Information Processing – Teacher Questionnaire

Student Name ______Grade ______Date ______

Teacher ______Subject(s) ______

Return this form to: ______

The above named student has been referred for a special education re-evaluation for specific learning disabilities. Please rate the student on the following behaviors that might indicate the presence of an information processing condition.

*** Please rate the percent of time the student is able to perform the following tasks related to information processing:

Storage / 0 – 25% / 26 – 50% / 51 – 75% / 75 – 100% / Not Observed
Follows two to three-step directions regularly
Is able to recall previously learned information quickly
Grasps simple word meanings
Recognizes and recalls information over a period of time
Organization
Hands in assignments on time
Desk/Locker is organized
Completed assigned work
Using planning skills
Aligns work spatially
Sequences information
Acquisition
Links new information to old
Obtains information by hearing
Obtains information by seeing
Obtains information by reading
Obtains information by touching
Can discriminate visually
Can discriminate auditorially
Retrieval
Has appropriate response time when called
Develops strategies to help recall information
Can name and label
Associates sounds with letters
Counts and/or calculates automatically
Recalls sequential steps for a task
Expression
Participates in class activities
Demonstrates oral fluency
Demonstrates reading fluency
Demonstrates writing fluency
Responds appropriately to nonverbal communication
Asks questions/gives answers related to the content
Manipulation
Applies learned information to new situations
Infers information (if this, then that)
Summarizes information
Interprets information
Differentiates details from key concepts
Writes letters/sentences close to grade level

Please respond to the following questions.

  1. Please describe this student’s present level of academic performance in your classroom. Include strengths and weakness you observe in your classroom.
  1. Describe this student’s attention and concentration in class.
  1. Describe this student’s organizational skills.
  1. What adaptations / modifications work well for this student?
  1. Does this student demonstrate any preferred learning styles or strategies?
  1. What is the student’s response to corrective feedback?
  1. Does the student express him or herself fluently (include oral expression and written expression)?

9. How does the student’s performance compare with peers?

Below ______Above

1 2 3 4 5

10. Average percentage of assignments completed: ______

Average Percentage of accuracy on assignments: ______

Average percentage attained on tests: ______

  1. Describe this student’s use of social skills and interaction with other peers in your class: