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Calcutta International School Student Screening Questionnaire by Class Teachers Middle and Senior School

This document is a student screening questionnaire from Calcutta International School that is completed by class teachers to evaluate students' social, work, and emotional behaviors. It includes a scale of 0-3 to rate how frequently students display certain behaviors in the current academic session, such as arguing, cooperating with peers, preparedness for class, distraction, sadness, anxiety, and more. Teachers are to indicate only one number for each behavior, and there is space at the end for any additional comments from the teacher about the student.

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Spriha Patronobis
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60 views2 pages

Calcutta International School Student Screening Questionnaire by Class Teachers Middle and Senior School

This document is a student screening questionnaire from Calcutta International School that is completed by class teachers to evaluate students' social, work, and emotional behaviors. It includes a scale of 0-3 to rate how frequently students display certain behaviors in the current academic session, such as arguing, cooperating with peers, preparedness for class, distraction, sadness, anxiety, and more. Teachers are to indicate only one number for each behavior, and there is space at the end for any additional comments from the teacher about the student.

Uploaded by

Spriha Patronobis
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CALCUTTA INTERNATIONAL SCHOOL

STUDENT SCREENING QUESTIONNAIRE BY CLASS TEACHERS


MIDDLE AND SENIOR SCHOOL

Name of the student:________________________________ Age:_________________

Class + Section: ____________; Students age :____________; Year of joining CIS: ________________

Using the following scale, identify how frequently the student has displayed each of the following
behaviours in this academic session. Indicate only one number for each behaviour

0 = Never, 1 = Sometimes, 2 = Often, 3 = Almost Always

SOCIAL BEHAVIOUR

0 1 2 3
Arguing with peers
Complains frequently about peers
Rebel behaviour towards authority figures
Co-operating with peers
Polite and socially appropriate response towards others
Impulsiveness
Aggression towards others ( Verbal/Physical )
Teases others frequently
Bullies other
Is being/Has been bullied
Is able to make and keep friendships
Is able to make eye contact
Remains aloof
Isolated by some or many peers
Can easily interact with new students
WORK HABITS AND CLASSROOM BEHAVIOUR

0 1 2 3
Interested in class lessons
Preparedness for instructions/ Follows instructions
Needs repeated instructions
Slow to finish work
Difficulty in copying from board
Does not bring required books to school frequently
Production of acceptable work
Difficulty working independently
Distracted easily
Restless (frequently out of place or fidgeting)
Class engagement
Completes work
Not able to submit work within deadlines
Age appropriate written work
Has been involved in disciplinary issues/ warning given for
not following school rules

EMOTIONAL BEHAVIOUR
0 1 2 3
Sadness
Fearfulness
Anxious
Temper outbursts
Adaptable to change
Easily demotivated
Lack of Confidence
Takes feedback well
Withdrawal
Difficulty rebounding from setbacks
Hypersensitive to feedback from others (misconstrues
feedback from others)
Takes onus for own behaviour (even if he/she has done
something wrong)
Blames others

Any other comments :

Signature of Class Teacher :_______________________________

Date :_____________________________

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