<p> SECTION 504 CHECKLIST OF OBSERVABLE BEHAVIORS Student Name______Birthdate______Teacher Name______</p><p>Please check those items that apply to this student. Date______CURRENT GRADE IN CLASS: _____ School______School Behavior _____ Works well independently _____ Short attention span, easily distracted _____ Is cooperative _____ Rarely works to potential _____ Sleeps in class _____ Poor test performance _____ Inconsistent performance _____ Incomplete assignments _____ Frequent absences _____ Slow to finish work _____ Frequent referrals/detentions _____ Decreased involvement in school activities _____ Reluctant to speak in front of others _____ Disrupts class _____ Lacks pride in work _____ Daydreaming _____ Doesn't follow oral directions _____ Frequently tardy _____ Wastes time _____ Physically active _____ Failing grades _____ Misinterprets simple directions _____ Feigns illness _____ Defies authority _____ Uses obscene language/gestures _____ Is easily motivated by ______Destroys/abuses property ______Doesn't participate in class</p><p>Social/Emotional _____ Has difficulty relating to adults _____ Is creative _____ Immature _____ Has good sense of humor _____ Anxious, tense and nervous _____ Shows good curiosity _____ Defensive, resistant _____ Seems to feel good about self _____ Passive resistant _____ Gets along well with others _____ Outgoing and friendly _____ Aggressive, argumentative, fights _____ Overt change of attire _____ Negative/refuses to comply _____ Unable to express thoughts orally _____ Appears depressed, sad, moody _____ Withdrawn, isolates self from others _____ Disrespectful to others _____ Involved in social activities _____ Easily manipulated by others _____ Communicates well with adults _____ Manipulates authority _____ Cries easily _____ Perfectionist, rigid _____ Over sensitive to criticism _____ Seeks attention _____ Worries excessively _____ Evasive/doesn't accept responsibility _____ Has extreme fears/frightens easily _____ Inappropriate reaction to poor performance _____ Gets picked on by others _____ Is generally confident _____ Inappropriate sexual behavior Health/Physical _____ Is generally healthy and fit _____ Messy with work and belongings _____ Fatigued, sleepy _____ Pupils dilated _____ Appearance change _____ Eyes red, puffy, bloodshot _____ Weight loss/gain _____ Unsteady gait, stumbles _____ Lacks bladder/bowel control _____ Slurred speech _____ Poor hygiene _____ Loss of inhibitions _____ Marks, bruises on arms, legs _____ Odor of alcohol _____ Uncoordinated physically _____ Change in extracurricular activities _____ Has trouble with fine motor tasks _____ Reported parental concern _____ Unclear articulation _____ Reported concern by peers _____ Below average language development _____ Talks freely of alcohol/drug use List any additional concerns you have about this student.</p>