Present Level Questionnaire printable pdf download

Present Level Questionnaire

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General Education Teacher of Service

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Special Education Teacher of Service

Student:

Grade:

Date:

Teacher:

Subject:

School:

Please return to TOR by:

1. Do you think his/her current services are appropriate? YES

(Insert current services here.)

If not, what would you suggest?

2. What accommodations work best for this student in your classroom? Circle “Yes” or “Not

Needed”. (List all current accommodations)

Yes – Not Needed (Insert current accommodations here.)

• Other accommodations (Please specify)

3. What is the student’s progress on his/her IEP goals: (Insert current goals here. i.e. reading

goals for the LA TOS, math goals for the Math TOS, behavioral/organizational goals to all.)

4. Present level of student’s school skills and work habits:

Attendance –

Attention skills –

Class participation –

Organization –

Self-advocacy –

Work ethic –

Homework completion -

5. Present level of student’s social/interpersonal skills:

Interaction with peers and adults –

Behaviors of concern –

Discipline data -

6. Academic Progress:

Current Grade:

Success/8 Step Grouping:

Current Acuity/mClass Scores:

Specific Skill Deficits:

Additional Comments:

Present Level Questionnaire