Teacher’s Professional Judgment Questionnaire Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Child's Name *FirstMiddleLastTeacher's Name *FirstMiddleLastDate *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920EVALUATION INFORMATION: Below are a series of questions that ask for your professional judgment about this child. There are no right or wrong answers, rather we are trying to better understand how this child acts in your classroom. MORNING: Do you think this child is hyperactive? *Not at allJust a littlePretty muchVery muchDoes this child talk out of turn? *Not at allJust a littlePretty muchVery muchDo you think this child is inattentive? *Not at allJust a littlePretty muchVery muchIs this child’s desk poorly organized? *Not at allJust a littlePretty muchVery muchIs this child easily distracted in the classroom? *Not at allJust a littlePretty muchVery muchDoes this child record assignments inaccurately? *Not at allJust a littlePretty muchVery muchDoes this child’s behavior escalate in a group setting versus a one on one setting? *Not at allJust a littlePretty muchVery muchDoes this child frequently not turn in homework assignments? *Not at allJust a littlePretty muchVery muchDoes this child work at an inconsistent pace? *Not at allJust a littlePretty muchVery muchDoes this child have difficulty in an academic area? *Not at allJust a littlePretty muchVery muchDoes this child need more supervision at the start of a task/project? *Not at allJust a littlePretty muchVery much If yes which academic areas: *AFTERNOON: Do you think this child is hyperactive? *Not at allJust a littlePretty muchVery muchDoes this child talk out of turn? *Not at allJust a littlePretty muchVery muchDo you think this child is inattentive? *Not at allJust a littlePretty muchVery muchIs this child’s desk poorly organized? *Not at allJust a littlePretty muchVery muchIs this child easily distracted in the classroom? *Not at allJust a littlePretty muchVery muchDoes this child record assignments inaccurately? *Not at allJust a littlePretty muchVery muchDoes this child’s behavior escalate in a group setting versus a one on one setting? *Not at allJust a littlePretty muchVery muchDoes this child frequently not turn in homework assignments? *Not at allJust a littlePretty muchVery muchDoes this child work at an inconsistent pace? *Not at allJust a littlePretty muchVery muchDoes this child have difficulty in an academic area? *Not at allJust a littlePretty muchVery muchDoes this child need more supervision at the start of a task/project? *Not at allJust a littlePretty muchVery much If yes which academic areas: *Any Additional Behavior or Social Concerns please list below: Electronic Signature Disclosure and Consent: * I AGREE By selecting the “I agree” button, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting “I agree” using any device, means, or action, I consent to the legally binding terms and conditions of this document. I further agree that my signature on this document is as valid as if I signed the document in writing. I am also confirming that I am authorized to enter into this Agreement. If I am signing this document on behalf of a minor, I represent and warrant that I am the minor’s parent or legal guardian. I may decline to electronically sign this document and withdraw my consent to sign this document electronically by contacting the signature requestor directly, which may delay transactions. I may contact the signature requestor separately to request to sign this document on paper or to receive a paper copy of the signed document. Any fees for such paper copy will be charged then by the signature requestor.Teacher's Name: *FirstMiddleLastDate Signed: *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Submit
