Teacher Observation and Classroom Accommodations Checklist

This form should be initiated by the referring teacher

Student First Name *

Student Last Name *

Teacher First Name *

Teacher Last Name *

Teacher Email Address *

Grade *

School *

ENVIRONMENT *

ASSIGNMENTS *

TEACHING TECHNIQUES *

SCHEDULE *

LEARNING STYLE *

Limit # of oral instructions

Teach note taking skills

Provide copy of notes and/or examples

Peer tutoring or cooperative group

Vary reading approach

Use best learning modality (A,V,K)

Identify learning strength

MATERIAL *

ORGANIZATIONAL *

MATERIAL *

MISCELLANEOUS *

OTHER Classroom Accommodations *

Please provide any other details pertaining to this student that may be of benefit to the Student Support Team's evaluation of need for tier III interventions. *

Please provide any details regarding this student's engagement with their learning (i.e. attendance concerns, apathy, social/emotional concerns, etc) *