Teacher Report Form Please provide your observations about this student. Student Information Student's First Name Student's Last Name Student's Date of Birth Teacher Information Your Name Your Email School Name Grade Subject(s) Taught How long have you known this student? Academic Performance Reading Level Below Grade LevelAt Grade LevelAbove Grade Level Math Level Below Grade LevelAt Grade LevelAbove Grade Level Writing Level Below Grade LevelAt Grade LevelAbove Grade Level Overall Academic Performance ExcellentGoodAverageBelow AveragePoor Academic Concerns (if any) Behavioral Observations Ability to Maintain Attention/Focus ExcellentGoodFairPoorVery Poor Follows Directions AlwaysUsuallySometimesRarelyNever Completes Tasks/Assignments AlwaysUsuallySometimesRarelyNever Impulsivity Level NoneMildModerateSevere Hyperactivity Level NoneMildModerateSevere Behavioral Concerns (if any) Social/Emotional Development Peer Relationships ExcellentGoodFairPoorVery Poor Relationships with Adults ExcellentGoodFairPoorVery Poor Emotional Regulation ExcellentGoodFairPoorVery Poor Social/Emotional Concerns (if any) Additional Information Current Accommodations/Modifications IEP or 504 Plan Status Has IEPHas 504 PlanNeitherDon't Know Student Strengths Recommendations Additional Comments
