Teacher Evaluation Form Page 2
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1
2CAP RATING SCALE
Child’s Name:____________________________
Child’s age:___________
Child’s sex:
M___ F___
Filled out by: _____________________________
______________________________________________________
DIRECTIONS:
Below is a list of items that describe pupils. For each item that describes the
pupil now or within the past week, check whether the item is Not True,
Somewhat or Sometimes True, or Very or Often True. Please check all items
as well as you can, even if some do not seem to apply to this pupil.
Not
Somewhat
Very
True
or Sometimes
or Often
True
True
1. Fails to finish things he/she starts
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2. Can’t concentrate, can’t pay attention
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for long
3. Can’t sit still; restless or hyperactive
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4. Fidgets
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5. Daydreams or gets lost in his/her thoughts
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6. Impulsive or acts without thinking
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7. Difficulty following directions
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8. Talks out of turn
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9. Messy work
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10. Inattentive, easily distracted
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11. Talks too much
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12. Fails to carry out assigned tasks
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OTHER COMMENTS:
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Parent category: Business