Questionnaire to Determine Students Strengths and Weaknesses

Student Name: ___________________________________ Student ID: ______________ Sch. Year: __________

Teacher: ________________________________________ Grade: ____________ Todays date: _________

Academic
If available, previous years grades:

Grade: ______ Grade: ______ Grade: ______ Grade: ______ Grade: ______ Grade: ______
Reading
Language
Arts
Math
Science
Social
Studies
P.E.
Art/Music
Has the student participated in intervention before? (Please Circle) Yes or No

If yes, please list areas for intervention and include grade level:
1. _____________ and _________ grade 3. _____________ and _________ grade
2. _____________ and _________ grade 4. _____________ and _________ grade

Please list State Assessments Scores, if any:

Reading ________ Math ________
Writing ________ Science ________
End-of-year ________ Other: ________

Reading level: ____________

Comprehension: How is the student comprehension? (please place a check next to the observed skill)
Is the student able to: _________Predict _________Visualize _________Question _________Connect
_________ Identify _________ Infer _________Evaluate
Does the student writes in complete sentences? Yes or No
Does the student speak in complete sentences? Yes or No

Math level: _________

Ask student:
What are the two thinks he or she finds easy in math? _________________________________________________________________
What are the two thinks he or she finds difficult in math? _____________________________________________________________
What does one think you are excited about math? ___________________________________________________________________
What is ne think you are nervous about math? ______________________________________________________________________
Behavior
What is the overall conduct grade of the student? _________________________________________________
Does the student have a behavior intervention plan in place? ________________________________________
When student is off-task, what behaviors does he or she display? _____________________________________
Functional Skills
Is the student able to keep desk or area organized? Yes/Easy No/Needs help
Is the student able to keep track of daily assessments? Yes/Easy No/Needs help
Is the student handwriting neat? Yes/Easy No/Needs help
Is the student able to open bookbag or other school materials? Yes/Easy No/Needs help
Is the student able to transition to different activities smoothly? Yes/Easy No/Needs help
Comments: (please use the back of the page)

dpaez012@fiu.edu | FLORIDA INTERNATIONAL UNIVERSITY COLLEGE OF EDUCATION -TEACH LAB