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MADISON METROPOLITAN SCHOOL DISTRICTALTERNATIVE MIDDLE SCHOOL PROGRAM REFERRAL
(REVISED 2013)
SCHOOL-BASED ALTERNATIVE, NEON, OR REPLAY
Prior to making a referral, you should ensure that the following have occurred:
Other interventions have been attempted. For special education students, a Functional Behavioral Assessment has been completed and a BIP
implemented for at least three months?
School-Based Alternative East School-Based Alternative West Students identified with EBD Students identified with EBD East/LaFollette Area Students in grades 6-8 West/Memorial Area Students in grades 6-8 Students placed via IEP Students placed via IEP Full day at program or partial day split between
program and school Full day at program or partial day split between
program and school CC Teacher, SEA, Social Worker Regular Ed Staff with SEA Specialized transportation provided as needed Specialized transportation provided as needed Contact: Noelle Sapiro
([email protected]) Contact: Jim Haessly ([email protected])
Phone: 663-8428 Phone: 663-8428 Address: Black Hawk Middle School
1402 Wyoming Way Address: Lussier Community Education Center
55 S. Gammon Road
NEON
Grades 6-8 (no second semester 8th graders) Current IEP EBD eligibility only, time limit is IEP based Full day at program or partial day split between program and school Hoyt School Specialized transportation provided as needed Contact: Noelle Sapiro ([email protected]) or Jim Haessly ([email protected]) Address: 3802 Regent Street, Madison, WI 53705 Phone: 663-8428
REPLAY Grades 7-8. Males only. Special education and regular education students. Under supervision of DCDHC SW for delinquency 1227 North Sherman Avenue Full day program for semester Inbound transportation provided. Specialized transportation provided as necessary. Contact: Aric Soderbloom ([email protected]) Address: 1601 North Sherman Ave, Madison, WI 53704 Phone: 204-2443
If a student is not accepted into an alternative program the Assistant Director for Special Education supporting your area of the district should be contacted for further assistance.
MADISON METROPOLITAN SCHOOL DISTRICTMIDDLE SCHOOL ALTERNATIVE PROGRAM
REFERRAL FORM
Submit referral via email to [email protected]. Referral form must be submitted electronically. (Indicate principal’s approval on signature line).
Referral: NEON REPLAY School-Based Alternative
Entrance Criteria (All should be checked) Student has a current IEP and is a student with an Emotional Behavioral Disability.
For NEON or SBA student is in Grades 6-8. RePlay is Grades 7-8.
Staff members have consulted with the Program Support Teacher assigned to student’s home school to review interventions attempted with student. After reviewing the interventions, the PST agrees that the referral is appropriate.
Research-based interventions have been implemented with integrity and for a length of time sufficient to conclude that more intensive interventions are necessary.
For students with an Emotional Behavioral Disability, Functional Behavioral Assessment (FBA) and Behavior Intervention Plan (BIP) implemented for a minimum of 3 months.
Date(s) and methods of Parent Contact to Discuss Referral to Alternative Programs:
Date(s): Method(s):
Parent Input:
DOCUMENTATION THAT MUST ACCOMPANY COMPLETED REFERRAL FORM:1. Completed FBA and BIP with documentation of implementation of a minimum of 3
months.2. Infinite Campus Behavior Report Summary.3. Summary of research-based interventions attempted and the resulting data
documenting the student’s response to these interventions.4. Summary of current academic functioning (e.g. copy of latest report card, information
from any other supplemental services).5. Summary or copies of most recent assessments (PLAA/PMA, SRI, MAPS, and any other
standardized academic or intellectual assessments.6. Completed Student Profile.
MADISON METROPOLITAN SCHOOL DISTRICTMIDDLE SCHOOL ALTERNATIVE PROGRAM
REFERRAL FORM
I. Background Information
Student Name: Student Number:
Staff Member Completing Form: Phone #:
School:
Grade: DOB: Gender:
Race: Disability(ies):
Address:
Mother’s Name: Home Phone:
Work Phone:
Cell Phone:
Father’s Name: Home Phone:
Work Phone:
Cell Phone:
Guardian’s Name and Address (if different from Parents):
Date and Method of Parental Contact:
Case Manager: Phone Number:
Date of Initial/Most Recent IEP Evaluation:
Date of Most Recent IEP:
Date FBA/BIP Was Implemented:
Number of Months FBA/BIP Have Been Implemented (up to date of referral):
II. Current Placement and Academic Performance
A. Student is currently attending his/her home school:
full day
partial day (list specifics):
reduced day, neutral site programming:
reduced day with community programming (i.e., Steps to Success, etc…):
B. Please estimate the percent of time student spends in each of the following:
Within the general education environment:
% of time without supports from special education
% with supports from special education, no modification of the curriculum
% with supports from special education, with modifications of the curriculum
% with supports from special education, with replaced curriculum
Outside of the general education environment:
% to solely manage behavior and/or regulation
% to teach social skills and/or self-regulation skills
% with no modification of the curriculum
% with modifications of the curriculum
% with replaced curriculum
C. Check the box for each area in which the student requires direct intervention to be successful in school:
Reading Written language Math
Behavior Academic Self-Regulation Academic Engagement
Behavior Self-Regulation
D. Diagnostic Assessments – Reading, Written Language, Math, Behavior:
MAPDate: Reading Proficiency Level: RIT:
Date: Reading Proficiency Level: RIT:
Date: Reading Proficiency Level: RIT:
Date: Reading Proficiency Level: RIT:
WKCEDate: Reading Proficiency Level: Scale Score:
Math Proficiency Level: Scale Score:
SRI:
E. Other summative assessments or anecdotal records:
F. List any alternative programs that the student has been enrolled in from kindergarten to now:
G. Specific Concerns (Academic, Behavior, Engagement and Learning Skills):
Academic: Behavior: Peer/Social:
Homework Incomplete Defiance Socially Isolated
Drop in Grades Inpulsivity Poor Social Skills
Missing Class Assignments
Obscene Language Dominates Peers
Risk of Failing Hyperactivity Older/Younger Contacts
Math: Difficulty Taking Responsibility
Avoids Contact with Staff
Basic Facts Bullying Behavior Passive with Peers
Broad concepts/Reasoning Verbal Aggression Bullied by Peers
Word Problems Physical Aggression Affect:
Reading: Performance Anxiety Distracted
Vocabulary Anxious/Nervous Inattentive
Phonics Inattentiveness Anxious
Fluency Off Task Behavior Defensive/Irritable
Comprehension Over-Stimulated Sad/Crying
Writing: Attention Seeking Angry
Expression/Content Basic Needs: Lethargic
Mechanics Sleep Erratic Behavior
Spelling Hygiene Extreme Negativism
Attendance: Nutrition Unexplained Fear or Grief
Frequent Unexcused Absences
Asking for Help
Eyeglasses Frequent Excused
Absences ATODA (Alcohol, Tobacco, and Other Drug Abuse Prevention) Multiple Tardies
NOTES/COMMENTS:
H. Teaching Strategies/Interventions Already Implemented - Behavior
To improve ability to attend to verbal information:
To improve work completion:
Shorten length of listening activities Use student checklist
Reduce visual distractions in the classroom
Use study carrel
Provide pictures or other visual cues Use timer for work completion
Write key vocabulary on the board Use headsets to block extraneous noise
Use tape material presented through headphones into smaller parts
Use point sheet
Provide work one paper at a time Use choral speaking in group to maintain
attention Prove work assignments list
Provide opportunities for periodic rehearsal of information provided verbally
Break lengthy assignments into smaller parts
Reduce amount of written work Provide scribe for classroom notes; allow
student to copy notes from peer regulation Simplified worksheets
Use of graphic organizers Send home extra set of texts
Break longer presentations into shorter units
Keep materials in classroom
Allow student to record lesson experiences /thoughts
Use of fidgets, breathing self-regulation
To improve positive group participation skills:
Touch, cue or proximity when attention
wanes Praise positive participation
Re-direct student when attention wanes Call on student to share
Change student’s seat to decrease distractions
Allow rehearsal opportunities
Use role-playing to teach appropriate behavior Shorten tasks and amount of materials
Use material to fit student’s instructional level
Provide a “cool down” space
Provide older student or adult mentorTo improve transitions between activities:
Use peer “buddy” to model appropriate behaviorKeep routine structured
Clear expectations and rules posted Use TAB procedure for self reflection
Mark student’s “space” and materials Use sensory break or heavy work
Post schedule of the day for transitions Use written behavior contract with student
Cue student prior to transition Use regular feedback between home and school
Allow student opportunities for movement
What were the most successful behavior interventions from the above list:
I. Teaching Strategies/Intervention Already Implemented - Reading
To improve decoding (word attach) skills: To improve reading comprehension:
Check on vision Pre-read story to student/paired reading
Provide opportunities for daily reading Re-read favorite stories
Repeat phonic rules verbally (auditory cues)
Read stories with predictable text
Discuss pictures/illustrations before reading story (visual cues) Present phonic rules on chart (visual cues)
Use log of misread words for practice orally first
Ask student to illustrate sentences or stories
Highlight key concepts in textUse literature-based instruction with
semantic cues or stories Ask student to write sentences for reading vocabulary words
Small group instruction _______ daily Ask student to list details of story
Use guided reading groupUse sequence pictures and then retell
storyTo improve sight work recognition skills:
Ask student to finish incomplete story Use card reader/language master for drill
practice then retell story Use guided reading group
Use work configuration cues Use supplemental materials/resources
Send word list home for practice Use high interest texts at instructional level
Provide flash card practice
Use language experience/concrete meaning
Use a word wall for important vocabulary
What were the most successful reading interventions from the above list:
J. Teaching Strategies/Interventions Already Implemented – Listening, Mathematics, Spelling
Listening: Mathematics:
To improve ability to follow verbal directions: Reduce copying from a book using preprinted or copied sheets
Check on hearing Use legible, uncrowded worksheets
Repeat directions Once Twice Three or more times
Use graph paper
Rephrase directions Use flash cards for drill on facts
Provide preferential seating away from distracting noises (e.g. pencil sharpener)
Use manipulatives
Provide repetition of math drills Provide preferential seating near teacher
or source of sound Use songs, rhymes, or games
Ask student to repeat directions in their own words
Allow student to vocalize self
Use number lines, counters, and charts Simplify directions into one step at a time
Allow student to use math fact tables Use visual cues or written directions
paired with verbal directions Allow student to use calculator
Use visual or auditory cue prior to giving directions, i.e. “show me 5”
Reduce number of math examples
Highlight key words in math problems Present directions at slower pace
Spelling: Frequent checks for understanding
Use spelling flash cards for practice Provide movement breaks
Allow student to spell in tape recorder Provide visuals of main ideas
Teach sight words in a meaningful phrase or sentence Emphasize main ideas
Present directions in “routine” in the Teach specific spelling rules
same manner and at the same time Use same works for reading, spelling, and
writing tasks Provide wait time to respond to directions
Test only words list, not sentences
Reduce number of expected words
Test student orally
Send home spelling words for practice
What were the most successful listening, language processing, math, and spelling interventions from the above list:
1. Please describe the strengths of the student in the areas of academics, behavior, and social/emotional functioning:
2. Reason for referral (in objective, measurable terms describe three target behaviors of the student that you believe must change for the student to be successful in their current educational placement):
3. Does this student have any positive peer and/or adult relationships? If yes, please describe the nature of the relationship (e.g. peer – long time friend; adult – teacher; peer – classmate that helps student; adult – big sister):
4. Does this student demonstrate the ability to attend any class on a punctual and regular basis? If yes, please list the class(es). If no, please indicate the number of days on which a full or partial absence was documented:
5. Is the student involved with any community agencies? If yes, please list the agency, the contact person, and the phone number of the contact person:
6. Has this student received any recent or previous psychiatric evaluations, diagnoses, or changes (e.g. changes in diagnoses, medication status, current treatment, etc.):
7. Describe:a. The SECONDARY OR TERTIARY INTERVENTIONS/SUPPORTS provided to this student:b. The student’s response(s) to these interventions and supports:
8. Does the student have a history of drug or alcohol use, abuse, or addiction? If yes, describe the student’s history of alcohol/drug involvement:
9. Does this student pose a safety risk due to assaultive and/or aggressive behavior to self or others? If yes, please describe the nature, severity, and frequency of behavior(s):
10. Is this student currently under supervision due to delinquency? If yes, provide details of the offenses that resulted in the adjudication. (Also document if he/she has been under supervision in the past):
11. Does this student have any current or historical affiliations with a gang? If yes, provide additional information:
12. List 3 academic, social or emotional goals that are a priority for programming:
Student ProfileIntake Screening Version
Revised 10-01-12
Student Name: Date Completed: Rater:
Context in which you interact with student (check one): General education setting Group alternative program setting within school building Individual alternative setting within school building Individual Community setting (e.g., community-based instruction) Group Alternative Program setting in non-school setting Other (describe):
This student profile does not define the interventions to be implemented. Rather, it simply provides guidance on which behaviors to target for change.
The profile also does not provide information about the function of these behaviors. A FBA should be conducted to identify the functions of the behaviors. Utilizing function-based interventions will increase the likelihood of intervening successfully and creating more durable behavior change.
Directions:1. Review data for this student from the previous six months:
ReferralsAttendanceCheck-in/check-outIntensity, frequency, duration of behaviors
2. Person who knows student the best should complete each item by clicking the check box corresponding to the ONE description for each item that best fits the student’s behavior over the past six months.
I. Relationships
Check the ONE DESCRIPTION for each item that best describes the student.
1. Student’s positive relationships with staff members.The student has no positive relationship with staff members. The student has a developing positive relationship with one staff member. The student has developing positive relationships with multiple staff members. The student has established a positive relationship with one staff member. The student has established positive relationships with multiple staff members.
2. Student’s statements about staff members. The student expresses anger/antagonism towards multiple staff members weekly. The student expresses anger/antagonism towards a single staff member weekly. The student expresses anger/antagonism towards at least one staff member less than 4 times
per month. The student expresses anger/antagonism towards at least one staff member. The student does not express anger/antagonism towards any staff member.
3. Student’s relationships with other students. The student has no positive prosocial relationships with other students. The student has a developing positive prosocial relationship with one other student. The student has developing positive prosocial relationships with multiple other students. The student has established a positive prosocial relationship with one other student. The student has established positive prosocial relationships with multiple other students.
4. Student’s statements about other students. The student expresses anger/antagonism towards multiple other students weekly. The student expresses anger/antagonism towards one other student weekly. The student expresses anger/antagonism towards more than one other student weekly. The student expresses anger/antagonism towards at least one other student less than weekly. The student does not express anger/antagonism toward any other student.
II. Physical Safety
5. Aggression that results in damage to property. The student engages in behavior that results in property damage multiple times per day. The student engages in behavior that results in property damage on a daily basis. The student engages in behavior that results in property damage weekly. The student engaged in behavior that resulted in property damage more than 4 times in the
past month. The student has not engaged in behavior that resulted in property damage in the past month.
6. Physical aggression towards other students. The student has engaged in aggression towards other students multiple times per day. The student has engaged in aggression towards other students daily. The student has engaged in aggression towards other students weekly. The student has not engaged in aggression towards other students in the past month. The student has not engaged in aggression towards other students in more than a month.
7. Physical aggression toward adults. The student has engaged in physical aggression towards adults multiple times per day. The student has engaged in aggression towards adults daily. The student has engaged in aggression towards adults weekly. The student has not engaged in aggression towards adults in the past month. The student has not engaged in aggression towards adults in more than a month.
8. Student’s serious self-harm attempts. Behaviors that could result in death or dismemberment (e.g., attempting to hang self).
The student has attempted serious self-harm in the past month. The student has attempted serious self-harm in the past 6 months. The student has attempted serious self-harm in the past year. The student has attempted serious self-harm prior to the past year. The student has never attempted serious self-harm.
9. Student’s minor to moderate self-harm attempts. Behaviors that are unlikely to result in death or dismemberment (e.g., cutting).
The student has attempted minor to moderate self-harm in the past month. The student has attempted minor to moderate self-harm in the past 6 months. The student has attempted minor to moderate self-harm in the past year. The student attempted minor to moderate self-harm prior to the past year. The student has never attempted minor to moderate self-harm.
10. Student’s self-harm statements. The student has stated intent to harm self in the past month. The student has stated intent to harm self in the past 6 months. The student has stated intent to harm self in the past year. The student stated intent to harm self previous to the past year. The student has never stated intent to harm self.
III. Following School Rules and Staff Directives
11. Frequency of following school rules and teacher directives. The student has refused to follow school rules multiple times per day. The student has refused to follow school rules daily. The student has refused to follow school rules weekly. The student has refused to follow school rules 1 to 3 times in the past month. The student has followed all school rules and directives in the past month.
12. Verbal aggression when refusing to follow school rules or teacher directives. When refusing to follow school rules or staff directives, the student demonstrated verbal
aggression multiple times per day. When refusing to follow school rules or staff directives, the student demonstrated verbal
aggression daily. When refusing to follow school rules or staff directives, the student demonstrated verbal
aggression weekly. When refusing to follow school rules or staff directives, the student demonstrated verbal
aggression 1-3 times in the past month. When refusing to follow school rules or staff directives, the student has not demonstrated
verbal aggression in the past month.
13. Physical aggression when refusing to follow school rules or teacher directives. When refusing to follow school rules or staff directives, the student demonstrated physical
aggression multiple times per day. When refusing to follow school rules or staff directives, the student demonstrated physical
aggression daily. When refusing to follow school rules or staff directives, the student demonstrated physical
aggression weekly. When refusing to follow school rules or staff directives, the student demonstrated physical
aggression 1-3 times in the past month. When refusing to follow school rules or staff directives, the student has not demonstrated
physical aggression in the past month.
14. Accepting correction or a consequence. The student has actively refused to accept correction or consequences multiple times per day. The student has actively refused to accept correction or consequences daily. The student has actively refused to accept correction or consequences weekly. The student has actively refused to accept correction or consequences 1 to 3 times in the past
month. The student has accepted all correction or consequences in the past month.
15. Accepting “No” for an answer. The student has refused to accept “No” multiple times per day. The student has refused to accept “No” daily. The student has refused to accept “No” weekly. The student has refused to accept “No” 1 to 3 times in the past month. The student has accepted “No” on all occasions in the past month.
16. Encourages other students to not follow staff directives. The student has encouraged other students to refuse to follow staff directives multiple times
per day. The student has encouraged other students to refuse to follow staff directives daily. The student has actively encouraged other students to follow staff directives weekly. The student has actively encouraged other students to follow school rules 1 to 3 times in the
past month. The student has not actively encouraged other students to follow staff directives in the past
month.
17. Arguing with adults. The student has argued with adults about directives multiple times each day. The student has argued with adults about directives on a daily basis. The student has argued with adults about a directive less than 5 times. The student has argued with an adult about a directive 4 or fewer times. The student has not argued with an adult about a directive in the past month.
18. Staying in assigned space (do not record student as leaving assigned area if they follow a preplanned routine of time away or taking a break outside of the assigned area).
The student leaves the assigned area multiple times per day. The student leaves the assigned area daily. The student leaves the assigned area less than 5 times per week. The student leaves the assigned area less than 2 times per week. The student has remained in his/her assigned area 100% of the time this month.
19. Passive withdrawal (under aroused). The student sleeps or engages in other avoidance behavior without disrupting the learning of
other students multiple times per day or for the majority of the day. The student sleeps or engages in other avoidance behavior without disrupting the learning of
other students on a daily basis for less than ½ of the day. The student sleeps or engages in other avoidance behavior without disrupting the learning of
other students 2 to 4 times per week. The student sleeps or engages in other avoidance behavior without disrupting the learning of
other students no more than once per week. The student has not slept or engaged in other non-disruptive avoidance behavior for over a
month.
IV. Student’s Emotional Style.
20. Resilience. The student becomes upset when he/she experiences a setback and does not recover for more
than a day. The student becomes upset when he/she experiences a setback and does not recover until the
next day. The student becomes upset when he/she experiences a setback, but recovers gradually over
the course of the day. The student becomes upset when he/she experiences a setback, but recovers almost
immediately. The student does not become upset when he/she experiences a setback.
21. Outlook. The student expresses cynicism and pessimism and struggles to see anything as positive almost
all the time. The student sees things negatively most of the time. The student sees things positively about 50% of the time. The student sees things positively much of the time. The student sees things positively almost all the time (e.g., maintains a high level of energy and
engagement even when things don’t go his/her way).
22. Social intuition. The student is blind to outward indications of other people’s mental and emotional states. The student is puzzled by outward indications of other people’s mental and emotional states
most of the time. The student accurately infers the emotional states of other people based on the other person’s
behavior occasionally. The student accurately infers the emotional states of other people based on the other person’s
behavior most of the time. The student accurately infers the emotional states of other people based on the other person’s
behavior almost all of the time.
23. Self-awareness. The student is oblivious to their emotional state almost all the time. The student is rarely aware of their own emotional state and the relationship to their behavior. The student is aware of their own emotional state and the relationship to their behavior some
of the time. The student is aware of their own emotional state and the relationship to their behavior most
of the time. The student is aware of their own emotional state and the relationship to their behavior almost
all the time.
24. Sensitivity to context. The student is almost never aware of the conventional rules of social interaction. The student is rarely aware of the conventional rules of social interaction. The student is aware of the conventional rules of social interactions some of the time. The student is aware of the conventional rules of social interactions most of the time. The student is aware of the conventional rules of social interaction and adjusts his/her behavior
consistent with these conventions almost all the time.
25. Attention. The student can almost never screen out emotional or other distractions and stay focused. The student can rarely screen out emotional or other distractions and stay focused. The student can sometimes screen out emotional or other distractions and stay focused. The student can screen out emotional or other distractions and stay focused most of the time. The student can screen out emotional or other distractions and stay focused almost all the
time.
V. Community Participation
26. Student contributes positively to his or her classroom, school, and community. The student disrupts group community activities. The student passively withdraws from group community activities, but does not actively disrupt. The student is typically physically present for group community activity, but participates
minimally. The student positively participates in group community activities. The student assumes a leadership role in group community activities.
27. Staff selected instructional arrangement. The student is receiving all instruction in a large group arrangement. The student is receiving the majority of instruction in a combination of large and small group
arrangements. The student is receiving the majority of instruction primarily in a small group arrangement. The student is receiving the majority of instruction individually or with one other student. the student is receiving all instruction and support individually. Instruction is provided by 1 or
more adults.
28. Student selected engagement in the learning community. The student self-selects to be alone – away from the group the vast majority of time (i.e.,
prefers to be educated 1:1). The student self-selects to be alone – away from the group most of the time. The student self-selects to be with the group only for specific activities (e.g., gym time). The student self-selects to be with the group of students most of the time. The student self-selects to be with the group of students almost all the time.
29. Negative and positive influence on peer group dynamics. The student leads peers into group antisocial activities. The student follows peers in antisocial group activities. The student engages in a prosocial relationship with at least one peer. The student engages in prosocial relationships with multiple peers and participates in at least
one positive peer group. The student engages in prosocial peer relationships and is a leader of at least one positive peer
group.
30. Need to educate student separate from peers due to negative influence on peers’ learning. The student must always be educated separate from other students to prevent him/her from
disrupting the learning of other students. The student must be educated separately from other students most of the time to prevent
him/her from disrupting the learning of other students. The student must occasionally be educated separately from other students to prevent him/her
from disrupting the learning of other students. The student rarely must be educated separately from other students to prevent him/her from
disrupting the learning of other students. The student almost never needs to be educated separately from other students to prevent
him/her from disrupting the learning of other students.
31. Need to educate student separate from peers due to negative effect on student’s learning. The student must always be educated separately from other students for him/her to benefit
from academic instruction. The student must be educated separately from other students most of the time for him/her to
benefit from academic instruction. The student must occasionally be educated separately from other students for him/her to
benefit from academic instruction. The student rarely must be educated separately from other students in order for him/her to
benefit from academic instruction. The student almost never must be educated separately from other students in order for
him/her to benefit from academic instruction.
VI. Academic Self-Regulation
32. Interest in school work. The student has no interest in school work. The student has limited interest in school work. The student has moderate interest in school work. The student has high interest in school work in some subjects. The student has high interest in school work in all subjects.
33. Academic effort. The student puts forth little or no effort. The student puts forth limited effort. The student puts forth moderate effort. The student puts forth above average effort. The student puts forth extraordinary effort.
34. Desire to do well on school work. The student has little or no desire to put forth any effort on school work. The student has limited desire to do well on school work. The student has moderate desire to do well on school work. The student has above average desire to do well on school work. The student has high desire to do well on school work.
35. Desire to be successful at school. The student has no desire to be successful at school. The student has a limited desire to be successful at school. The student has a moderate desire to be successful at school. The student has an above average desire to be successful at school. The student has a high desire to be successful at school.
36. Ability to monitor school work. The student has little or no ability to keep track of school work he/she needs to do. The student has limited ability to keep track of school work he/she needs to do. The student has a moderate ability to keep track of school work he/she needs to do. The student has above average skills to keep track of school work he/she needs to do. The student has exceptional skills to keep track of school work he/she needs to do.
37. Desire to please teachers. The student has no desire to please teachers. The student has a limited desire to please teachers. The student has moderate desire to please teachers. The student has above average desire to please teachers. The student has a high desire to please teachers.
Note: It is likely that the student may only overrate OR underrate their skills and performance. So, you may
find that you can only respond to 2 of the 4 items.
38. Student overrating of academic skills. The student overrates his/her academic skills in all academic subjects. The student overrates his/her skills in most academic subjects. The student accurately evaluates his/her skills in 50% of academic subjects. The student accurately evaluates his/her skills in most academic subjects. The student accurately evaluates his/her skills in all academic subjects.
39. Student underrating of academic skills. The student underrates his/her academic skills on all academic work. The student underrates his/her skills on most academic work. The student accurately evaluates his/her skills on about 50% of academic work. The student accurately evaluates his/her skills on most academic work. The student accurately evaluates his/her skills on all academic work.
40. Student overrating of academic performance. The student overrates his/her performance in all academic subjects. The student overrates his/her performance in most academic subjects. The student accurately evaluates his/her performance in 50% of academic subjects. The student accurately evaluates his/her performance in most academic subjects. The student accurately evaluates his/her performance in all academic subjects.
41. Student self-evaluation of academic performance. The student underrates his/her academic performance in all academic subjects. The student underrates his/her performance in most academic subjects. The student accurately evaluates his/her performance in 50% of academic subjects. The student accurately evaluates his/her performance in most academic subjects. The student accurately evaluates his/her performance in all academic subjects.
