One Planet Academic Tutoring Support Goal Sheet

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Academic Tutoring Support Goal Sheet
Classroom Teacher: __________
Date:__________________
Student Name: _______________________________________
Grade: ____________
_____ Sharon
_____ South Royalton
_____ Tunbridge
Referral made for the following academic supports:
___ Reading
___ Writing
___ Mathematics ___ Science ___ Homework Support
1-2 Goals/Objectives for Academic Support in above area:
What will be used as a pre-tutorial assessment?_________________________________
What will be used as a post-tutorial assessment?_________________________________
Teachers: Please fill out this form for tutor and give to Site Coordinator
TO BE COMPLETED BY TUTORS
Tutoring Day(s):
M
T
W
TH
Re-Assess Date: __________
Results of pre-tutorial assessment?___________________________________________
Results of post-tutorial assessment?___________________________________________
Other comments?_________________________________________________________

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