Student Name: ________________________________ Grade/Class: _________________
School Year: _________________ Updated on: _________________
Accommodation | Documented Need Connection | Setting | Frequency of Use | Effectiveness Rating | Teacher Notes/Comments | Student Feedback |
---|---|---|---|---|---|---|
Example: Extended time (50%) on assignments | Processing speed deficit documented in psychoeducational evaluation dated 10/15/2023 | Math class | Daily (10/1-10/5) | 4/5 | Student completed 90% of assignments when accommodation provided | Helpful, reduces anxiety |
5 = Extremely effective (significant improvement in performance/participation)
4 = Very effective (noticeable improvement)
3 = Moderately effective (some improvement)
2 = Slightly effective (minimal improvement)
1 = Not effective (no observable improvement)
N/A = Not applicable or not used during this period