"Classroom Observation Form - Killeen Independent School District" - Texas

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Form 2
Killeen Independent School District
RtI Classroom Observation Form
Student: __________________________________ ID#: _____________ Grade: __________ D.O.B: ________________
Teacher: ________________________ Course: ________________________ Date: _____________ Time: ___________
st
nd
rd
th
Nine-week Average:
1
_____
2
_____
3
_____
4
_____
Last Benchmark Grade: _____________
The student above has been referred to the RtI Committee. RtI Coordinator or campus administrator needs to observe
the student in the classroom and complete the form below to provide input to the committee when determining how
best to address the individual needs of the student. Thank you!
Learning Target: (please write the learning target as posted in the teacher’s classroom.)
Please indicate student’s ability to perform tasks below.
Which adjustments, if any, did you observe the teacher
3 = Good, 2 = Adequate, 1 = Poor, 0 = Not Observed
make to help this student be successful in the lesson?
3
2
1
0
Follows teacher’s instructions
Provide visual cues, pictures, graphic organizers, etc
Participates in group activities
Provide discussion, presentation or small group work
Participates in class discussion
Provide hands-on, movement or rhythmic activities
Shows understanding of class discussion
Provide choices to demonstrate mastery, e.g. projects
Shows retention/transfer of information
Provide written as well as verbal instructions
Applies prior knowledge to new situations
Divide or chunk activities into small segments
Remains on-task when given an assignment
Provide peer-tutoring to reinforce instruction
Asks for assistance when needed
Provide one-on-one tutoring before or after school
Takes initiative in beginning assignments
Provide opportunities to attend content mastery
Completes assignments
Assign campus-based programs (e.g. ZAP, lunch bunch)
Organization skills (e.g. note-taking)
Other:
Follows classroom rules
Other:
Shows self-control
Other:
Follows written instruction
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Updated September 2015
Form 2
Killeen Independent School District
RtI Classroom Observation Form
Student: __________________________________ ID#: _____________ Grade: __________ D.O.B: ________________
Teacher: ________________________ Course: ________________________ Date: _____________ Time: ___________
st
nd
rd
th
Nine-week Average:
1
_____
2
_____
3
_____
4
_____
Last Benchmark Grade: _____________
The student above has been referred to the RtI Committee. RtI Coordinator or campus administrator needs to observe
the student in the classroom and complete the form below to provide input to the committee when determining how
best to address the individual needs of the student. Thank you!
Learning Target: (please write the learning target as posted in the teacher’s classroom.)
Please indicate student’s ability to perform tasks below.
Which adjustments, if any, did you observe the teacher
3 = Good, 2 = Adequate, 1 = Poor, 0 = Not Observed
make to help this student be successful in the lesson?
3
2
1
0
Follows teacher’s instructions
Provide visual cues, pictures, graphic organizers, etc
Participates in group activities
Provide discussion, presentation or small group work
Participates in class discussion
Provide hands-on, movement or rhythmic activities
Shows understanding of class discussion
Provide choices to demonstrate mastery, e.g. projects
Shows retention/transfer of information
Provide written as well as verbal instructions
Applies prior knowledge to new situations
Divide or chunk activities into small segments
Remains on-task when given an assignment
Provide peer-tutoring to reinforce instruction
Asks for assistance when needed
Provide one-on-one tutoring before or after school
Takes initiative in beginning assignments
Provide opportunities to attend content mastery
Completes assignments
Assign campus-based programs (e.g. ZAP, lunch bunch)
Organization skills (e.g. note-taking)
Other:
Follows classroom rules
Other:
Shows self-control
Other:
Follows written instruction
Comments:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Updated September 2015