2010 Middle School Teacher Survey
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1. Default Section

1. Name of Student:

Name of Student:

2. Grade

Grade

3. Subject taught

Subject taught

4. To what extent has your student changed behavior in terms of

	Did not need to improve	Significant Improvement	Moderate Improvement	Slight Improvement	No Change	Slight Decline	Moderate Decline	Significant Decline
Turning in his/her homework on time	*To what extent has your student changed behavior in terms of Turning in his/her homework on time Did not need to improve	Turning in his/her homework on time Significant Improvement	Turning in his/her homework on time Moderate Improvement	Turning in his/her homework on time Slight Improvement	Turning in his/her homework on time No Change	Turning in his/her homework on time Slight Decline	Turning in his/her homework on time Moderate Decline	Turning in his/her homework on time Significant Decline
Completing homework to your satisfaction	Completing homework to your satisfaction Did not need to improve	Completing homework to your satisfaction Significant Improvement	Completing homework to your satisfaction Moderate Improvement	Completing homework to your satisfaction Slight Improvement	Completing homework to your satisfaction No Change	Completing homework to your satisfaction Slight Decline	Completing homework to your satisfaction Moderate Decline	Completing homework to your satisfaction Significant Decline
Participating in class	Participating in class Did not need to improve	Participating in class Significant Improvement	Participating in class Moderate Improvement	Participating in class Slight Improvement	Participating in class No Change	Participating in class Slight Decline	Participating in class Moderate Decline	Participating in class Significant Decline
Volunteering (e.g. for extra credit or more responsibilities)	Volunteering (e.g. for extra credit or more responsibilities) Did not need to improve	Volunteering (e.g. for extra credit or more responsibilities) Significant Improvement	Volunteering (e.g. for extra credit or more responsibilities) Moderate Improvement	Volunteering (e.g. for extra credit or more responsibilities) Slight Improvement	Volunteering (e.g. for extra credit or more responsibilities) No Change	Volunteering (e.g. for extra credit or more responsibilities) Slight Decline	Volunteering (e.g. for extra credit or more responsibilities) Moderate Decline	Volunteering (e.g. for extra credit or more responsibilities) Significant Decline
Attending class regularly	Attending class regularly Did not need to improve	Attending class regularly Significant Improvement	Attending class regularly Moderate Improvement	Attending class regularly Slight Improvement	Attending class regularly No Change	Attending class regularly Slight Decline	Attending class regularly Moderate Decline	Attending class regularly Significant Decline
Being attentive in class	Being attentive in class Did not need to improve	Being attentive in class Significant Improvement	Being attentive in class Moderate Improvement	Being attentive in class Slight Improvement	Being attentive in class No Change	Being attentive in class Slight Decline	Being attentive in class Moderate Decline	Being attentive in class Significant Decline
Behaving well in class	Behaving well in class Did not need to improve	Behaving well in class Significant Improvement	Behaving well in class Moderate Improvement	Behaving well in class Slight Improvement	Behaving well in class No Change	Behaving well in class Slight Decline	Behaving well in class Moderate Decline	Behaving well in class Significant Decline
Academic performance	Academic performance Did not need to improve	Academic performance Significant Improvement	Academic performance Moderate Improvement	Academic performance Slight Improvement	Academic performance No Change	Academic performance Slight Decline	Academic performance Moderate Decline	Academic performance Significant Decline
Coming to school motivated to learn	Coming to school motivated to learn Did not need to improve	Coming to school motivated to learn Significant Improvement	Coming to school motivated to learn Moderate Improvement	Coming to school motivated to learn Slight Improvement	Coming to school motivated to learn No Change	Coming to school motivated to learn Slight Decline	Coming to school motivated to learn Moderate Decline	Coming to school motivated to learn Significant Decline
Getting along well with other students	Getting along well with other students Did not need to improve	Getting along well with other students Significant Improvement	Getting along well with other students Moderate Improvement	Getting along well with other students Slight Improvement	Getting along well with other students No Change	Getting along well with other students Slight Decline	Getting along well with other students Moderate Decline	Getting along well with other students Significant Decline

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