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Which of the following areas of classroom behavior do you have concerns about? Sustaining attention Listening Raising hand and waiting to be called on Participating appropriately Other None

Which of the following school skills do you have concerns about? Organization Homework Study Habits Other None

Which of the following academic areas do you have concerns about? Reading Written Language Math Social Studies Science Foreign Language Other None

Which of the following areas of social development do you have concerns about? Interpersonal (social) skills Making friends Other None

Which of the following areas of self image do you have concerns about? Is comfortable with him or herself Shows pride in achievements Demonstrates confidence or initiative Is able to trust others Attitude Other None

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