Evaluation

Directions: Please check the number that best indicates how this student behaves in your classroom.

Teacher, please check one of these boxes to indicate gender of student.

1. He/she exhibits behavior that is typical of successful students.

1 2 3 4 5

2. He/she is comfortable at school and has fun learning new thingsat school.

1 2 3 4 5

3. He/she is a responsible student.

1 2 3 4 5

4. He/she pays attention in class.

1 2 3 4 5

5. He/she asks for help when necessary.

1 2 3 4 5

6. He/she tries to improve when school work is deficient.

1 2 3 4 5

7. He/she works well with other students.

1 2 3 4 5

8. He/she cooperates well with me as a teacher.

1 2 3 4 5

9. He/she enjoys school

1 2 3 4 5

10. He/she exhibits self-respect.

1 2 3 4 5

5=Strongly Agree

1=Strongly Disagree

Teacher, on a scale from 1 - 10 with 10 being the highest rating, please rate the overall behavior of this student in your class.

Teacher, on a scale from 0 - 100 with 100 being highest, please write the current academic average of this student in your class.

Teacher/counselor, please check one of these boxes. Pre/Post

Student Identification Number

Date

TOTAL SCORE