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* 1. Student's Name:

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* 2. Teacher Name(and subject taught)

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* 3. Please indicate this student's performance in English(Written Communication)

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* 4. Please indicate this student's performance in Mathematics

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* 5. How would you rate the quality of homework assignments you receive from this student with respect to:
Accuracy in following directions

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* 6. How would you rate the quality of homework assignments you receive from this student with respect to:
Thoroughness/completeness

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* 7. How would you rate the quality of homework assignments you receive from this student with respect to:
Neatness/Organization

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* 8. How would you rate the quality of homework assignments you receive from this student with respect to:
Special thought, creativity or connections to other topics/ideas

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* 9. How would you rate the quality of homework assignments you receive from this student with respect to:
Application of concepts and skills

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* 10. How often does this student submit homework assignments on time?

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* 11. Overall, how satisfied are you with the quality of homework assignments submitted by this student?

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* 12. Initiative:
Sets goals for self

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* 13. Initiative:
Student takes initiative to get information and resources needed to accomplish work

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* 14. Initiative:
Student persists on task even when experiencing difficulty

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* 15. Initiative:
Student makes own effort to begin assignment before asking for assistance.

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* 16. Initiative:
Student prioritizes tasks to meet goals in an age-appropriate manner(e.g. which assignments or tasks to complete first, how to finish a project, how to finish tasks within specified time).

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* 17. Engagement in Learning:
Student stays focused on task at hand

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* 18. Engagement in Learning:
Student is alert and focused during class time.

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* 19. Engagement in Learning:
Student is interested in learning new things.

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* 20. Engagement in Learning:
Student contributes constructively to class discussions.

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* 21. Problem Solving Skills:
Student is able to provide concrete examples or evidence to support his/her statements or opinions.

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* 22. Problem Solving Skills:
When student encounters difficulty, he/she is able to identify and describe the problem.

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* 23. Problem Solving Skills:
Student is able to generate multiple, potential solutions to problems.

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* 24. Problem Solving Skills:
When student encounters a problem, he/she makes own effort to try out possible solutions.

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* 25. Problem Solving Skills:
Student is able to use higher-order thinking skills as is appropriate for grade level.

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* 26. Do you have any other comments about this student?

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