Referral For Multidisciplinary Team Evaluation - Language Impairment Classroom Teacher Report

ADVERTISEMENT

South Bend Community School Corporation
Special Education Services
Referral for Multidisciplinary Team Evaluation – Language Impairment
Classroom Teacher Report
Please check: _____Parent referral (attach Record of Parental Request)
____Teacher referral (date referred:__________)
Please check:
_____Parent referral (attach Record of Parental Request)
_____Teacher referral (date referred_____________)
Classroom Teacher completes these pages:
Student: _______________________ School: _________________ ID#: ___________ STN#: _______________
Teacher providing information: ____________________ How long has student been in your class? ____________
Subject area(s) if applicable: _____________________________________________________ Grade: _________
Check any skills below that you have considerable concerns about in this student’s oral communication .
Observations may also include settings other than the classroom.
Language Skills: (These skills – typical of 3-5 year olds - are listed in developmental order)
Preschool
_____maintains a topic over several utterances
_____uses is, am and are frequently in a variety of contexts
_____begins questions using is
_____talks about completed activities
_____requests explanations
_____gives reasons
_____shares feelings verbally
_____uses the conjunction and
_____asks for permission
_____describes two events in sequence
_____uses sentences 4-8 words in length
_____knows age
_____follows three verbal instructions
_____asks for meaning of words
_____describes experiences accurately
_____tells simple stories
Comments:__________________________________________________________________________________
___________________________________________________________________________________________
th
The following skills (listening, speaking, and those related to reading) are typical of Kindergarten through 6
graders and are listed in sequential order by grade.
Listening
_____follows 1-2 simple directions in a sequence
_____listens to and understands age-appropriate stories read aloud
_____follows a simple conversation
_____remembers information
_____responds to instructions
_____follows 2-3 step ____ 3-4 step directions in sequence
_____understands direction words (e.g., location, space, and time words)
_____correctly answers questions about a grade-level story
_____listens attentively in group situations
_____understands grade-level material
_____listens and draws conclusions in subject area learning activities
Comments: ___________________________________________________________________________
______________________________________________________________________________
8/19/12

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Education
Go
Page of 3