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Learner profile
Please tell me a bit about this student so I can plan appropriate content for them, place them in a class with compatible classmates, and better understand how best to treat them as the unique individual they are.
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1.
Student information.
(Required.)
First name:
Last name:
Age:
Birth date:
Preferred pronoun:
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2.
Please list any medical, emotional, or behavioral challenges that may be encountered during our interactions (e.g., need to be best, intensities / overexcitabilities, low blood sugar, sensory issues, adjusting to baby sister), and suggestions for how to address them. I take these as insights that help me better connect with the wonderful unique person, not as problems to be solved.
(Required.)
Trait or challenge:
Advice:
Trait or challenge:
Advice:
Additional traits and/or challenges:
Advice:
3.
Include any additional traits, challenges, and advice here.
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4.
Does this student have needs that I may need help accommodating?
(Required.)
Yes
Not sure
No
5.
Many students who get the services of a paraprofessional or other aide in a regular classroom, are exclusively in special education classes in school, or who don't fit in a traditional classroom may have special needs that I can't accommodate alone. Some other students may also have such needs. I don't turn away students with needs that are hard to accommodate, I work with the student and parents to get the help I need so the student can thrive.
Please describe this student's needs that I may need help accommodating.
Also describe who will stay with this student (or stay in another room in case help is needed) during classes until we are comfortable they no longer need this support. Feel free to schedule a free consultation to discuss how best to accommodate this student.
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6.
What do you wish teachers would know and remember about your child?
(Required.)
Now, some questions about how this student learns:
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7.
Is this student a visual-spatial learner?
(Required.)
Not at all
Very much so
Clear
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8.
Is this student an auditory-sequential learner?
(Required.)
Not at all
Very much so
Clear
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9.
Is this student a kinesthetic learner?
(Required.)
Not at all
Very much so
Clear
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10.
Is this student good at memorizing material (e.g., math facts)?
(Required.)
Not at all
Very much so
Clear
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11.
Does this student enjoy reading?
(Required.)
Hates it
Loves it
Clear
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12.
Does this student enjoy building things?
(Required.)
Hates it
Loves it
Clear
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13.
Does this student enjoy writing characters and drawing?
(Required.)
Hates it
Loves it
Clear
14.
Comments:
Last, some questions about how this student interacts with other students:
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15.
Please indicate how quiet / outgoing this student is:
(Required.)
quiet / shy
outgoing / talkative
Clear
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16.
Does this student have any difficulties having quiet or shy classmates?
(Required.)
No
Yes (describe in comments)
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17.
Does this student have any difficulties having outgoing, talkative, and/or loud classmates?
(Required.)
No
Yes (describe in comments)
18.
Comments:
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19.
Please indicate how quickly this student answers questions:
(Required.)
thinks or processes before answers / contemplative
answers quickly / guesses / impulsive
Clear
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20.
Does this student have any difficulties having classmates who answer slowly?
(Required.)
No
Yes (describe in comments)
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21.
Does this student have any difficulties having classmates who answer quickly?
(Required.)
No
Yes (describe in comments)
22.
Comments:
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23.
Please indicate how often this student needs to move:
(Required.)
at rest
in motion
Clear
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24.
Does this student have any difficulties having classmates who are often at rest?
(Required.)
No
Yes (describe in comments)
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25.
Does this student have any difficulties having classmates who are often in motion?
(Required.)
No
Yes (describe in comments)
26.
Comments:
27.
Anything else Dr. Deb should know:
28.
General comments/suggestions about this student, this form, etc.: