* 1. Child information

* 2. Teacher information:

* 3. Parent's information who gave you consent to complete this form:

* 4. What math curriculum does your school use?

* 5. MATH-Computations, Functional and all other types. Child's functioning grade level? Specific skills for remediation or enrichment?

* 6. What literacy curriculum does your school use?

* 7. What assessments do you use to assess a children’s reading level?

* 8. What is the child’s current reading level?

* 9. What was the child’s reading level in September when you first evaluated them?

* 10. Did the child make reading progress over the course of the school year? If so, what strategies or interventions worked? If little progress was made, why do you feel that the child has made little progress? What suggestions would you have for someone working with this child over the summer? Areas such as handwriting, grammar, punctuation, and word identification?

* 11. Please list SPECIFIC BEHAVIORS that you would like to see targeted for improvement in the classroom setting (i.e. needs to follow directions on the first try; raise hand and wait before being called on etc.).These may be behaviors that you have indicated before on the classroom questionnaires or behaviors that you have not listed/identified before.

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