Personal Quality Checklist 2c2q3a

Teacher Rating Scale (Created by Pamela Russell, May 2002)

Name: ______________________________________

Date: ______________________

I. Directions: Use the following scale to rate the student’s behavior in your class. NEVER

0

MOST OF THE TIME

2

SOMETIMES

1

ALWAYS

3

NOT APPLICABLE

N/A

_____1. Makes appropriate use of free time (e.g., performs homework & other assignments) _____2. Remains on task for required length of time _____3. Follows directions _____4. Makes responsible decisions _____5. Is organized _____6. Is dependable _____7. Demonstrates initiative in absence of directions _____8. Demonstrates problem-solving skills _____9. Pays attention _____10. Responds appropriately to authority figures/is respectful _____11. Demonstrates respect to peers _____12. Follows rules II. Directions: Please list strengths and weaknesses concerning the student in your class. STRENGTHS:

________________________________________________________________________ ________________________________________________________________________

WEAKNESSES:

________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________

III. Directions: Please list accommodations or modifications you feel were beneficial to this student in your class. ACCOMMODATIONS: (curriculum is NOT changed)

________________________________________________________________________ ________________________________________________________________________

MODIFICATIONS: (works on different curriculum)

________________________________________________________________________ ________________________________________________________________________

IV. Utilize the space provided below to list other concerns you may have that were not addressed in sections I, II, and III. ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________

IEP Data Student’s Name: __________________________________

Date: ____________________

Teacher’s Name: __________________________________

Subject: _________________

Areas of Strengths &/or Weaknesses:

__________________________________________ __________________________________________ __________________________________________ __________________________________________

Beneficial Accommodations/Modifications:

_________________________________________ __________________________________________ __________________________________________ __________________________________________

Other:

__________________________________________ __________________________________________ __________________________________________ __________________________________________

Personal Qualities Checklist (Pamela Russell, December, 1999)

Name: _____________________________________________________

Date: ___________________

Directions: Rate the student based on his /her current level of competence for each behavior listed. A score of one would be the lowest score and five would be the highest score.

BEHAVIORS

1 Poor

1.

Demonstrate self-advocacy skills. A. Expressing feelings of self-worth B. Describing others’ perception of self C. Accepting and giving criticism D. Developing a positive view of self E. Practicing personal safety

2.

Develop the ability to recognize responsible behavior in self & others. A. Respecting the rights and properties of others B. Respecting authority and following Instructions C. Exerting a high level of effort D. Setting and achieving goals

3.

Demonstrate an awareness of appropriate communication & social skills. A. Personal relationships B. Group and individual work activities C. Group and individual leisure activities D. Utilization of available community resources

4.

Recognize diversity among multicultural populations. A. Gender B. Race C. Ability/Interest D. Language E. Tolerance/acceptance

2 Fair

3 Average

4 Good

5 Excellent

5.

Develop awareness of independent behaviors. A. Self-advocacy B. Self-organization C. Affects of one’s behavior

6.

Develop appropriate decision-making/goal-setting skills. A. Locate and select sources of assistance B. Anticipate consequences C. Develop and evaluate alternatives D. Recognize the nature of the problem E. Develop goal-setting behavior

COMMENTS:

SIGNATURE: _______________________________________________________ CIRCLE THE APPROPRIATE PERSON DOING THE RATING: (1) Parent

DATE: ______________________________ (2) Student

(3) Employer

(4) Teacher

Parent/Teacher Rating Scale (Created by Pamela Russell, May 2002)

Name: ______________________________________

Date: ______________________

Directions: Use the following scale to rate the student’s work related behaviors, interpersonal relations, and social/community expectations. NEVER

0

MOST OF THE TIME

2

SOMETIMES

1

ALWAYS

3

Work Related _____1. Makes appropriate use of free time (e.g., performs homework assignments, studies, etc.) _____2. Remains on task for required length of time _____3. Follows directions _____4. Makes responsible decisions _____5. Is organized _____6. Is dependable _____7. Demonstrates initiative in absence of directions _____8. Demonstrates problem-solving skills _____9. Pays attention _____10. Is persistent in seeking success (e.g., will stay on task) _____11. Takes responsibility for his/her own actions _____12. Learns from mistakes _____13. Recognizes consequences of inappropriate behavior and responds appropriately

Interpersonal Relations _____1. Responds appropriately to peers _____2. Cares for personal appearance (e.g., grooming, clothing, etc.) _____3. Demonstrates the ability to resolve conflict situations appropriately

NOT APPLICABLE

N/A

_____4. Responds appropriately to authority figures _____5. Adjusts easily to new situations (e.g., works with individuals he/she does not know, adjusts to new surroundings, etc.) _____6. Maintains consistent patterns of acceptable behavior and emotions _____7. Is loyal to friends, family, and work associates Social/Community Expectations _____1. Is responsible for appropriate care of personal property _____2. Follows rules _____3. Obeys laws _____4. Behaves appropriately in the absence of supervision _____5. Demonstrates appropriate care and handling of others’ property _____6. Is honest _____7. Follows safety guidelines _____8. Demonstrates ability to control temper Other areas of parent &/or student concerns or needs: