Teacher Feedback Form
It is time to complete either an IEP for the student  indicated in the email's subject line. As a professional who works with this student, it is very important that your input be included. Please answer the following questions regarding this student’s academic performance and feel free to add any additional information you feel may be relevant. It is very important that all areas are complete as this information is required in the IEP by law for educational decision-making.
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Students Name *
Please list your name and which class(es) you have this student. *
Please provide the student's most current grade(s). (If the student is failing, please include the number of missing assignments). *
Classroom-Based Data
Please provide as much specific data as possible. Responses such as, "I love having this student in class" are not adequate by themselves alone and must be included with objective data or specific observations. .
Please indicate the student's work habits *
Required
Please indicate the student's participation in class: *
Required
Please indicate the following social/emotional skills and traits" *
Excellent
Good
Fair
Poor
Not observed
Self-concept
Motivation
Peer Interaction
Please indicate the student's behavioral skills: *
Required
Does the student have any behaviors which adversely affect them in the classroom? If yes, please list behavioral interventions and strategies that you have tried or are currently using. *
Please indicate the student's concentration and attention: *
Required
General Classsroom Data: Additional Comments
Reading Skills- Complete if Applicable
Please answer to the best of your ability. Strengths include what the student CAN do regardless of whether it is at grade level.
Please indicate strengths and needs in reading:
Strength
Need
N/A
Student reads and understands class work/worksheets
Student reads and understands tests/assessments
Student is able to complete bookwork independently
Student decodes words fluently
Student recognizes high frequency words
Student reads grade-level text fluently
Student understands new vocabulary
Student determines the meaning of unknown words
Student identifies/produces antonyms, synonyms, homonyms, and rhyming words
Student identifies/produces homonyms, and rhyming words
Student recognizes elements of literature
Student identifies the main idea
Student identifies significant supporting details
Student sequences a series of events
Student predicts what will happen next
Student recognizes figurative language
Student identifies rhyme, rhythm, repetition, and/or poetry
Student recognizes different text structure (i.e compare/contrast, cause/effect)
Student asks relevant questions in order to comprehend text
Student is performing at grade level in the area of reading
Reading: Please list all accommodations you provide the student and whether they are effective
Reading: Additional Comments
Writing Skills- Complete if Applicable
Please answer to the best of your ability. Strengths include what the student CAN do regardless of whether it is at grade level.
Please indicate strengths and needs in writing:
Strength
Need
N/A
Student legibly records data
Student spells high frequency words correctly
Student uses a variety of word choices
Student uses a variety of sentence structures
Student uses correct conventions
Student uses pre-writing strategies
Student clearly identifies and narrows a topic
Student writes a thesis statement
Student uses organizational patterns (i.e. beginning/middle/end, introductions, etc)
Student includes relevant details to support main idea
Student effectively writes a multi-paragraph essay
Student uses appropriate voice for situation and audience
Student expresses writing using content areas (i.e. persuasive, expository)
Student uses note taking skills
Student uses resources (i.e., dictionary, word lists, etc.)
Student applies writing skills to a variety of situations
Student is performing at grade level in the area of writing
Writing: Additional Comments
Writing: Please list all accommodations you provide the student and whether they are effective.
Math Skills- Complete if Applicable
Please answer to the best of your ability. Strengths include what the student CAN do regardless of whether it is at grade level.
Please indicate strengths and needs in math:
Strength
Need
N/A
Student solves addition and subtraction problems
Student solves multiplication and division problems
Student solves one-step equations
Student solves two-step equations
Student solves multiple-step equations
Student solves decimal problems
Student solves problems involving fractions
Student understands place value
Student identifies symbols and terminology (i.e., +, %, greater than, etc.)
Student understands and applies appropriate units of measure (i.e. feet, miles, gallons, etc)
Student recognizes/identifies 2- and 3-dimensional geometric shapes
Student identifies and counts/completes problems involving money
Student solves word problems
Student uses problem-solving strategies
Student accurately uses a ruler
Student graphs an equation
Student is performing at grade level in the area of math
Math: Please list all accommodations you provide the student and whether they are effective.
Math: Additional Comments
Communication within the Classroom
How would you rate the student's ability to learn and use new and age-appropriate vocabulary?
Very Poor
Excellent
Clear selection
How would you rate the student's ability to understand age-appropriate vocabulary in spoken and written language?
Very Poor
Excellent
Clear selection
How would you rate the student's ability to express themselves in a clear and organized manner?
Very Poor
Excellent
Clear selection
How would you rate the student's ability to comprehend complex spoken and written language?
Very Poor
Excellent
Clear selection
How would you rate the student's ability to use age-appropriate articulation (pronunciation) of sounds in speech?
Very Poor
Excellent
Clear selection
How would you rate the student's ability to use smooth and fluent speech when speaking?
Very Poor
Excellent
Clear selection
How would you rate the student's ability to use a typical vocal volume, rate, rhythm, and pitch when speaking?
Very Poor
Excellent
Clear selection
How would you rate the student's ability to relate to and interact with their peers?
Very Poor
Excellent
Clear selection
For students who receive speech/language services: does the student’s communication deficit affect them socially?
Clear selection
For students who receive speech/language services: does the student’s communication deficit affect them academically?
Clear selection
Other
Please list any other general accommodations you provide the student and whether they are effective
Is there any other information you would like to report about this student?
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