"Communication Observation Form - Provo City School District"

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Provo City School District
Child Find
Communication Observation Form
Student:
Birthdate:
Grade:
Classroom Teacher:
Observer:
Date:
Time:
Length of Observation:
Reason for Observation:
Setting: (classroom, playground, cafeteria, etc.)
Physical Environment: Where is the student seated? What is student’s proximity to
teacher?
at table
at desk
on the floor
on chair in group
at listening center
at learning center
at chalkboard
middle of room
front of room
back of room
other:
Auditory Environment: (background noise, outside noise, etc.)
Language Demands of the Activity/Instruction: (include examples)
Provo City School District
Child Find
Communication Observation Form
Student:
Birthdate:
Grade:
Classroom Teacher:
Observer:
Date:
Time:
Length of Observation:
Reason for Observation:
Setting: (classroom, playground, cafeteria, etc.)
Physical Environment: Where is the student seated? What is student’s proximity to
teacher?
at table
at desk
on the floor
on chair in group
at listening center
at learning center
at chalkboard
middle of room
front of room
back of room
other:
Auditory Environment: (background noise, outside noise, etc.)
Language Demands of the Activity/Instruction: (include examples)
Provo City School District
Child Find
Comprehension:
low
high
Verbal Demands:
low
high
Responsiveness to Instructional Strategies:
wait time
repetition
rephrasing
visual supports
graphic organization
other:
Is the student’s communication comparable to the other students?
Yes
No
Comments:
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