NIA Educational  

Directions:  is enrolled in our tutoring program.  We would like to get student achievement data as well as your feedback on how the student is achieving in school.

Section I. Review each of the Behavior Report Card items below. For each item, rate the degree to which the student showed the behavior or met the behavior goal.   

Section II.  Please fill in the table below with student data.

Teacher Name Email


1. The student writes down homework assignments correctly and completely.

2. The student takes all work materials home that are required for his or her homework assignments.

3. The student turns in his or her completed homework on time.

4. The student focuses his or her attention on teacher instructions, classroom lessons and assigned work.

5. The student remembers academic instructions and directions without needing extra reminders.

6. The student is motivated to work on class assignments/projects.

7. The student takes care in completing his or her assignments and avoids careless errors.

8. The student completes and turns in his or her assigned class work on time.

9. The student is prepared for class, with all necessary school materials (e.g., books, pencils, papers).

10. The student arrives on time to school or to class.

11. The student is able to complete in-class work independently, and does not require adult or peer help.

12. The student participates fully in group discussions.

13. The student takes notes on lecture content, capturing the essential information presented.

14. The student is willing to ask for peer or teacher assistance whenever he or she requires help on coursework.


SECTION II: Student Achievement Data

  Quarter 1 Midterm 1 Quarter 2 Midterm 2 Quarter 3 Midterm 3 Quarter 4
# of Times Absent
# of Days Tardy
# of Discipline Referrals



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