School District of New London

Problem Solving Team Classroom Teacher Report

Student Name Grade Date of Birth

Person completing report/position Class

Check those statements, which best describe the student: Academic Learning is slow to learn new concepts has a short attention span, distractible is disorganized Social/Behavioral writes letters or numbers poorly seems unhappy or depressed daydreams often prefers to be alone has difficulty understanding directions seems to act out for attention displays inconsistencies in work appears lacking in self-confidence is absent frequently argues often has difficulty with time orientation appears over-anxious and nervous has difficulty completing assignments appears inappropriately fearful seems not to work to his/her ability sulks to get his/her own way has difficulty with written language has trouble controlling temper other: has physical fights with others has trouble making friends has a dislike for school is sensitive to criticism Health has difficulty accepting direction and redirection has vision or hearing problems (circle) other: acts sleepy and tired complains of many physical ailments Communication is poor in muscular strength Is hard to understand (articulation) is poor in muscular control and balance has difficulty with verbal expression medications has poor vocabulary other health problems. List: uses immature sentence structure

Current grade in class:

Comments on academic achievement:

Comments on classroom behavior:

Narrative of interventions and strategies used for the student and their results.

Teacher Date