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Does the student behave differently from the other students in your class?
 
Strongly Disagree
 
Disagree
 
Neutral
 
Agree
 
Strongly Agree
 
 
 
Please describe how the student behaves differently from the other students in your classroom??
   
 
 
 
The student learn at a slower rate than the other students in your class.
 
Strongly Disagree
 
Disagree
 
Neutral
 
Agree
 
Strongly Agree
 
 
 
What are the learning concerns that you have for this student based on diagnosed impairment??
   
 
 
 
What Reading difficulties do you notice with the student that may be caused by the diagnosed impairment?
   
 
 
 
What Math difficulties do you notice with the student that may be caused by diagnosed impairment?
   
 
 
 
What accommodations/interventions have you tried in the classroom? ((Please provide 2 weeks documentation of tried acccommodations/interventions with this interview))
   
 
 
 
In your opinion, what factors are affecting the student's ability to learn?