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EDUCATIONAL
SCHOOL REPORT

​

Educational School Report

 

This form is to be completed by school staff; this is not a request for transfer. Glenwood Academy 500 W. 187th Street Glenwood IL 60425 inforequest@glenwoodacademy.org 708-756-6111

Has this student ever been retained?
Yes
No
Will this student be promoted at his present level of achievement? (Required)
Yes
No
Does/has this student receive or require any form of modified lessons? (Required)
Yes
No
If yes, indicate all modifications
Presentation Environment
Time Demands
Materials
Use of groups and peers
Use of teacher aide
Does this student receive/require Special Education Services? (Required)
Yes
No
Does this student receive/require Speech Therapy Services? (Required)
Yes
No
Does this student have an Individualized Education Program (IEP)? (Required)
Yes
No
Does this student have an Intervention Plan in place? (Required)
Yes
No
Has the student been recommended for a case study? (Required)
Yes
No
Has the student been recommended for an educational evaluation? (Required)
Yes
No
Has it been determined that the child has a learning disability? (Required)
Yes
No
Has it been determined that the child has a behavior disorder? (Required)
Yes
No
Has it been determined that the child has a behavior disorder? (Required)
Yes
No
Has it been determined that the child has Attention Deficit Disorder? (Required)
Yes
No
Does the child require remedial reading? (Required)
Yes
No
Does/did the child attend Title I Classes? (Required)
Yes
No
Has a psychological evaluation ever been recommended? (Required)
Yes
No
Has a psychological evaluation ever been given? (Required)
Yes
No
Does/has student ever receive(d) counseling?(Required)
Yes
No
Effort (Required)
Working to capacity
Good
Fair
Poor
None
Has this student ever received a Vision referral? (Required)
Yes
No
Corrective lenses? (Required)
Yes
No
Is the student resistant or compliant with wearing his/her eye glasses in class?
Resistant
Compliant
Has this student ever received a hearing referral? (Required)
Yes
No
Hearing Aid? (Required)
Yes
No
Has this student been suspended? (Required)
Yes
No
Has this student been expelled? (Required)
Yes
No
Does this student display inappropriate behaviors in the school setting? (Required)
Gym
Hallway
On the playground
None
Are leadership qualities displayed? (Required)
Yes
No
Peer Relationships (Required)
Excellent
Good
Fair
Poor
Acceptance of consequences/criticism (Required)
Excellent
Good
Fair
Poor
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