Title Page
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Student Name
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Grade Level
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School Year (e.g S.Y 2018-2019)
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Conducted on
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Observed by
Academic / Instructional Behaviors
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Attentive to instructions and tasks
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Follows along with instruction/ task
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Constructively contributes to class
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Organized work and work habits
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Works carefully and neatly
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Completes tasks
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Work willingly and without frustration
Social Behaviors
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Friendly and respectful toward adults
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Friendly and respectful toward peers
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Interacts appropriately with peers in a social setting
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Interacts appropriately with peers in an academic setting
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Respects others' safety and personal space
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Engages with peers
General Behavior and Conduct
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Exceptional work ethic
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Excellent manners
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Positive role model
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Shows great concern for school
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Involved in school activities
Completion
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General Observations / Recommendations
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Name & Signature of Teacher