General Education Teacher Questionnaire Template
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1South Bend Community School Corporation
Special Education Services
215 S. St. Joseph St, South Bend, IN 46601
Ph: 574.283.8130 Fax: 574.283.8105
General Education Teacher Questionnaire
Please complete this questionnaire and return to: ________________________ Please return by: _____________
(date)
Student Name: __________________________ STN#: ______________________ Date: ___________________
Teacher: _______________________________School: _____________________ Grade: __________________
1. Do you think his/her current services are appropriate? If not, what would you suggest?
2. What, if any, additional information is needed to help you in the classroom?
3. What modifications work best for this student in your classroom?
4. Student work habits (takes responsibility, completes assignments, etc.):
5. Social/interpersonal skills (with peers and teachers):
6. Current Grades:
7. Attendance:
_____ Good Attendance
_____ Frequently Absent (No. of days absent ___)
8/18/12
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