Today's Date:
Student Name:
Teacher Name:
Subject:

An ARD meeting has been scheduled for the student whose name appears above.
Your input is very important to us in planning the appropriate program and placement 
for this student. Please complete the information listed below, sign and return to the 
special education teacher prior to the scheduled meeting.

DATE/TIME/LOCATION OF ARD:

STUDENT'S CURRENT GRADE IN YOUR CLASS:

STUDENT'S ATTITUDE IN YOUR CLASS (Please place an asterisk (*) by all that apply):
Excellent     
Good     
Indifferent     
Poor     
Improving

ACADEMIC STRENGTHS (Please place an asterisk (*) by all that apply):
Attends to task through completion
Follows classroom directions
Cooperative
Demonstrates organizational skills
Demonstrates daily assignments
Takes responsibility for belongings, supplies
Attends tutorials when needed

ACADEMIC DIFFICULTIES (Please place an asterisk (*) by all that apply):
Failure to complete assignments
Failure to make up work/tests
Poor quality of assigned work
Failure to follow directions
Failure to bring materials to class
Lack of effort
Poor test results
Excessive absences
Excessive tardies
Other:

BEHAVIORAL (Please place an asterisk (*) by all that apply):
Cooperative
Respectful
Talks excessively
Repeats disruptive behaviors
Displays negative attitude
Distracting
Disrespectful
Other:

Comments or suggestions that you think would be helpful to the ARD Committee 
(Please list modifications you have observed that are needed, as well as 
those which you feel should be eliminated):