Elementary Student Input Form

My name is:

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OFF

My age is:

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OFF

The grade I am in: (a)   ​ ​ ​

• 1
• 2
• 3
• 4

Today's date is:

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OFF

Classes and subjects I am really good at:

• science
• math
• reading
• art
• writing

Classes and subjects I need extra help with:

• science
• math
• reading
• art
• writing

It helps me when I:

• have things read to me
• have extra time
• sit in the front of the room
• have help getting organized
• use a math chart

It also helps me when my teachers:

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OFF

I work my best:

• by myself
• in a small group
• with a partner

Things I do really well:

• telling stories
• typing
• drawing
• being a helper
• following the rules