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Greenfield Center School
Teacher/Childcare
Provider Questionnaire
Student
Evaluation for the Admissions Office
Teacher/Childcare Provider Questionnaire (pdf) Download a PDF version of this form by clicking this link |
If you need the free Adobe Acrobat Reader to view the PDF form, click here |
Name of Student: ___________________________________
Date of Birth: ________________
Dear
Teacher,
We appreciate your cooperation in completing this form.
It provides one important way of gaining insight into the child
and is reviewed with the full awareness that children are constantly
changing and developing. We place particular value on your observations
of classroom behavior and your descriptive comments in each area.
For
Pre-school Teachers or Childcare Providers:
Days of the week enrolled _____________________
Hours per day ________________ Size of group ________________ Age range ______________
Grade ______________________ Size of group ________________ Age range ______________
Social/Emotional Development
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Exhibits |
Age |
Developing |
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Able to work/play independently |
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Is supportive of peers |
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Is comfortable with adults |
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Able to work/play cooperatively |
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Develops and sustains friendships |
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Initiates work/play activities |
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Is imaginative |
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Exhibits leadership |
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Works collaboratively |
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Uses materials purposefully |
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Shows feelings/responses appropriate to the situation |
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Descriptive Comments:
Cognitive Development
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Exhibits |
Age |
Developing |
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Is attentive |
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Listens in a group |
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Contributes to group discussion |
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Follows directions |
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Completes tasks |
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Able to focus on one task |
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Respects classroom routines |
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Expresses ideas clearly |
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Moves easily from one activity to another |
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Responds positively to constructive criticism |
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Is inquisitive |
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Is willing to try new activities |
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Initiates work without teacher support |
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Enjoys new challenges |
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Exhibits problem-solving abilities |
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Descriptive Comments:
Physical
Development
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Exhibits |
Age |
Developing |
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Small muscle control and coordination |
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Large muscle control and coordination |
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K-2 Speech development (articulation) |
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Descriptive Comments:
Special Services
Please identify and describe any special needs, including
auditory and visual development:
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Remedial Reading |
_ |
Occupational Therapy |
_ |
Remedial Math |
_ |
Counseling |
_ |
Learning Disabilities |
_ |
Speech and Language |
_ |
Physical Therapy |
Parent
and Family Information
Please comment on parent cooperation and support for the child’s
school experience.
For
Applicants Grades 1-7:
Describe literacy or reading/writing skills:
Describe math skills:
For all Applicants:
We encourage you to share any other information that you think would be helpful. Include comments concerning strengths, weaknesses, or any special needs or concerns of this child and/or family. Please use additional paper if necessary.
Teacher
Name ______________________________________
Date __________________
Phone _______________
School Address ___________________________________________________
I have known the child for _____________ years __________ months.
My relationship has been that of _________________________________________
Return
to
Admissions Office
Greenfield Center School
71 Montague City Road
Greenfield,
MA 01301