CLASSROOM COMMUNICATION & LEARING CHECKLIST

Student: __________________________ Date: _________ Teacher: ______________

RATE THE EXTENT TO WHICH EACH OF THE STATEMENTS BELOW DESCRIBES THE STUDENT!

SCALE:	0  (never)	1  (rarely)	2  (some of the time)	3  (most of the time)

The Student:						   	Rating		       Comments

LISTENING

1.  has trouble paying attention		0 1 2 3

2.  has trouble following spoken directions		0 1 2 3

3.  has trouble remembering things people say		0 1 2 3

4.  has trouble understanding what people are saying		0 1 2 3

5.  asks people to repeat what they have said		0 1 2 3

6.  has trouble understanding word meanings		0 1 2 3

7.  has trouble understanding new ideas		0 1 2 3

8.  has trouble looking at people when talking		0 1 2 3

9.  has trouble understanding facial expressions (body language)		0 1 2 3

SPEAKING

10. has trouble answering questions people ask		0 1 2 3

11. has trouble answering questions as quickly as others		0 1 2 3

12. has trouble asking for help		0 1 2 3

13. has trouble asking questions		0 1 2 3

14. has trouble using a variety of vocabulary words when talking	0 1 2 3

15. has trouble thinking (finding) the right word to say		0 1 2 3

16.  has trouble saying what he or she is thinking			0 1 2 3

17. has trouble describing things to people				0 1 2 3

18. has trouble staying on the subject when talking			0 1 2 3

19. has trouble getting to the point when talking			0 1 2 3

20. has trouble putting things in the right order			0 1 2 3

21. uses poor grammar when talking				0 1 2 3

22. has trouble using complete sentences when talking		0 1 2 3

23.  talks in short, choppy sentences				0 1 2 3

24.  has trouble expanding on an answer or providing details		0 1 2 3

25.  has trouble having a conversation with someone			0 1 2 3

26.  has trouble talking with a group of people			0 1 2 3

27.  has trouble being understood (saying things another way)		0 1 2 3

28.  gets upset when people don’t understand him or her		0 1 2 3

READING

29.  has trouble sounding out words when reading			0 1 2 3

30.  has trouble understanding what he or she has read		0 1 2 3

31.  has trouble explaining what he or she has read			0 1 2 3

32.  has trouble identifying the main idea of what’s read		0 1 2 3

33.  has trouble remembering details from something read		0 1 2 3

34.  has trouble following written directions				0 1 2 3

WRITING

35.  has trouble writing what he or she is thinking			0 1 2 3

36.  uses poor grammar when writing				0 1 2 3

37.  has trouble writing complete sentences				0 1 2 3

38.  writes short, choppy sentences					0 1 2 3

39.  has trouble expanding an answer of providing details in writing	0 1 2 3

40.  has trouble putting words in the right order in sentences		0 1 2 3

CHOOSE THE PROBLEMS THAT CONCERN YOU THE MOST.  CIRCLE THE TOP 10 OUT OF 40

Please list any other you have observed or concerns you have about the student’s listening, speaking, reading, and writing skills and rate them from 0-3.

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Please return this form to: ____________________________________ by ____________________ Thanks!

Wayne A. Secord, 2002