Wufoo

Student's Name *
Grade *
Teacher's Name *
School *
What are the student's academic, cognitive, and/or behavioral strengths? (e.g. Does the student call out in class, is s/he shy, does s/he have a particular learning style, etc.?) *
What are the student's weaknesses or areas of difficulty in the social arena? *
Does the student have friends? If yes, please describe those friendships (e.g. does s/he have a best friend? What is the nature of those friendships?). If no, please talk about what the student does during social time. For example, is s/he ever teased? *
How does the student work in group situations? *
What are the student's interests? Does s/he have a wide variety of interests? Do these interests serve as rewards or reinforcers? Does s/he share those interests with the peers in an appropriate way? *
Please describe how the student expresses the following the emotions and what triggers these emotions:

Frustration

Anxiety

Concern

Anger

Happiness *
What are some special "tricks" or strategies that you think would help another teacher work with this student? *
Please feel free to share any other insights about this student that you think Take2 Summer Camp teachers could use as they work with this child to help him/her develop social skills.
Digital Signature
Teacher's Name *
Date * MM / DD / YYYY
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