Student Functional Behavior Assessment Interview printable pdf download

Student Functional Behavior Assessment Interview

South Bend Community School Corporation

Special Education Department

Student Functional Behavior Assessment Interview

Student:

School:

Grade:

Date of Birth:

Age :

Interviewer:

Date Completed:

Directions: To complete this survey, it is recommended that each question be read to the student in an informal

manner. While you should guard against pressuring a student to complete each statement, please be

sure to follow-up or clarify any vague responses.

Section A

Always

Sometimes

Never

1. In general, is your work too hard for you?

2. In general, is your work too easy for you?

3. When you ask for help appropriately, do you get it?

4. Do you think work periods for each subject are too

long?

5. Do you think work periods for each subject are too

short?

6. When you do seatwork, do you do better when

someone works with you?

7. Do you think people notice when you do a good job?

8. Do you think you get the points or rewards you deserve

when you do good work?

9. Do you think you would do better in school if you

received more rewards?

10. In general, do you find your work interesting?

11. Are there things in the classroom that distract

you?

12. Is your work challenging enough for you?

13. Do you think you can concentrate on schoolwork?

14. Do you get along well with your classmates?

8/6/10

Student Functional Behavior Assessment Interview