TEACHERINTERVIEWFORMFORACADEMICPROBLEMS.docVIP

TEACHER INTERVIEW FORM FOR ACADEMIC PROBLEMS (Adapted from Academic Skills Problems, 1996, E. Shapiro) Student: ___________________________ Teacher: _______________________ Birth date: __________________________ Date: __________________________ Grade: ____________________________ School: ________________________ Interviewer: ____________________ GENERAL Why was this student referred? What type(s) of academic problem(s) does this student have? READING Primary type of reading series used Secondary type of reading materials used ( Basal reader ( Basal reader ( Literature-based ( Literature-based ( Trade books ( Trade books ( None Reading series title (if applicable) ___________________________________________ Grade level of series currently placed ________________________________________ Title of book in series currently placed _______________________________________ How many groups do you teach? ____________________________________________ Which group is this student assigned to? ______________________________________ At this point in the school year, where is the average student in your class reading? Level and book ____________________________________________________ Place in book (beginning, middle, end, specific page) ______________________ Time allotted/day for reading _______________________________________________ How is time divided? (Independent seatwork? Small group? Cooperative groups?) _______________________________________________________________________ _______________________________________________________________________  How is placement in reading program determined? ______________________________ _______________________________________________________________________ How are changes made in the program? _______________________________________ _______________________________________________________________________ Does this student participate in Chapter 1 (remedial) reading programs? How much? ___ ______________