Functional Academic Skills Checklist

Please complete this questionnaire as part of this student’s evaluation for special education services.
Your input is important to help make appropriate decisions for this student. Thank you for your time
and effort.

Student: Date:

Rater’s Name: Class:

Behavior Occurs
Enter the number in the column that best describes how often the student performs listed behaviors
below: (1) Not at all, (2) A little, (3) A fair amount, (4) Much, (5) Very much

1 2 3 4 5
1. Uses free time appropriately.

2. Has good work habits (i.e. is organized, makes efficient use of

time, etc.)
3. Listens carefully to teacher instructions/directions for
assignments
4. Answers or attempts to answer questions when called on by
teacher
5. Displays independent study skills (can work adequately with
minimum teacher support)
6. Responds to conventional behavior management techniques
(praise, reprimands, time out)
7. Responds to requests promptly
8. Attends to assigned tasks

9. Produces work of acceptable quality given his/her skill level

10. Does seatwork assignment as directed

11. Completes tasks or activities

12. Works within time limit

13. Refrains from making noises in the classroom

14. Raises hand before speaking out

15. Stays in seat when requested

16. Gets attention in appropriate ways

17. Leaves room only with permission

1
 Behavior Occurs
Enter the number in the column that best describes how often the student performs listed behaviors
below: (1) Not at all, (2) A little, (3) A fair amount, (4) Much, (5) Very much

1 2 3 4 5
18. Follows instructions

19. Does homework

20. Asks for help when it’s needed

21. Understands directions/instructions

22. Volunteers questions/information in class

23. Appears relaxed in the classroom

24. Comes prepared (remembers books/materials needed for class)

25. Participates in class discussion

26. Maintains eye contact when speaking or being spoken to

27. Checks work before handing it in

28. Is able to ignore classroom distractions

29. Makes necessary corrections on assignments without getting

overly frustrated
30. Feels comfortable about being in school

31. Feels comfortable about being with other students

32. Feels comfortable about being taught new subject matter

33. Follows classroom/school rules

34. Performs to ability in reading

35. Performs to ability in written language

36. Performs to ability in math

37. Performs to ability in oral communication

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What are this student’s strengths?

What are this student’s weaknesses?

What do you think this student needs in order to succeed in school?