the class (please explain in next question)

Clear selection

If you answered "Depends on the Class" , please elaborate:

Does the student demonstrate they are ABLE to effectively utilize the services of an interpreter to access academic content and social interactions?

Consistently

Most of the time

Sometimes

Occasionally

Never

Other:

Clear selection

If you selected NEVER or OTHER please elaborate

How often does the student utilize the services of the interpreter to access academic content and social interactions?

Consistently

Most of the time

Sometimes

Occasionally

Never

Other:

Clear selection

If you selected NEVER or OTHER please elaborate

Please list any other concerns that you have for this student or how they access content.

Submit

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