Will this student need assistance with the following skills or activities?
_____ academic activities/skills _____________________________________________
_____ classroom routine ___________________________________________________
_____ mobility ___________________________________________________________
_____ eating _____________________________________________________________
_____ toileting ___________________________________________________________
_____ other _____________________________________________________________
Which of the following instructional formats have proven successful with this
student?
_____ small group
_____ tutorial/one-to-one
_____ large group
_____ peer buddy
_____ cooperative learning
_____ computer assisted
_____ peer tutor
_____ activity-based instruction
(games,
_____ homebound
stimulations, role playing, presentations)
_____ lecture/practice
_____ class discussions
_____ experiental lessons (real-life
_____ assistive technology
activities)
_____ other
_____ alternative school
_____ assistance from Behavioral Specialist
Which of the following instructional adaptations/modifications have proven
successful with this student? (Check all that apply)
_____ extended time
_____ assignment/homework reminders
_____ highlighted texts or reading
_____ changes in lesson materials
objective/outcome
_____ material modifications
_____ content vocabulary preview
_____ puzzles
or reinforcement
_____ guided notes/outlines
_____ partial assignments
_____ advance organizers
_____ alternate assignments/projects
_____ in-class assistance from special
_____ use of calculator
services (inclusion)
_____ grading modifications
_____ alternate discipline plan
_____ assessment modifications
_____ community functional skills program
_____ other ____________________________________________________________
Label each of the following as: (+) a strength
(o) a weakness
_____ copying from board
_____ creating projects
_____ copying from overhead
_____ writing (journals, reports, creative, etc.)
_____ gaining info from printed materials (text, handout, etc.)
_____ gaining info from charts, graphs, pictures, etc.
_____ gaining info from lecture
_____ gaining info from film/filmstrip/video/audio tape
_____ gaining info from a field trip
_____ oral expression and communication skills
_____ organizing and maintaining a notebook